CW: Medical Treatment
Eli McCreary of Omaha, NE had been diagnosed with kidney cancer. One day, he received a call from the local hospital. They told him he was uninsured.
Confused, he called a helpline. He was told that he needed to have a job to keep his Medicaid coverage. “You’re required to do work to stay on,” McCreary said a representative told him. “And you haven’t fulfilled your work requirement.”
McCreary has a history of substance abuse. He also has diabetes and chronic obstructive pulmonary disease, or COPD. “I don’t understand what job I can get,” McCreary said. “I can’t walk. I can hardly breathe. I can’t move around. What job am I going to get?”
Unfortunately, McCreary is not alone. Around 20% of adults in Medicaid expansion states could lose their coverage due to new work requirements, according to a study published in JAMA Health Forum.
When talking about Medicaid work requirements, proponents often frame them as a matter of personal responsibility, but the data tell a different story. More than 66% of adults who receive Medicaid are already working.
For many people, unemployment is due to health conditions, disabilities, caregiving responsibilities, or other circumstances that make finding and maintaining work difficult. Even among people who do work, inconsistent schedules and fluctuating hours can put them at risk of losing coverage. A person may be employed one month and lose their job the next through no fault of their own.
Supporters of these policies argue that work requirements encourage employment and reduce government spending. Yet previous policies have found little evidence that these policies increase long-term employment. Instead, many people lose coverage because they struggle to navigate reporting systems, miss paperwork deadlines, or fail to meet complex administrative requirements.
Arkansas, one of the first states to implement Medicaid work requirements, shows how poorly Medicaid work requirements can be implemented. Data from the Arkansas Department of Human Services shows that over 62,000 people had to follow the new rules. By December 2018, more than 18,000 had lost their coverage.
Often, it wasn’t because they refused to work, but because they couldn’t meet or report the requirements. Losing coverage didn’t always mean someone was unemployed. In many cases, it meant they just couldn’t figure out how to navigate the system.
A study found that approximately 33% of those affected hadn’t even heard about the new requirements, and 44% weren’t sure if they applied. When people lose their health insurance due to confusion, it raises questions about how these programs are designed.
The consequences of losing Medicaid can be catastrophic. Without coverage, people may delay doctor visits, skip medications, postpone cancer screenings, or avoid seeking treatment altogether because of cost. Conditions that could have been managed early often become more serious and more expensive when care is delayed.
McCreary’s story shows why work requirements are ineffective. Work requirements tie coverage to employment, but life does not wait for someone to find a job. Cancer does not disappear because a person is uninsured. Diabetes does not become easier to manage. COPD does not stop making it difficult to breathe.
Health insurance should not be a reward for having a job. Medicaid is supposed to help ensure that low-income Americans have access to medical care when they need it most. Policies that strip coverage from people who are sick, disabled, or struggling with employment undermine that mission rather than strengthen it.
As lawmakers continue debating the future of Medicaid, they should remember people like McCreary. Many people are dealing with illnesses. Others are just trying to make it through the day. Many Medicaid beneficiaries are working. Medicaid work requirements are not a solution. They are just another barrier for millions of people who need health coverage.
Sources:
Froelich, Jacqueline. “In Arkansas, Thousands of People Have Lost Medicaid Coverage over New Work Rule.” 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.
Pradhan, Rachana. “Nebraska Rushed Medicaid Work Rules. Then a Cancer Patient Was Told He’d Lost Coverage.” KFF Health News, 10 Nov. 2026, https://kffhealthnews.org/medicaid/medicaid-work-requirements-lost-coverage-nebraska-early-rollout/.
Shafer, Paul R., et al. “Medicaid Work-Reporting Requirements Under HR 1 and Insufficient or Inconsistent Work Hours.” JAMA Health Forum, vol. 7, no. 8, 2026, p. e262938. JAMA Network, https://doi.org/10.1001/jamahealthforum.2026.2938.
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.