CW: Poverty
When Desoto Regional Health System borrowed $36 million last year to restore a rural hospital that opened in 1952, officials expected Medicaid, a combined federal-state health program for low-income individuals and the disabled, to stay stable. However, those funds are now in peril as President Trump and the Republican-controlled Congress seek to reduce the over $900 billion health-care program that covers more than one in every five Americans.
Desoto CEO Todd Eppler stated that Medicaid cuts could make it more difficult for his hospital to repay loans and provide treatment to patients. “I just hope that the people who are making these decisions have thought deeply about it and have some context of the real-world implications,” he said, “because it’s going to affect us as a hospital and going to affect our patients.”
One of the decision-makers is Eppler’s congressional representative, House Speaker Mike Johnson, who resides around 35 miles north of here. He said he thinks the Republican leader and his team appreciate the hospital’s position. The mother of Johnson’s chief of staff is the chief executive officer of a rural hospital in the region. “I’ve never met a congressman yet that wanted a rural hospital in their district to close, and certainly Mike is no exception to that rule,” Eppler said.
According to KFF, the health information organizations that publishes KFF Health News, about 290,000 people in Johnson’s district were registered in Medicaid last year, accounting for approximately 38% of the entire population. About 118,000 people are enrolled in the program as a result of the Affordable Care Act, which allows states such as Louisiana to expand Medicaid to cover low-income adults, many of whom work in low-wage jobs without health insurance.
Louisiana ranks second in Medicaid enrollment, at nearly 32%, reflecting the state’s high poverty rate. As Republicans consider cuts, their decisions might have far-reaching effects for their constituents here. Four of the eight Republican-controlled House districts with the highest number of Medicaid enrollment as a result of the expansion are in Louisiana.
Johnson’s predominantly rural district ranks sixth in terms of expansion enrollments. Chloe Stovall, 23, works in the produce section of the SuperValu grocery store in Vivian, Louisiana. She says that her weekly take-home pay while working full-time is $200. She does not have a car and walks a mile to work. The company offers health insurance, but she says she will not be eligible until she has worked there for a full year — and even then, it will cost more than Medicaid, which is free. “I’m just barely surviving,” she said.
Johnson pushed a budget agreement through the House in February that calls for removing at least $880 billion from a pool of money that includes Medicaid over the next decade to help for an extension of President Trump’s tax cuts and border goals. Republicans in Congress are now debating where to cut, and Medicaid is going to suffer significant cuts. In defense of his plan, Johnson said that Medicaid is “not for 29-year-old males sitting on their couches playing video games.”
According to Stovall, nearly everybody she knows who receives Medicaid works at least one job. Data shows that this is the case as well. According to KFF, 64 percent of beneficiaries under 65 who are not receiving disability benefits and are not covered by Medicare worked full- or part-time in 2023.
Nearly 30% of those who are unemployed say they are not working because of caregiving responsibilities, school attendance, or an illness or disability All of these circumstances qualified as exemptions under previous work requirement laws.
Only 8% said they were retired, unable to find work, or not working for other reasons. Nonetheless, many Medicaid beneficiaries would be at risk of losing coverage if a work requirement is implemented due to the administrative burden of reporting their working status.
Republicans on Capitol Hill are looking for ways to pay for tax cuts achieved during President-Elect Trump’s first term in office. Medicaid, which is paid for jointly by the federal government and the states, is on their radar. Requiring states to create Medicaid work requirements, as many Republicans advocate, would reduce federal spending by an estimated $109 billion over a decade, according to the Congressional Budget Office.
This is because the cost of approximately 900,000 people would be covered totally by states. Unfortunately, another 600,000 people would become uninsured, according to CBO estimates. Approximately 72.4 million people nationwide are on Medicaid.
Supporters argue that requiring Medicaid participants to work, study, or prepare for a career helps them achieve self-sufficiency and financial security. Kristi Putnam, secretary of the Arkansas Department of Human Services, said in a statement announcing her state’s most recent request that it would encourage people to “embrace economic opportunities that can lead to true job advancement.”
Critics argue that such rules end up hurting far more people than they help. In a 2020 study examining how Arkansas work requirements played out, researchers from the Harvard T.H. Chan School of Public Health “found no evidence that the policy succeeded in its stated goal of promoting work, instead finding substantial evidence of harm to health care coverage and access.”
More than 95% of the Arkansas beneficiaries surveyed by the researchers had already completed the employment requirement or should have been eligible for an exemption. The researchers discovered that the biggest reason people lost coverage was that they were unable to confirm if they were following the guidelines correctly. Many people who lost their insurance stopped taking their medications, postponed treatment, and went into debt.
Additionally, past data has shown that work requirements are not successful. According to the state Department of Human Services, in Arkansas there were 265,223 Arkansas Works enrollees, with more than 62,000 of them affected by new work requirements. More than 18,000 people had lost Medicaid coverage by December 2018, because they did not meet the qualifying requirements.
Medicaid provides essential services to millions of people in this country. For many, it’s their only health insurance. Cuts to Medicaid coverage would mean their lives would change in an instant.
Cervantes, Sammy, et al. “Understanding the Intersection of Medicaid and Work: An Update.” KFF, KFF, 4 Feb. 2025, http://www.kff.org/medicaid/issue-brief/understanding-the-intersection-of-medicaid-and-work-an-update/.
Chatlani, Shalina. “Under Trump, Many States Might Pursue Medicaid Work Requirements .” Stateline, States Newsroom, 22 Nov. 2024, stateline.org/2024/11/22/under-trump-many-states-might-pursue-medicaid-work-requirements/.
Froelich, Jacqueline. “In Arkansas, Thousands of People Have Lost Medicaid Coverage over New Work Rule.” NPR, NPR, 18 Feb. 2019, https://www.npr.org/sections/health-shots/2019/02/18/694504586/in-arkansas-thousands-of-people-have-lost-medicaid-coverage-over-new-work-rule.
Galewitz, Phil. “The House Speaker’s Eyeing Big Cuts to Medicaid. in His Louisiana District, It’s a Lifeline.” KFF Health News, KFF, 7 Apr. 2025, kffhealthnews.org/news/article/medicaid-cuts-gop-speaker-mike-johnson-louisiana-patients-hospitals/.
Sommers, Benjamin D., et al. ‘Medicaid Work Requirements In Arkansas: Two-Year Impacts On Coverage, Employment, And Affordability Of Care’. Health Affairs, vol. 39, no. 9, Health Affairs, Sept. 2020, pp. 1522–1530, https://doi.org/10.1377/hlthaff.2020.00538.