President Donald Trump is expected to sign his law on extensive domestic politics on Friday, which includes almost $ 1 trillion in cuts against Medicaid, the state health insurance program for low-income and disabled Americans.
The new legislation is described as a “large, beautiful calculation”, will extend the tax reductions of Trump in 2017 and partially compensate for it by introducing the financing of Federal Medicaid, the introduction of copays for some services and – for the first time – the nationwide medicaid labor requirements. The final version of the invoice contained no estimate of the coverage losses. An earlier report on the Congress's household office predicted that around 11 million people lose their health insurance and could not be insured due to the program cuts by 2034.
Medicaid is jointly financed by the Federal Government and the States, which usually prescribe that applicants meet certain criteria, such as: B. low income, disability or care status.
Only two states implemented the requirements for work requirements for Medicaid work in 2018 and Georgia in 2023. The Georgia program, which is called the path to coverage, remains in force.
Arkansas's work requirements were in the 10 months, and more than 18,000 people in the state have lost the coverage of Medicaid. Georgia has not done a good job, how many have lost reporting, but the enrollment remains low, said Leighton KU, director of the Center for Health Policy Research at the Milken Institute School of Public Health at George Washington University.
When people lose the cover of Medicaid, they see them as “a kind of slap in the face,” said Ku.
“If your income goes back when you are unemployed, you will lose everything,” he said. “If you are most in need. Then you lose your food aid, then you lose your health insurance coverage.”
Trudy Rogers.With the kind permission of Trudy Rogers
Kendall Rogers, 40, from Stone Mountain, Georgia, is looking for a job after losing his Medicaid coverage this year due to the state's work requirements, according to his mother Trudy Rogers, 59.
The change means that Trudy now has to take care of himself for long parts of the day. She has fibromyalgia and nerve problems in the back that make it difficult for her to move away.
Kendall took care of her almost full -time, said Trudy, but Georgia's work requirements offer no exceptions to nursing staff for older adults.
She called the new requirements “an insult not only for him, but for me.”
“Because he is now forced to look for work and I need him to stay in the house,” she said.
Covered with bureaucracy
In order to justify the cuts, the Republicans have argued that they do not take Medicaid from those who are rightly justified, as they say, single mothers or disabled people, but of “young, efficient men”, of whom they say that they abuse the system.
“If you tidy up and support it, you save a lot of money and give back working to young men who are on the go instead of playing video games all day,” said House spokesman Mike Johnson, R-La., In April.
But as can be seen in Georgia and Arkansas, this is not that is largely affected.
Cynthia Gibson, director of the health law compartment of the Georgia Legal Services Program, which helps with the appeal against Medicaid refuses that many people in the state lose cover, not because they are not working, but because they are not aware of the new rules or make themselves available with administrative problems such as missed paper stuff or no information. Others, such as Kendall Rogers, take care of family members, but do not qualify for exceptions.
Likewise, only 3% or 4% of people at Medicaid did not work in Arkansas in 2018 and did not qualify for the exceptions as part of the state program, said Dr. Benjamin Sommer, doctor and health economist at the Harvard Th Chan School of Public Health. Summer published a study in the New England Journal of Medicine in 2019, in which the effects of Arkansas' work requirements were examined.
His investigations showed that around 40% of the other around 96% of the 80 hours per month required in the state of Medicaid worked. The rest had either diseases that prevented them from working, or other responsibilities such as school or care for family members.
The implementation of the work requirements did not lead to a higher employment rate – one of the arguments that the officials of Arkansas used in favor of the new work rules.
“Most people, almost everyone, already did something [the state] I wanted them to do it, ”he said. Very few were“ the proverbial on the couch, video game history, which we hear from some followers ”.
The most common, said Gibson, people don't really know that they have lost the reporting until they visit their doctors.
“And that creates a kind of panic,” she said. “Sometimes you may have something really important that the doctors don't do when you take out your insurance and find out that you have no more cover.”
Gibson said that the people who are most often affected by the work request are those in non -corporal workplaces, including independent employees -such as Uber drivers or members of the delivery -who do not receive regular salary statements and cannot meet the requirements for the working test in Georgia.
Others are people with certain disabilities who do not qualify for exceptions and supervisors for children or older relatives.
The cost of non -coverage
People who lose cover often avoid going to the doctor or receiving medical care, unless it is an emergency because they do not want to accumulate debts, she said.
“You just don't get treatment; you don't go to the doctor,” she said.
Heather Payne, 53, from Dalton, Georgia, could not avoid medical care after she had a number of weak strokes in 2022.
Unable to work, she was informed that she did not qualify for a plan for affordable care programs and did not qualify for the Medicaid program in Georgia because she was a childless adult.
Heather Payne.Jason Kane / NBC News
Later she wrote down in the classroom to become a nurse practitioner – a career that she could pursue despite her disability. At that time, the state's work request came into force. However, Payne was said that she still hadn't qualified for Medicaid because she did not take enough loan lessons. She couldn't afford to take more.
In order to pay for her doctor bills, she has burned her savings of $ 40,000 and is now in collections for tens of thousands of dollars.
“If you have a problem, there is no help for you,” she said. “You have the feeling that society doesn't care what happens to them.”
Dimitris Terrell, 49, from Clarkston, was also afraid that her 24-year-old son Justin Anderson could collect debt after changes in the Georgia Medicaid program.
Anderson does not work, but he has a Medicaid cover because he has Crohn's disease, a bowel disease that can cause chronic inflammation of the stomach intestine.
Terrell said her son had to pay large copays last year after the state started to calculate Copays for prescription medication and certain services.
Anderson paid over $ 400 out of his pocket during the doctor's visits and hundreds of dollars for the dentist, whom he could not afford, his mother said.
She is also worried about his loss of loss – either because he would no longer qualify or because of a missed paperwork.
“He is pretty sad and shocked,” said Terrell. “He said: 'How, mom, I don't understand why I have to pay.'”
