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A new hurdle for poor Americans, approved by the House, would cause millions to lose coverage, including many who are working but can’t meet reporting rules.
By Margot Sanger-Katz and Sarah Kliff
The reporters have covered Medicaid since before the program was expanded as part of the Affordable Care Act.
May 22, 2025Updated 11:23 a.m. ET
Among the spending cuts proposed in House Republicans’ “big, beautiful bill” is a policy they have sought to enact for a decade: a requirement that Medicaid recipients provide proof of employment as a condition of receiving health insurance.
Republicans have repeatedly tried and failed to enact such rules. They proposed laws that didn’t pass, and attempted state-level experiments that were blocked in court.
The work requirement in the bill that just passed the House represents the strictest version Republicans in Congress have ever put forward. The reporting requirements are more stringent than in previous bills. It would be easier to lose benefits, and harder to re-enroll. And it would apply to a larger set of Medicaid recipients, including Americans previously determined to be too old to need such requirements.
The legislation, which President Trump supports, still needs to pass the Senate, where Republican members are supportive of work requirements but where a few have expressed reservations about large Medicaid cuts.
Republican leadership has described the policy as combating “waste, fraud, and abuse.” President Trump has said no one will lose health insurance under the legislation. But experts say it would leave millions uninsured.
While House Republicans fought fiercely among themselves over other Medicaid cuts, like dialing back funding for the Obamacare expansion, they have universally embraced work requirements. The policy is popular with the public, too: Recent polling finds that 60 percent of Americans and even 47 percent of Democrats support the idea.
