WASHINGTON (AP) — Approximately 11.8 million adults and children could face the loss of health insurance if the Republican-backed domestic policy package becomes law. The proposed changes, encapsulated in the GOP’s “One Big, Beautiful Bill Act,” aim to gradually reduce enrollment in federal health care programs like Medicaid and the Affordable Care Act (ACA) over the next decade, potentially cutting nearly $1 trillion from Medicaid, the ACA, and the Children’s Health Insurance Program (CHIP).
The potential rollback of health insurance coverage comes amid a backdrop of increasing health insurance rates in the U.S., coupled with record federal spending on health care. Currently, around 78 million individuals are enrolled in Medicaid, with another 24 million participating in the ACA’s marketplaces. Medicaid, a joint federal-state initiative, operates under various names across states, such as Medi-Cal in California and MassHealth in Massachusetts.
Impact on Medicaid and ACA Enrollees
One of the key provisions of the GOP plan is the increased frequency of income and eligibility checks for Medicaid recipients, which will occur every six months. This heightened scrutiny could disproportionately affect vulnerable populations, such as the homeless or transient individuals, who may miss government notifications for required paperwork. Martha Santana-Chin, CEO of L.A. Care Health Plan, highlighted the challenges faced by these individuals, stating, “The life experience of these individuals is not necessarily one that allows them the luxury of having to work through onerous paperwork.”
Historical data from Texas, which increased income eligibility checks between 2014 and 2019, revealed that thousands of children lost coverage, contributing to the state’s high rate of uninsured children. The GOP bill also mandates more frequent verification of enrollees’ addresses and death records.
For those enrolled in ACA marketplace coverage, the bill introduces stricter income verification processes and potential penalties for discrepancies. Unlike employer-based coverage, where re-enrollment is automatic unless opted out, ACA participants will face delays as they await government verification.
Challenges for Children’s Health Insurance
The proposed legislation allows states to delay enrollment in CHIP for children whose parents are behind on premium payments. According to the health policy research firm KFF, premiums for children’s coverage can reach up to $100 a month in some states. Additionally, states can impose waiting periods for children transitioning from private insurance to Medicaid, reversing Biden administration policies that prohibited such barriers.
Immigrant Coverage at Risk
The bill also tightens the criteria for lower-cost ACA coverage, restricting access for thousands of refugees and asylum seekers entering the U.S. Furthermore, states offering Medicaid to immigrants, regardless of legal status, will face reduced federal funding. This change could compel states to discontinue immigrant health programs, as seen in California’s freeze on new Medi-Cal enrollments for immigrants and Illinois halting its program.
Work Requirements and Bureaucratic Hurdles
The GOP’s proposed work requirement is expected to be a significant factor in coverage losses. Individuals aged 19 to 64 must work, volunteer, or attend school for at least 80 hours per month to qualify for Medicaid. Exemptions exist for those who are disabled, pregnant, or parenting a child under 14. Michael F. Cannon, director of health policy studies at the Cato Institute, commented, “It can encourage people who don’t value Medicaid coverage not to sign up for it. And that saves the government money.”
Despite most Medicaid enrollees already meeting these criteria, bureaucratic errors and documentation challenges could result in coverage loss. Arkansas’ 2018 attempt to implement work requirements led to 18,000 individuals losing Medicaid within seven months, until a federal judge intervened.
Complications for Dual Enrollees
Millions of individuals qualifying for both Medicare and Medicaid, often due to disabilities, face additional hurdles. The GOP bill seeks to reverse Biden administration efforts to streamline enrollment processes, potentially increasing the paperwork burden and risking coverage loss. Jennifer Tolbert, director of state health policy at KFF, warned, “By rescinding these rules and no longer requiring states to make some of these simplifications, it’s likely that some people will lose coverage because they get caught up in these paperwork burdens.”
The implications of the GOP’s proposed bill are significant, potentially reversing years of progress in expanding health care coverage. As the bill moves through legislative channels, its impact on millions of Americans remains a critical point of concern for policymakers and health advocates alike.