House Republicans’ proposal to implement stricter Medicaid work requirements is designed to strip out waste, fraud and abuse from the widely used healthcare program, but the changes could see millions of Americans booted from their benefits in the process.
The Republican-controlled Congress and the White House are mulling work requirements for able-bodied, childless adults between the ages of 18 and 64. People fitting those criteria would be required to work at least 80 hours a month to maintain their benefits, or by participating in community service, going to school or engaging in a work program.
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Those requirements would not apply to pregnant women, parents, medically frail individuals and people with substance-abuse disorders, among others.
The policy proposals for the nation’s largest healthcare program, which provides benefits to roughly 72 million Americans, are part of the House GOP’s broader budget reconciliation bill that includes a litany of President Donald Trump’s tax, immigration, energy, defense and deficit-decreasing policy desires.
Republicans have viewed Medicaid as fertile ground for steep spending cuts in their pursuit of putting a dent in the national debt as part of the president’s mega-bill, with work requirements being among the most popular proposals on the table.
House Speaker Mike Johnson, R-La., pitched the GOP’s work requirements as having a “moral component” that was geared toward getting young, able-bodied men into the workforce.
“If you are able to work, and you refuse to do so, you are defrauding the system,” he said on Sunday on “Face the Nation” with Margaret Brennan. “You’re cheating the system. And no one in the country believes that that’s right.”
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Of the millions of people who are on Medicaid, there are nearly 14 million who are considered able-bodied working-age adults without dependents as of 2022, according to data from the People’s Policy Project.
While Trump has vowed that Republicans were “not touching anything” in Medicaid, recent reports from the nonpartisan Congressional Budget Office (CBO) found that work requirements for able-bodied adults and other proposals from the House GOP’s suite of policy tweaks to Medicaid could result in about 7.6 million people losing health insurance over the next decade.
Republicans have argued that the work requirements, in particular, were designed to claw back benefits from people who chose not to work, and posed a far more palatable option for lawmakers wary of other proposed changes, like tweaks to the federal Medicaid reimbursement rate to states.
Fiscal hawks have been keen to reduce spending as the nation’s debt continues to climb. Currently, the debt sits at over $36 trillion, according to FOX Business’ National Debt Tracker.
House Republicans aimed to carve out at least $1.5 trillion in spending cuts with their version of the reconciliation package, which advanced from the lower chamber last week. Cuts to Medicaid are expected to account for at least $700 billion of that, according to a report from the CBO.
The version of work requirements that made its way into the bill was slightly different from what was originally proposed, a move made by House Republican leadership to appease hardliners in the House Freedom Caucus who threatened to sink the legislation unless work requirements were fast-tracked.
Now, the work requirements have been moved up from fiscal year (FY) 2029 to FY 2026.
While the CBO’s latest report did not include last-minute changes to the start date for work requirements to kick in, a previous report found that adding stricter guardrails to the program would bring about roughly $280 billion in spending cuts — a figure that is likely now higher because of the implementation date moving up.
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