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center on budget and policy priorities
Medicaid Work Requirements Could Boot 36 Million People Off Their Health Coverage: Report
"Work requirements are simply another way to cut Medicaid," wrote the authors of an analysis from the Center on Budget and Policy Priorities.
Feb 07, 2025
As right-wing lawmakers pursue imposing conditions on Americans' ability to access Medicaid and other social services, the Center on Budget and Policy Priorities this week published analysis warning that work requirements for Medicaid recipients could put 36 million Americans, or 44% of all Medicaid enrollees, at risk of losing their health insurance.
"Research shows that work requirements do not increase employment," according to the authors of the CBPP report, which was published on Wednesday. The authors argue that these types of requirements are based on the premise that Medicaid enrollees do not work, when data shows that they do.
"Nearly 2 in 3 adult Medicaid enrollees aged 19-64 already work, and most of the rest would likely not be explicitly subject to the requirement based on having a disability, caring for family members, or attending school," the report states.
The group estimates that of those 36 million people who could be impacted, 20 million are enrolled through the Affordable Care Act's Medicaid expansion.
While almost all Medicaid enrollees either work or would qualify for an exemption under most Medicaid work requirement proposals, according to CBPP, the report points to multiple past examples that indicate many enrollees still lose coverage with the imposition of work requirements due to "administrative burden and red tape."
For example, when Arkansas in 2018 temporarily implemented a policy that placed work requirements on Medicaid recipients, about 25% of enrollees subject to the requirements, some 18,000 people, lost coverage before a federal court paused the program seven months later.
As another example, New Hampshire implemented a short-lived Medicaid work requirement program in 2019 with more flexibility in reporting requirements and "more robust outreach efforts" in order to avoid Arkansas' mistakes, according to CBPP, but 2 in 3 enrollees who had to comply with the requirements "were likely to be disenrolled after just two months, amid reports of widespread confusion among enrollees about how to comply with the requirements."
The analysis—which the authors say is not an estimate of the number of people who will be impacted by a specific policy proposal—defines the population at risk of losing their coverage as adults between ages 19 and 64 who are not enrolled in Medicaid through disability pathways, i.e. a wider net of people than are specifically targeted in some recent GOP proposals.
The 36 million number is a larger group of enrollees compared to a previous CBPP estimate that was in response to a specific proposal whose work requirements would have targeted fewer people.
Multiple recent GOP proposals regarding Medicaid work requirements target "able-bodied" workers, though they vary in other specifics.
The far-right policy blueprint "Project 2025" calls for the Centers for Medicare and Medicaid Services to "clarify that states have the ability to adopt work incentives for able-bodied individuals" on Medicaid. And in late January congressional Republicans passed around a list of ideas for how to fund a bill full of GOP priorities that included imposing Medicaid work requirements for "able-bodied" adults without dependents, modeled after the Limit, Save, Grow Act, a bill passed by the House in 2023.
On Thursday, Sens. John Kennedy (R-La.) and Eric Schmitt (R-Mo.) reintroduced the Jobs and Opportunities for Medicaid Act, a bill that would require "able-bodied adults without dependents who receive Medicaid benefits to work or volunteer for at least 20 hours per week."
Because the Kennedy and Schmitt bill includes an exemption for adults with dependents, it would impact a smaller number of people than the CBPP's Thursday analysis. But still, as a general matter, "work requirements are simply another way to cut Medicaid," according to the authors of the analysis. Republicans' January list of cost cut options estimated that adding Medicaid work requirements along the lines of what was specified in the Limit, Save, Grow Act would yield $100 billion in 10-year savings.
In a Friday letter to Senate Majority Leader John Thune (R-S.D.) and House Speaker Mike Johnson (R-La.), all 47 members of the Senate Democratic Caucus wrote: "We urge you to reject proposals that use Medicaid as a piggy bank for partisan priorities and continue to defend the importance of this vital program."Keep ReadingShow Less
Trump GOP's Tax Plans Mean Pain for Families, Windfalls for the Wealthy
One think tank urged Congress to "create a more equitable federal tax system that raises revenue sufficient to meet the nation's needs and requires wealthy households and corporations to pay their fair share."
Feb 04, 2025
As U.S. President Donald Trump and congressional Republicans plot more tax cuts for the rich at the expense of working people, a progressive think tank on Tuesday put out a policy brief detailing how those cuts and price-hiking tariffs would deeply harm working families.
The Center on Budget and Policy Priorities brief is part of CBPP's "2025 Budget Stakes" series, which also includes documents on potential "painful cuts" for "vulnerable people" and the possible loss of health coverage, food aid, and rental assistance.
"High-income households and profitable corporations would grow even wealthier under Republican proposals for trillions of dollars in new or extended tax cuts," the new report states, "even as Republican proposals for trillions of dollars of cuts to health assistance, food assistance, and other programs would leave more children in poverty, more families without stable housing, and more people without health coverage."
"As a first step, Congress should let the 2017 tax cuts for households with high incomes expire on schedule."
"The major tax law that President Trump and a Republican-controlled Congress enacted in 2017 was heavily skewed to households with high incomes," the brief continues. "It was also expensive, costing $1.9 trillion over 10 years, according to the Congressional Budget Office's 2018 estimate. And it failed to deliver the economic gains its backers promised; studies found the benefits didn't 'trickle down' to most workers."
The current debate over taxes in Washington, D.C. is happening not only because Republicans now control the White House and both chambers of Congress, but also because key parts of the GOP's Tax Cuts and Jobs Act of 2017 expire at the end of this year.
The CBPP brief warns that extending the expiring provisions from what critics called the "GOP Tax Scam" would:
- Do relatively little for households with low or middle incomes;
- Add trillions in debt, much of it to benefit the wealthy;
- Worsen racial inequities; and
- Weaken the nation's ability to fulfill our commitments to seniors and meet national needs and challenges.
The document features a section on the Internal Revenue Service, which explains that "during the 2010s, steep budget cuts imperiled the IRS' ability to serve taxpayers and enforce the nation's tax laws. But funding from the 2022 Inflation Reduction Act is helping the IRS dramatically improve its customer service, operate the direct file mechanism so people can file their taxes directly with the IRS for free, and modernize and improve its tax enforcement efforts."
"Those efforts are already paying off in cracking down on tax cheats and ensuring that wealthy people pay more of the taxes they owe," the brief notes. "But Congress has already canceled some of the new enforcement funding, and Republican budget proposals call for repealing the rest."
Although Trump on Monday struck deals with the Canadian and Mexican governments to delay 25% tariffs on goods from the United States' neighboring nations, CBPP also sounded the alarm about Trump's campaign promises regarding the taxes.
"Research shows that the extra costs imposed by these tariffs are passed on to consumers; the tariffs announced February 1 would cost a typical middle-income household around $1,200 per year, according to one estimate," the brief states. "Tariffs can also provoke trade wars, which can harm domestic businesses."
Republican proposals would deliver trillions in tax cuts benefiting high-income households and profitable corporations, while cutting health and food assistance. This would increase poverty, reduce housing stability, and raise prices through new tariffs. www.cbpp.org/research/fed...
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— Center on Budget and Policy Priorities (@centeronbudget.bsky.social) February 4, 2025 at 10:55 AM
The document argues that "instead of extending and expanding costly tax breaks for those who least need help, Congress should create a more equitable federal tax system that raises revenue sufficient to meet the nation's needs and requires wealthy households and corporations to pay their fair share."
"As a first step, Congress should let the 2017 tax cuts for households with high incomes expire on schedule," the brief says. "Congress also should expand the child tax credit, especially for the roughly 17 million children who don't receive the full credit today because their families' incomes are too low, and expand the earned income tax credit for workers not raising children in their home, who now receive little or nothing from the credit."
"In addition, Congress should scale back corporate tax breaks and reduce the special tax breaks enjoyed by very wealthy households that shield their considerable income from taxation," the report concludes. "And Congress should provide the IRS with the funding it needs to enforce the nation's tax laws and better ensure that wealthy people and corporations pay the taxes they legally owe."
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GOP Attack on Medicaid Puts 'Millions of People at Risk of Losing Benefits': Analysis
"In short, recent proposals for a per capita cap or block grant would cause people to lose health coverage and benefits, shift costs and risks to states, and destabilize healthcare providers."
Jan 07, 2025
Republican proposals to impose a per person cap on federal Medicaid funding or turn the government health insurance program for lower-income Americans into a block grant would leave millions of people without coverage or care, according to an analysis published Tuesday.
The Center on Budget and Policy Priorities (CBPP), a progressive think tank, examined GOP policy proposals including the per capita funding cap and making Medicaid a block grant and found that such policies "would dramatically change Medicaid's funding structure, deeply cut federal funding, and shift costs and financial risks to states."
"Faced with large and growing reductions in federal funding, states would cut eligibility and benefits, leaving millions of people without health coverage and access to needed care," CBPP added.
Policymakers should protect #Medicaid’s federal-state funding to avoid harming millions of people. Caps or block grants would force deep cuts, shift costs to states, destabilize providers, and threaten access to care. www.cbpp.org/research/hea...
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— Center on Budget and Policy Priorities (@centeronbudget.bsky.social) January 7, 2025 at 9:41 AM
According to the analysis:
Many of those losing Medicaid coverage would be left unable to afford lifesaving medications, treatment to manage chronic conditions like cardiovascular disease and liver disease, and care for acute illnesses. People with cancer would be diagnosed at later stages and face a higher likelihood of death, and families would have more medical debt and less financial security. A large body of research shows that Medicaid improves health outcomes, prevents premature deaths, and reduces medical debt and the likelihood of catastrophic medical costs.
"Before resurrecting harmful per capita cap proposals, policymakers should consider how similar past proposals would have impacted states' budgets and thus their ability to support Medicaid enrollees," CBPP advised.
The analysis comes as Republicans—who control both houses of Congress and, starting on January 20, the White House as President-elect Donald Trump takes office—pursue a massive tax cut that would be funded in part by cutting social programs including Medicaid. GOP lawmakers are also considering work requirements for Medicaid recipients in order to help pay for the tax cut, which critics argue would primarily benefit rich people and corporations.
According to a 2024 report by the National Association of State Budget Offices, Medicaid—which, along with the related Children's Health Insurance Program, serves nearly 80 million U.S. adults and minors with limited income and resources—makes up more than half of all federal funding for states.
Total Medicaid spending was approximately $860 billion for fiscal year 2023, with the federal government contributing around 70% of the funds. The CBPP analysis notes that "under a per capita cap, states would get additional funding as the number of enrollees increased, but if the caps were set at an insufficient level, the state's funding shortfall would grow as more people enrolled."
The report also says that "the design of per capita caps can expose states to cuts even if spending falls below caps for some eligibility groups, and even if spending growth falls below the cap on average over time. And as the caps would be permanent, the size of the cuts and the number of states affected would continue growing over time. These losses in federal support would impose significant strain on states and put millions of people at risk of losing benefits and coverage."
Under a block grant, "the funding shortfall would be even worse since federal funding wouldn't change in response to enrollment increases," the analysis states.
"In short, recent proposals for a per capita cap or block grant would cause people to lose health coverage and benefits, shift costs and risks to states, and destabilize healthcare providers," the publication concludes. "The federal funding cuts to states would be large and unpredictable. Restructuring Medicaid's financing would also make the program highly vulnerable to future cuts, as it would impose a funding formula that could be easily ratcheted down further—for example, by setting the cap or its growth rate even lower. Policymakers should reject proposals for per capita caps and block grants and instead retain the current federal-state financial partnership."
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