Importance Score: 78 / 100 🔴
Potential Impacts of Proposed Changes to the U.S. Social Safety Net
The U.S. social safety net could face significant changes if the budget legislation, supported by President Donald Trump and approved by the House of Representatives on Thursday, is enacted. This bill proposes alterations to Medicaid eligibility, food assistance programs, and funding for specific healthcare services. Specifically, it would mandate several low-income adults to demonstrate work activity to qualify for Medicaid health insurance coverage and also increase the number required to work to receive food assistance, obligate hospitals to confirm patients’ citizenship, and reduce financial support for reproductive health services, including the nation’s largest abortion provider.
Key Provisions of the Bill
- Work Requirements for Medicaid: Many able-bodied Medicaid enrollees would be required to demonstrate they are working to maintain health coverage.
- Changes to SNAP (Food Stamps): Increases work requirements and limits waivers in high unemployment areas.
- Restrictions on Funding for Immigrant Healthcare: Penalizes states using state funds for Medicaid-covered services for immigrants without legal status.
- Defunding Planned Parenthood: A provision would bar Planned Parenthood from receiving Medicaid funds.
- Eliminating Gender-Affirming Care: Medicaid would cease covering gender-affirming care for individuals of all ages starting in 2027.
Medicaid Work Requirements: Potential Coverage Loss
Under the proposed legislation, starting next year, numerous able-bodied Medicaid recipients will need to prove they are employed to retain their health insurance benefits. Although roughly 92% of current enrollees reportedly meet this requirement, estimates from prior versions of the bill by the Congressional Budget Office suggest that approximately 5 million individuals could lose their coverage.
Concerns About Work Requirements
- Increased eligibility checks and administrative burdens may lead to wrongful termination of coverage.
- This could particularly affect rural hospitals, which may see a rise in unpaid emergency care.
- Experts argue that work requirements do not necessarily lead to increased employment, but rather to a reduction in insured individuals.
For example, when Arkansas implemented a work requirement, over 18,000 people lost coverage before the program was blocked by federal courts.
Joan Alker, executive director of Georgetown University’s Center for Children and Families, has stated, “If you lose your job going forward, good luck to you. There is a good chance you’re going to be uninsured because of this bill.”
SNAP Work Requirements Expanded
The Supplemental Nutrition Assistance Program (SNAP), previously known as food stamps, already contains work requirements for some recipients. Currently, able-bodied adults ages 18-54 without dependents must work, volunteer, or participate in training programs for a minimum of 80 hours per month, or face a limit of three months of benefits within a three-year period.
Changes to SNAP Eligibility
- The House-passed legislation would increase the age for work requirements to 65.
- It would also extend requirements to parents without children younger than age 7.
- The bill would restrict the ability to waive work requirements in areas with high unemployment.
These combined changes could put an estimated 6 million adults at risk of losing SNAP benefits, according to the Center on Budget and Policy Priorities. Similar to Medicaid work requirements, those for SNAP may lead to a reduction in program participation without a corresponding rise in employment.
Restrictions on Healthcare for Immigrants
The bill stipulates that the federal government will penalize states that utilize their own funds to provide Medicaid services to immigrants who lack legal status or to offer subsidies to assist them in purchasing health insurance. In states that extend coverage to children, federal funding for the Medicaid expansion population (typically low-income adults) would decrease from 90% to 80%.
Potential Impact on States
- States may reduce Medicaid coverage to avoid federal penalties.
- KFF indicates this provision could affect 14 states and Washington, D.C., that currently cover children regardless of immigration status.
- California’s governor recently announced plans to freeze new enrollments in state-funded healthcare for immigrants without legal status as a cost-saving measure.
Planned Parenthood Funding Limitations
According to Planned Parenthood, denying them Medicaid funds could potentially lead to the closure of approximately one-third of their health centers, placing around 200 centers at risk, particularly in states where abortion remains legal. This could cut the number of Planned Parenthood centers in those states by about half. Although federal funds are already prohibited from covering abortion services, state Medicaid funds in certain states currently do so.
Concerns from Planned Parenthood
“We’re in a fight for survival — not just for Planned Parenthood, but for the ability of everyone to get high-quality, non-judgmental health care,” said Planned Parenthood President and CEO Alexis McGill Johnson.
Elimination of Gender-Affirming Care Coverage
The bill includes a provision to cease Medicaid coverage for gender-affirming care for individuals of all ages beginning in 2027, while this type of care includes puberty blockers, hormone therapy, and surgeries. It also prohibits requiring coverage of these treatments on insurance plans sold through Affordable Care Act exchanges.
Views on Gender-Affirming Care
An AP-NORC Center for Public Affairs Research poll indicated that roughly half of U.S. adults oppose government funding for this type of care for those 19 and older.