House Republicans are pushing to add work requirements for a sizable chunk of Medicaid recipients, a move that could strip health coverage from hundreds of thousands of low-income New Yorkers. But with the potential changes set to happen in 2029 – after two Congressional elections and a Presidential one – some observers think there’s a good chance Democrats’ worst-case scenario might never happen.
House Republicans included a requirement that the roughly 23 million adults aged 19 to 64 years old made eligible for Medicaid under the Affordable Care Act expansion must work or seek work to be covered under the government insurance plan for poor residents.
But conventional wisdom says the path for Republicans to maintain their governing trifecta in Washington over the next four years is exceedingly slim and America’s political landscape is likely to shift before the measure would take effect.
“Neither are they making anybody work for their benefits nor are they gutting a program. It’s not going to happen,” said Bill Hammond, a senior health policy fellow at the conservative think tank Empire Center, of what he sees as the most likely political scenario.
The far-off enforcement date has raised the hackles of conservative hardliners, who want to see the cuts take place sooner, one of several sticking points that have divided Republicans in Congress. The intra-party factions that have emerged between some blue- and red-state Republicans have threatened to upend the reconciliation bill, which would cut approximately $715 billion in health spending, mostly from Medicaid.
Speaker Mike Johnson told reporters this week that the effective date could be moved up in exchange for raising the state and local tax deduction cap, a measure sought by Republicans in higher-tax states like New York.
The state Department of Health estimates that, of the 3.7 million working-age adults on Medicaid in New York, between 2.2 and 2.6 million would be exempt from work requirements, according to figures reported by Newsday in May, shortly before the reconciliation bill was introduced. Of the remaining 1.1 to 1.5 million, about half are estimated to be employed or seeking a job; the rest could be impacted by the new restriction. A separate report from the Urban Institute and Robert Wood Johnson Foundation found that number to be as high as 1 million New Yorkers, based on an analysis of Medicaid enrollment data and outcomes in two states that have adopted similar measures.
