Welcome to The Poverty Trap, a newsletter and podcast for people who are fed up with the inequality baked into America’s system and want to individually and collectively make change. Thinking about subscribing? Here’s what one “founding member” subscriber recently had to say about The Poverty Trap: “You do great work, Joan. I don’t always get to read your newsletter, but when I do, I leave more informed and more compassionate…” Amy B. For the first time in the history of the Medicaid program, the federal government is requiring able-bodied adults ages 19-64 to work or volunteer 80 hours a month, unless applicants meet certain medical exemptions. This “community engagement” requirement was part of the so-called “One Big Beautiful Bill Act (OBBBA) passed by the Republican majority last July 4th, and is the first time the federal government has tied health care for the poor and disabled to work requirements. The Congressional Office of Budget and Management, a non-partisan agency that provides Congress with independent budget analyses, estimates that 11.8 million people will lose Medicaid coverage due to the OBBBA ( H.R. 1) in the next 10 years. 4.8 million of those will be due to the implementation of work requirements. Meanwhile, the Trump Administration and its talking heads continue to spin the separation of millions of Americans from their health insurance as a good thing. Dr. Mehmet Oz, Administrator of Medicare and Medicaid Services (part of the Department of Health and Human Services), called the novel work requirements “a path to prosperity”. Watch the full PBS Newshour clip below, and see what you think. But here is another snippet where Dr. Oz stereotypes millions of Americans who have already gone through the rigorous process to qualify for Medicaid: “If you’re sitting at home, which is true for the millions of people who are able-bodied on Medicaid, on average you’re spending 6.1 hours watching television or just hanging around,” he [Dr. Mehmet Oz] said, appearing to cite an American Enterprise Institute analysis that may not accurately reflect how nonworking Medicaid recipients with [out] disabilities spend their time, KFF found. And Republican pundit, Scott Jennings, weighed in on the poor in a statement from “CNN NewsNight with Abby Phillip”, July 1 [2025], shortly before Congress passed the OBBBA: “Almost 5 million able-bodied Medicaid recipients ‘simply choose not to work’ and ‘spend six hours a day socializing and watching television.” Oh, really? Here’s how a Kaiser Family Foundation analysis rated Mr. Jennings’ statement describing 5 million Medicaid recipients as “choosing not to work” : The Keiser Family Foundation, other fact checkers and I beg to differ with your claims, Dr. Oz and Trump Administration talking heads. And I don’t think you believe these lies either. If you make so little money that you qualify to receive Medicaid in any state ($0 — $1,732/month for a single person), you spend a major portion of each day applying for full-time jobs with health care, not watching TV or playing video games. You are frantically searching and applying for jobs because you cannot exist on zero income, or the top monthly allowable amount of about $1,700 bucks, even if you have applied for and received every social program available. No one wants to live like this! Although rents have declined slightly since their pandemic peak, median rent these days is still $1,548/month for a one bedroom and $1,844/month for a two bedroom apartment. So if you want to keep a roof over your head and maybe pay utility bills, eating will be difficult unless you also apply for SNAP or earn some amount of money. By the way, not everyone has a living parent or grandparent into adulthood, let alone one of their couches to lie around on all day watching TV and otherwise “socializing”. I know from experience that it borders on tortuous to apply for, qualify for and then actually receive government help of any kind because in practice, it is not a straightforward, linear process. Here’s an example: You usually are required to have an in-person or phone appointment to file an application for Medicaid, SNAP or other programs that lend a hand when you’re not earning enough money or don’t have family support. The appointments are often scheduled for the distant future, and you are told to bring a list of items, like a photo ID, utility bills addressed to you, Social Security card, etc. The person telling you what documentation is required to complete the appointment and application always leaves out one or more items, so you must supplement your initial application after the interview. Invariably, items are lost or never received…and the agency doesn’t bother to tell you they still are missing a necessary item, so your application sits in limbo while you assume it is complete, and spend weeks waiting for notice it has been approved. This exact scenario happened to me several times during the yearly application process for Medicaid, SNAP and home heating and cooling assistance, in addition to an application for unemployment benefits. And this garbled process is before the new work requirements ushered in more paperwork and burdened state agencies with overhauling their systems. The 41 states, including D.C., that have expanded Medicaid to the population between the ages of 19—64 years old have been working with the Centers for Medicare and Medicaid Services (CMS) for nearly a year, revamping their computer systems to handle these new requirements—it’s not just the additional paperwork to prove applicants are working the required number of hours, now applicants have to re-certify their eligibility every six months, not once a year. But now there is an additional documentation requirement: The states were surprised when a little over a week ago on June 1, The Department of Health and Human Services’ CMS issued an interim final rule (with a 60 day comment period ending July 31) that requires applicants to submit another layer of proof that they are indeed “medically frail or otherwise have special medical needs”, and so are exempt from the work requirements. States may continue to accept a self-declaration or access the applicants’ medical records from other information it already has on file through 2027, the first year the Medicaid work requirements are in place. But starting in 2028, the new rule requires the applicant to prove, presumably with additional medical documentation: …that their condition “significantly impairs” their ability to perform the 80-hours of required monthly work activities. According to American Medical Association commentary, the OBBBA and long-standing medical policy, Medicaid eligibility requirements already exempt the following five categories of applicants as “medically frail”: Individuals with substance use disorders; Individuals with disabling mental disorders; Individuals with significant physical, intellectual, or developmental disabilities that impair activities of daily living; Individuals with serious or complex medical conditions; or Individuals who are blind or who otherwise meet the Social Security Act disability standard. Now the applicant, even if declared disabled by the Social Security Administration or is being treated for cancer, for example, must prove they are “significantly impaired” from their already exempted condition, such that they cannot comply with the new work requirements. Two professors at the Harvard T.H. Chan School of Public Health, Adrianna McIntyre and Benjamin Sommers recently commented on this new rule “overlay” published by the Trump Administration: What the rule says is that the disease needs to be actively interfering with your ability to work. So people with early-stage cancer who are in radiation treatment but still have the capacity to work or people who have HIV but can still technically work are not exempted.” “This is where we’ll see large and harmful coverage losses,” said [Dr. Ben] Sommers, Huntley Quelch Professor of Health Care Economics, in a June 3 STAT article. “This is a population that has high medical needs and is at major risk for harm if they lose coverage. That is the headline implication of the new rule.” If you would like additional information on the Medicaid work requirements and the June 1 rule interpretation, a Boston-based law firm provides a thorough and understandable analysis of the new rule, and its impact on current Medicaid recipients, new applicants and the states. __________________________ I’d love to hear what you think of the new work requirements required for the poor to get health insurance, and the additional reporting requirements and paperwork required to prove you are indeed sick enough to not have to work for 20 hours per week just to have insurance coverage. And let me throw another question out there: Is this the Republican retaliation for their inability to repeal the popular Affordable Care Act, which expanded Medicaid coverage? And…if you could re-stack, Like and Share this post with reckless abandon, I sure would appreciate it! The Poverty Trap is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to The Poverty Trap at povertytrap.substack.com/subscribe
