Too sick to work, some Americans are worried

Stephanie Ivory is counting on Medicaid to be treated for gastrointestinal conditions and a bombed disc that makes the position standing or seated for long painful periods. His handicaps prevent him from working, she said.

Ivory, 58, of Columbus, Ohio, thinks that she would be free from a requirement that the adult beneficiaries of Medicaid workBut she is concerned about the declaration process. “It is quite difficult to renew the coverage of Medicaid every six months with telephone calls and documents,” she said.

In Warrenton, Missouri, Denise Sommer has not worked for five years and relies on Medicaid to take care of anxiety, high blood pressure and severe arthritis on her back and her knees.

Sommer, 58, assumes that she could easily qualify for an exemption with a doctor’s note. “There are too many abuses in the system,” she said. She added that she was not worried that others lose the coverage so as not to meet the declaration requirements.

“This is their fault, because they should simply keep their address up to date with the state and read their mail,” she said.

President Trump One Big Beautiful Bill Act, sprawling legislation to extend his tax reductions and promulgate a large part of his national program, would require 40 states and the Columbia district, which extends Medicaid, to add a work requirement to the program. The registrants should regularly file documents proving that they work, volunteer or at least frequented school at least 80 hours per month, or that they qualify for an exemption.

Many Republicans say that unabled adults should not be on Medicaid, arguing that the work requirement will encourage more people to find a job. Mike Johnson room president Said that it would help to preserve Medicaid “for people who rightly deserve” the coverage “, not for men of 29 -year -old sitting on their sofas playing video games”.

Last month, Johnson said 4.8 million MEDICAID registrants choose not to work, a figure disputed by experts in health policy. Johnson spokesperson did not respond to a request for comments.

Studies of the Urban Institute and kff Show that, among the opening age registrants who do not receive federal disability services, more than 90% are already working or looking for work, or have a handicap, go to school or take care of a family member and are unable to work.

Most registered Medicaid registrants occupy low -wage jobs, often with long or irregular hours and limited advantages, if necessary. In particular, their jobs often do not provide health insurance.

A new study by the Urban Institute Found 2% of registrants for the expansion of Medicaid without dependent people, around 300,000 people, point out a lack of interest to work as a reason for not having a job.

The Budget Office of the Non -Sompaign Congress believes that the work requirement in the version of the Legislation Chamber would lead to around 5 million adults lost to the coverage of Medicaid by 2034; He has not yet analyzed the Senate bill. The Center for Budget and Policy Priories, a left -wing research organization, believes that the Senate version might lose coverage of 380,000 more people.

According to the CBO, the provision of labor demand represents the highest reduction in Medicaid in the invoice of the Chamber – around $ 300 billion over a decade, reflecting the savings to no longer cover millions of current registrants.

The planned savings are indicative, said Anthony Wright, executive director of USA families, a consumer policy and defense organization. “It gives an idea of ​​the order of its magnitude and its hardness,” he said.

Wright said that the states led by Republicans are likely to impose heavier reporting requirements. But even a less strict approach, he said, will impose paperwork mandates which make the eligible beneficiaries lose the coverage.

Stephanie Carlton, chief of staff of the Centers for Medicare & Medicaid Services, said on June 24 at the Aspen Ideas Festival in Colorado that the officials of the Trump administration thought that the CBO oversees the impact of the work requirement.

“We facilitate the task” so that people report their working hours using technology, “she said. It defended the requirement proposed as a means of better integrating the beneficiaries of Medicaid in their communities.

“We are a company, in particular through Covid, which has disengaged from communities. We spend a lot of time online, on social networks, and we waste this human interaction to human,” said Carlton. “We ask people to engage in their communities. It is a fundamentally good thing to do that is part of the advantages.”

Under the GOP’s proposal, people should meet the new work requirements when they initially register in Medicaid, then signal their status of work or exemption at least every six months – and potentially as often as every month.

“This is not a conversation in which America should be,” said Leslie Dach, founder and president of Protect our careA defense group that supports the affordable care law. “Think of real life. People are seasonal workers, or they work in retail, and that changes activity or hours. If you miss a month, you are launched.”

GOP legislation lists disability as an exemption, as well as circumstances such as incarceration or being a parent of a dependent child. (The Senate bill, released on June 16, would only have parents of children 14 and under.)

But even the existing state and federal programs in the service of disabled people have different standards to determine eligibility.

Kevin CorinthA principal researcher at the Conservative American Enterprise Institute, said that states can face challenges because many registrants in Medicaid disabled do not obtain social security disability insurance.

The federal government provides what is called additional security income to those who reach certain thresholds to be low -income and disabledAnd states are required to register SSI recipient in Medicaid.

But about two thirds of adult registrants who are under 65 and disabled – that is to say difficulties in vision, hearing, mobility or cognitive function, or in other areas – do not receive SSI, According to Kff.

“It is difficult to know where to draw the line on which is disabled enough” to be exempt from the work requirement, said Corinth. “Some people will pass through the meshes of the net and states will have to do the best possible job.”

He said states should rely on government databases, such as those maintained by their labor services, to determine if registrants work. But proving a handicap could be more trying for the registered themselves, he said.

Two states that have already tried to promulgate Medicaid work requirements have created strict rules for disabled people to obtain an exemption.

In Arkansas, Medicaid’s work requirement had an online exemption process in 10 steps for people who were not automatically exempt by the State.

Consequently, although 30% of persons subject to the requirement reported of one or more serious health limitations, only 11% have obtained a long -term exemption, according to the National Health Law Program.

The registrants of Medicaid in Arkansas described a portal of poorly functional web reports, an inadequate awareness and a generalized confusion, according to the interviews of focus groups by kff.

Georgia’s work requirements have also presented challenges for people looking for an exemption based on disability. They must request a “modification” of the State on its online portal, then wait for a telephone call from the State to set up an interview to examine the request. Then, they must register for the State employment training program before being authorized to register in Medicaid, according to the National Program of Health Law.

Georgia has not revealed how many people have requested an exemption due to an approved handicap or number.

More than 1 out of 5 out of 5 has a handicap, including 22% of the 19 to 49 year olds and 43% of these 50 to 64 year olds, According to Kff.

Michael Karpman, The main research partner of the Urban Institute, said that the conclusions of his group – that only a small fraction of the registrants of Medicaid is unemployed because they are not interested in a job – explain why the work reversal programs in Arkansas and Georgia had no significant effect on employment Even by increasing the number of uninsured adults.

“Many people fall from Medicaid rolls for red carpet reasons,” he said, noting challenges asking for exemptions or declaration work. “People have trouble with the documentation process.”

Karpman said many people are on Medicaid when they lose jobs that provide health coverage. GOP’s work requirements, however, refuse to cover them while looking for new jobs.

Chris Bryant, a MEDICAID registration in Lexington, Kentucky, has a bleeding disorder and lives in government housing with $ 1,100 per month in federal disability payments. He said that adding a work requirement to Medicaid will only add obstacles to people whose health problems prevent them from working. “It will be messy,” he said.

Bryant, 39, said that he knew people about Medicaid who could work but did not do so, although he assumed that it is a small part of the population. “People are on Medicaid because they must have it and have no other option.”

Emmarie Huetteman contributed to this report.

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