Previous Medicaid coverage losses related to ‘unwinding’ shed light on what to expect from future cuts
Medicaid “unwinding” in 2023—the process of ending federal restrictions on kicking people out of the public health insurance program during the pandemic—created administrative hurdles for individuals that could have contributed to 25 million people losing coverage. Now, other changes to Medicaid under President Trump’s One Big Beautiful Bill Act (OBBBA) could lead to millions more losing coverage, according to experts at Harvard T.H. Chan School of Public Health.
Under the OBBBA, Medicaid recipients across the nation will be required to document proof of employment—or reasons that they should be exempted from work—starting in January 2027.
“Policy debates regarding Medicaid rarely focus on the technicalities of how people get coverage and stay enrolled. Yet, these administrative processes are central to recent changes to Medicaid under OBBBA and, in fact, underpin the expected coverage losses responsible for the law’s projected savings,” wrote Adrianna McIntyre, assistant professor of health policy and politics, research assistant Jinwoo Kim, and Benjamin Sommers, Huntley Quelch Professor of Health Care Economics, in a Sept 4. JAMA Health Forum article. The article noted that, according to an estimate from the Congressional Budget Office, the OBBBA could lead to a reduction of about 10 million people from Medicaid by 2030, with 7.6 million projected to become uninsured.
McIntyre and Sommers—along with former research assistant Molly Morein, Kim, and Jose Figueroa, associate professor of health policy and management—also co-authored an Oct. 10 study in JAMA Health Forum that showed how Medicaid enrollment losses during unwinding varied substantially across states and demographic groups. The authors suggested that such variation “may inform expectations about pending Medicaid reforms.”
Sommers was also quoted in recent media articles about lessons that can be learned from the negative impacts of Medicaid work requirements in Georgia.
In a Sept. 29 NBC News story, Sommers said that Georgia’s work requirement—put in place at the same time the state expanded Medicaid in 2023—created paperwork challenges that prevented people from getting coverage who might have otherwise qualified. “Instead of taking Medicaid away or denying it to someone … because they’re having trouble checking all the right boxes, we ought to be using coverage as a way of helping people get healthy and improve themselves,” Sommers told NBC.
“There’s a real fear that what we saw in Georgia is going to be the same that plays out nationally,” he added.
In a Sept. 30 New York Times article, Sommers commented on a new study that found that linking proof of work to Medicaid coverage did not improve employment levels in Georgia, and that Medicaid coverage decreased after the requirement was put in place. Sommers, who was not involved with the study, said that most working-age adults on Medicaid are already employed or have work exemptions, but the involved process of providing proof may have prevented people from signing up for Medicaid in the first place.
Another study co-authored by Sommers was featured in an Oct. 9 ABC article. Published as a research letter in JAMA, the study found that emergency Medicaid for undocumented immigrants accounted for only 0.4% of total Medicaid spending in 2022, and concluded that cutting it as proposed in the OBBBA would save little while harming states with large populations of undocumented immigrants.
Read the JAMA Health Forum article: New Medicaid Enrollment Barriers and Lessons From Unwinding
Read the JAMA Health Forum study: US Coverage Changes During Medicaid Unwinding in 2023
Watch the NBC News story: New Medicaid work rules could strip coverage from millions of Americans
Read the New York Times article: Medicaid Work Requirements Don’t Boost Employment, Study Shows
Read the ABC article: Emergency Medicaid for undocumented immigrants accounts for less than 1% of state spending: Study
