Millions of Americans are about to lose their health insurance, and most of them are already doing everything they’re supposed to be doing.
The Congressional Budget Office (CBO) projects approximately five million people will lose Medicaid access when new work requirements take effect in January 2027. But GOP leaders dispute the estimates, saying people will only lose coverage if they choose not to work.
The coming changes, part of the One Big Beautiful Bill that passed in July 2025, are targeted at millions of Medicaid beneficiaries Republicans claim are able-bodied but not working and cheating the system.
“You’ve got about 4.8 million people on Medicaid right now nationwide who are able-bodied workers, young men, for example, who are not working, who are taking advantage of the system. If you are able to work and you refuse to do so, you are defrauding the system. You’re cheating the system,” House Speaker Mike Johnson (R-Louisiana) said in a May 2025 “Face the Nation” interview.
But most Medicaid beneficiaries either work or attend school and only about 2 percent of them “lack interest in working,” according to an Urban Institute analysis. The Institute also found that many unemployed beneficiaries have barriers to employment such as health conditions or caregiving duties.
The people hurt by this new policy
“Our analysis found that 69 percent of the Medicaid expansion group are working or enrolled in school. Another 12 percent have a health problem or disability, which would exempt them from work requirements, Another 4 percent were taking care of young kids. Basically, about 90 percent were working or had an exemption,” said Lisa Dubay, a senior fellow in the Health Policy Division at the Urban Institute.
The new policy will require adults ages 18 to 64 to prove they are employed, volunteering, or participating in a work program for at least 80 hours per month or attending school at least half-time, or qualify for an exemption to access coverage under the Affordable Care Act Medicaid expansion.
Some of the exemptions include being medically frail, a disabled veteran, enrollment in a substance use disorder treatment program, or a Native American or Alaska Native.
However, the changes will put low-income and other vulnerable populations at great risk.
“Women will be harmed and so will older people in the 55 to 64 age group,” Dubay said.
Dubay said these two groups may be more vulnerable because of health issues or caregiving responsibilities such as caring for a spouse; and there are people who do not meet work requirements “not because they are not working but because the law creates administrative burdens for the states and the people.”
What happens when you have few options?
While GOP leaders described the new policy as “common sense,” it will strand many people without many or any options for affordable insurance.
“There is no alternative other than purchasing something at full price, which people likely cannot afford,” Dubay said.
Gabriel Ellis primarily uses his Medicaid benefits for therapy and medications that help him manage his mental health conditions but is ensure what the policy changes will entail.
“I had been working on my business plan and also taking welding classes while I was working part time, but I decided to focus on working more hours because I am not sure what will happen,” said Ellis, who lives in Virginia, where 349,000 people are expected to lose Medicaid access according to KFF data.
Mississippi native Ann Thompson said she is afraid of how the requirements will affect her even though she meets the age requirement.
“Since I am 65 years old, I do not have to work, but I do not trust what is happening with these changes. So, I may come out of retirement to earn another degree and pursue a new career path,” said Thompson, who has been in medical retirement for 16 years.
Dubay recommends people who have concerns like Ellis and Thompson should talk with someone at their Medicaid agency, a community health center, or providers in their areas who serve the Medicaid population.
States are required to start notifying Medicaid enrollees about changes starting in September 30, 2026, and must implement the changes by January 1, 2027.
MORE FROM URWELL
- How environmental racism is getting worse and who’s pushing back
- What ‘forever chemicals’ are doing to our bodies — and how we can avoid them
- ICE fears cause long-term, costly health effects in children of immigrants, research shows
- Congress dangles health care for millions — again
- Digital health tools not reaching all who need them
- Covid-19 is evolving, but vaccine policy is eroding
