Shirley Lewis, a Jawonio Day Services participant, was among the Medicare recipients, healthcare workers, and caregivers who gathered with U.S. Senate Minority Leader Chuck Schumer at Helen Hayes Hospital in Haverstraw, N.Y. April 17, 2025. Schumer spoke about how cuts to Medicaid will affectrecipients as Republicans in Congress vote to enact cuts to the program as well as to other social safety net programs.
Washington D.C. – A staggering number of Americans, potentially up to 5 million, could lose their public health care coverage if federal work requirements proposed by Republicans are enacted nationwide. A newly released joint analysis from the Robert Wood Johnson Foundation and the Urban Institute paints a stark picture of the potential consequences.
The analysis, published Monday, projects that between 4.6 and 5.2 million of the estimated 13.3 million Medicaid expansion enrollees in 2026 could be stripped of their coverage under a federal work-requirement policy. Medicaid, a crucial program providing healthcare to lower-income individuals, currently serves over 80 million people in the U.S.
The proposal has emerged within the ongoing Congressional budget negotiations, where Republicans are seeking spending reductions and tax breaks. While avoiding direct cuts to Medicaid, a popular program President Trump once vowed to protect, Republicans have championed work requirements as a way to condition coverage and simultaneously reduce government spending.
Democrats have consistently opposed such measures, arguing they contradict the program’s fundamental aims, create unnecessary administrative hurdles, and would inevitably lead to deserving enrollees losing their healthcare access. The Trump administration previously encouraged states to implement work requirements, but these efforts faced legal challenges and were ultimately blocked by federal judges.
Since the beginning of Trump’s second term, Congressional Republicans have renewed their push for federal work requirements for non-disabled adults. A draft bill introduced in the House in February proposed a minimum work requirement of 20 hours per week of work or volunteering for certain adults to qualify for Medicaid coverage, with exemptions for medical conditions, family situations, and other specified reasons. Governors in states like South Carolina, Ohio, and Arkansas have also floated similar proposals.
Work requirements have become a significant point of discussion in the current Congressional budget negotiations, aligning with the GOP’s broader agenda for stricter eligibility criteria and the $880 billion in savings the House Energy and Commerce Committee has been tasked with finding over the next decade.
The analysis by the Robert Wood Johnson Foundation and the Urban Institute drew upon the experiences of Arkansas and New Hampshire, states that briefly implemented work requirements. Their findings suggest that a nationwide rollout could result in at least 10,000 adults losing coverage in all 40 expansion states – those that opted to expand Medicaid under the Affordable Care Act – with potential losses exceeding 100,000 in 13 of these states.
The researchers project the most significant coverage losses in highly populated states, with California potentially seeing 1 to 1.2 million individuals lose coverage and New York facing drops of 743,000 to 846,000. The report highlights that while over 90% of expansion adults aged 19 to 55 already work, participate in work-related activities, or meet exemption criteria, many would still lose coverage due to a lack of awareness of the policy and difficulties navigating state reporting systems.
Conversely, the Foundation for Government Accountability argues that implementing Medicaid work requirements nationwide could save federal taxpayers $260 billion over the next decade and encourage able-bodied adults to enter the workforce.
House Speaker Mike Johnson recently stated that the focus is on “returning work requirements” rather than cutting benefits for those “duly owed.” Last week, Republicans passed a budget resolution that will serve as the framework for upcoming legislation. While the framework did not specify which programs might face budgetary cuts, the slim Republican majorities in both the House and Senate suggest a cautious approach to directly cutting popular programs like Medicaid to avoid political repercussions.
