If Congress moves forward with a controversial proposal to require people to report work hours to keep Medicaid, more than a million of California’s poorest residents could lose their health insurance.
The budget bill that the U.S. House advanced last week includes a requirement that certain adults — largely those under 65 without children or a disability — meet work reporting rules. In California, about a third of them could lose their health coverage, according to an analysis by the research group Urban Institute. Based on 2026 enrollment projections, that’s between 1.2 and 1.4 million Californians.
As Congress looks at Medicaid for ways to help offset the cost of extending President Donald Trump’s 2017 tax cuts, imposing work requirements has increasingly been deemed as one of the most feasible and significant cost-savings actions. House Speaker Mike Johnson told CBS that work requirements have a “moral component” and that people who don’t work are “defrauding the system.”
But health policy researchers and advocates point to New Hampshire and Arkansas, where state-imposed work requirements failed in recent years. Their policies didn’t actually boost employment; they did, however, leave thousands of eligible people without health insurance within a matter of months. Both states have since canceled their work policies. Georgia is the only state that currently has work requirements.
Nationwide and in California, about two-thirds of Medicaid enrollees work, according to the health research firm KFF. Another 29% care for children, attend school or have a disability that would exempt them. But health advocates say the additional red tape to prove employment could be so cumbersome that many eligible people would fall out of the health…
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