From the day the government put Medicaid on the chopping block, I’ve warned that these cuts would have serious consequences for patients, hospitals, and the communities that depend on them.
As a retired orthopedic surgeon, I cared for patients in rural Michigan for more than 35 years, many of whom relied on Medicaid to afford treatment, access to full-time caregivers, and maintain their quality of life. Now, new work requirements are creating additional barriers that threaten access to care for some of our most vulnerable patients. This, combined with restrictions on state-directed payments, will put hospitals and health systems into financial distress from which they may not recover.
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Last summer, Congress passed the so-called One Big Beautiful Bill Act, or HR 1, which included approximately $1 trillion in Medicaid cuts over the next decade. The law also established strict eligibility provisions requiring many adults enrolled in Medicaid to verify at least 80 hours per month of employment, education, or volunteer service.
These cuts will be especially detrimental to the nearly 14 million adult Medicaid enrollees with a diagnosed physical health condition and the 75% of enrollees who have one or more chronic health conditions. Under the new law, patients are required to regularly update their work status and eligibility information every six months, increasing the risk that eligible individuals will lose coverage because of paperwork errors, reporting issues, or difficulty navigating complex administrative requirements. The Congressional Budget Office estimates that more than 5 million people will lose Medicaid coverage because of the provisions included in HR 1.
The Center for Medicare and Medicaid Services claims that new work requirements could help reduce poverty by encouraging workforce participation. However, we’ve already seen how this experiment ends. In 2018, Arkansas implemented Medicaid work requirements, and according to a study from the National Institutes of Health, the state saw no increase in employment. Instead, many residents lost coverage, with 50% reporting serious difficulties paying medical bills and 56% delaying care because of costs. States are also expected to shoulder significant administrative expenses to implement and enforce these new requirements, with some estimates placing those costs as high as $340 million.
The consequences extend far beyond the individuals who lose coverage. When patients become uninsured, they are more likely to delay care, skip medications, and postpone treatment until their conditions become more serious. Hospitals and health systems are still required to care for these patients regardless of their insurance status, meaning providers are left absorbing the costs. At the same time, HR 1 places new limits on state-directed payments, an important source of Medicaid funding that many states use to help sustain hospitals and providers by closing the gap between reimbursements and the actual cost of care. As more uninsured patients seek care, fewer resources are available to support the healthcare system that serves them. In fact, since HR 1’s passage, it’s been reported that 1,000 U.S. providers are at risk of facing layoffs and 440 hospitals are at risk of closure.
Health systems across the country, particularly rural and community hospitals, will face reduced revenue and rising uncompensated care costs if these laws are not addressed at the federal level. As a surgeon practicing in rural Michigan, I understood how thin the financial margins could be. Many rural hospitals operate as the sole source of care for entire communities. When those hospitals reduce services or close, as one recently did in my home state, patients lose access to emergency care, maternity services, specialty treatment, and often the healthcare professionals they trust most. With rural hospitals already facing rising healthcare costs, workforce shortages, and reimbursement challenges, Medicaid cuts risk creating even more healthcare deserts, forcing families to travel farther and wait longer for the care they need.
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Disease doesn’t go away, and it can’t be ignored. For the Medicaid patients I treated, access to care was often the difference between managing a chronic condition and watching it worsen, recovering from an injury and living with permanent limitations, or receiving timely treatment and delaying care until a crisis emerged. Many of these individuals are already working, caring for family members, managing disabilities, or navigating serious health challenges. They should not lose healthcare coverage because of a missed form, a reporting error, or a bureaucratic hurdle. Yet that is exactly what these new requirements risk doing.
A medical tsunami is approaching over the next two years as Medicaid begins to be stripped away from communities. Congress must act to stop these changes from taking full effect in 2027. Americans deserve better.
Dr. Fred Levin is a retired orthopedic surgeon and former medical director at Newaygo PACE in rural Michigan.
