As many as 356,000 Ohioans will lose health coverage under Trump spending law, new reports says

Medicaid work requirements that are part of the Trump/Republican One Big Beautiful Bill Act could cause 356,000 people in Ohio to lose their health care coverage, according to a new report, on top of about 113,000 who already have lost coverage after tax credits were allowed to expire.

The work requirements that are part of the Republican spending law claim to break the cycle of dependency. But in Ohio they will take health coverage away from huge numbers who are already employed, in school, or are caregivers, according to the analysis that was published last week.

In fact, it could take coverage away from a full half — or 356,000 — of those who get coverage under a 2014 expansion of Medicaid eligibility as part of the Affordable Care Act, said the report by Urban Institute with funding from the Robert Wood Johnson Foundation.

Nationally, between five and 10 million low-income Americans covered by their states’ Medicaid expansions will lose their insurance, it said.

The losses are in addition to at least 113,000 Ohioans who have already lost health coverage this year after Republicans allowed tax credits in Affordable Care Act marketplaces to expire. That number is sure to grow, and nearly half of those losing coverage work for or own small businesses.

The projected losses in Medicaid coverage stem from President Donald Trump’s One Big Beautiful Bill Act that Republicans passed last summer. It cut taxes on the richest 1% of Americans by $1 trillion over 10 years while cutting Medicaid by almost as much.

Work requirements and their related bureaucracy constitute a major tool driving those savings. They’re justified as a way to break the cycle of dependency on government handouts by getting the unemployed off their duffs and getting jobs.

But in practice, that hasn’t happened.

When Arkansas tried Medicaid work requirements in 2018, about 18,000 lost coverage in less than a year and the program had no impact on employment.

Even without work requirements, Medicaid beneficiaries say there’s a lot of red tape to maintain benefits, and some recipients say work requirements only increase it.

The new Urban Institute study modeled the new requirements, which take effect Jan. 1, to predict their impact on coverage.

It looked at the work requirements themselves and at the mandate that eligibility be redetermined every six months.

It looked at what those requirements will do to the Medicaid “expansion” population. 

It was created when the 2010 Affordable Care Act allowed states to expand Medicaid eligibility to people making up to 138% of federal poverty guidelines.

For a family of four, that’s less than $46,000 a year.

About 770,000 Ohioans are members of the expansion population. More than 21 million are part of it nationally, and a huge portion of them are about to be kicked out, according to the Urban Institute analysis.

“Combining the effects of six-month redeterminations and work requirements, we project that between 4.9 and 10.1 million fewer people will be enrolled in Medicaid expansion coverage in an average month in 2028 than under a scenario without either of these two policies, an enrollment decline of between 27% and 55% among those subject to work requirements,” it said.

The report modeled three scenarios: high, medium and low “mitigation.”

That means how helpful state Medicaid programs would be to people struggling with documentation to maintain their benefits.

The state Medicaid department will be facing a huge new administrative burden.

If it works extra hard to help people get and maintain their paperwork, an estimated 176,000 or a quarter of the expansion population will lose benefits, the report said. If it does just an average job, that number rises to 285,000 or 40%.

If the Medicaid department does a poor job helping clients, 356,000 — or half — of the expansion population will lose health coverage by 2028, the Urban Institute analysis said.

The new burdens were sold on putting people to work. But the overwhelming majority of the group losing benefits is already working or engaged in activities that make employment difficult or impossible.

“Most — 93.8% — (of people in the expansion population) were either employed, in school, taking care of family members, participating in an alcohol and drug treatment program, or dealing with intensive physical health or mental health illness (many had comorbid conditions),” the Ohio Department of Medicaid reported in a 2018 assessment.

Significantly, the assessment also found that employment among the expansion population had risen since 2016 — in the absence of work requirements.

That might suggest that without work requirements, Ohio’s Medicaid expansion is helping people get to work instead of helping them stay unemployed.

The Urban Institute report published last week also found that certain groups will be especially hard hit by the new red tape.

Coverage losses will happen not through any fault of many, but because of the administrative challenges the new requirements impose, it said.

One is a group that politicians claim they want to support — entrepreneurs. 

“Other subgroups face the prospect of even larger coverage losses if states cannot address gaps in available data,” the report said.

“Because self-employment income is particularly difficult for states to automatically verify, we estimate that between 30% and 73% of self-employed people subject to work requirements would lose Medicaid with high/low mitigation.” 

Another comprises sick people.

“Though states must provide exemptions for adults who are medically frail or have special medical needs, these exemptions may be difficult for states to verify using available data, or states may define them narrowly, excluding many enrollees and applicants with disabilities or serious health conditions,” the report said. 

Between 16% and 62% with a condition making them too ill to work will lose coverage, it said.

A third group that will be particularly hard hit are recipients between 50 and 64. An estimated 30% to 65% of them will lose coverage “mainly because they are less likely to be parents living with dependent children younger than age 13 and less likely to be automatically found to have satisfied the work requirement through employment,” the report said.

This story is republished from the Ohio Capital Journal. View the original article.