Trump’s Medicaid Work Requirements Will Rob 5-10 Million of Health Coverage
Medicaid work requirements are coming for millions of people’s health care. This is thanks to Trump’s Big, Ugly Bill, which mandates that states institute work requirements in order for patients to enroll or maintain health coverage under Medicaid. Work requirements are projected to strip 5-10 million people of health insurance in the coming years. And for no good reason, other than Republicans’ ideological opposition to government health care programs — and as a way to pay for Trump’s massive tax giveaway to the wealthy. (Although recently, Trump offered a little more context recently, saying the nation “can’t ‘afford’ Medicaid” anymore because of spending on “military protection” (AKA, his Iran War.)
The Big Ugly Bill — championed by wealthy GOP donors, tech bros, Big Pharma, and Big Oil — mandates that adults enrolled in Medicaid demonstrate that they are working, in school, or volunteering in order to obtain or maintain coverage. States are required to enforce these work requirements no later than January 1, 2027, though they have the option to implement them sooner. As of Friday May 1, Nebraska , will have the dubious distinction of becoming the first state to implement these new work requirements.
Save Medicaid rally in 2025, before Trump’s Big, Ugly Bill became law
Work requirements are incredibly gratuitous (and enforcing them can be costly). Seventy percent of Medicaid recipients already work or are in school. The others may not be able to work because of physical or mental disabilities, job discrimination, and other extenuating circumstances.
Let’s be clear: When Medicaid was enacted in 1965 as part of President Lyndon Johnson’s Great Society, there was no requirement that recipients work. Medicaid was designed to provide health coverage for vulnerable Americans who did not have employer-provided coverage. Full stop. It was enacted in tandem with Medicare, which also did not have any kind of work mandate.
LBJ believed that in a nation as prosperous as America, no one should be denied medical care because of their financial status. He didn’t mention anything about having to work for benefits.
We are one of the world’s only industrial nations that does not offer its residents universal health care. Nearly 80% of the world’s countries provide their residents some form of government-sponsored health care.
Meanwhile, some red states have decided that the federal minimum work requirement is too lenient. Indiana is leading that charge. Idaho has already followed Indiana’s lead, with the governor signing a stringent requirement into law on April 10. Similar efforts are gaining traction in Arizona, Missouri, and Kentucky.
If the aim is to promote employment, work requirements are failing spectacularly. They have not appreciably boosted employment in the states that have tried them (before the Big, Ugly Bill’s mandate). If, on the other hand, the objective of work requirements is to punish vulnerable people by stripping them of health coverage, it’s already promising to work splendidly.
“They (work requirements) haven’t worked in Arkansas which was the first state to experiment with them. The result was that 18,000 fewer people were on Medicaid. It’s obvious that when you’re sick and need health care — regardless of if you’re working — you need that access to health care. That’s why it makes no sense to tie work requirements to Medicaid.” – Anne Montgomery, NCPSSM senior health policy analyst
The data from Arkansas paints a clear picture. Many were booted off Medicaid not because they weren’t working, but because they couldn’t prove that they met the state’s work requirements. Doing so requires navigating a lot of bureaucratic red tape; many people give up or simply can’t complete the certification process. The new policy is even more unforgiving, as it reviews eligibility at both application and renewal, creating a cycle of exclusion that makes it increasingly difficult to enroll or maintain a spot in the program.
Older Medicaid patients could be hit hard by work requirements (Istock)
The risks are even higher for older workers who are not yet eligible for Medicaid – a group we refer to as “near seniors.”
“Those who are near elderly — older workers ages 50-64 — have never been subject to any kind of work requirement before. We are worried about this group in particular. They are being laid off at higher rates. There is an idea that we need to clear room for a younger, newer workforce.” – Anne Montgomery, NCPSSM senior health policy analyst
Most modern societies view health care as a right, not a privilege. Under Trump’s reign and Republican rule, the privileged are stripping health care from those who can least afford it.
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Learn more about this from Health Policy Expert Anne Montgomery HERE
Tommy Tuberville Thinks Your Social Security Benefits are a Scam
Last week, Sen. Tommy Tuberville (R-AL) showed a blatant disregard for 1.2 million of his constituents who depend on Social Security when he called the program a “scam” in a viral X post. The comment drew immediate backlash from seniors’ advocates, Democrats, and local media in his home state of Alabama.
@SenTuberville on X
Tuberville — who insists on being addressed by the moniker of “coach” from his days leading the Auburn University football team — has had an unremarkable tenure in the Senate, known mostly for partisan mud-slinging, hateful rhetoric, and sketchy financial practices. If we were to use coach-speak, a “highlight reel” from his time on Capitol Hill would include:
*Blocking hundreds of military appointments/promotions: Tuberville held up nearly 450 senior military promotions for roughly ten months in protest of a Pentagon policy reimbursing travel for service members seeking abortion‑related care. His blockade left key national‑security positions vacant and drew bipartisan criticism for undermining the armed forces.
*Repeated violations of the STOCK Act: He failed to timely disclose about 132 stock trades between 2021 and 2023, valuing roughly $1–3.5 million, including in companies with business before committees he sits on. Federal regulators fined him over a quarter‑million dollars for repeated violations of the law.
*Racially charged attacks on public officials: He publicly implied that New York City Mayor Zohran Mamdani bears responsibility for the 9/11 attacks.
Tuberville’s “scam” remark is part of a larger anti-Social Security narrative that the right has deployed for decades and is intensifying now — in hopes of undermining one of America’s most successful social insurance programs.
During a congressional hearing last month, GOP Senator Ron Johnson (R-WI) called Social Security a “forced retirement program.” He has also called Social Security a “Ponzi scheme,” placing him in the nefarious company of Senators Ted Cruz and Rand Paul, Elon Musk, and Donald Trump himself (in his 2000 book, The America We Deserve).
The libertarian Cato Institute’s Romina Boccia recently put her own spin on this, labeling Social Security a “legal Ponzi scheme” and arguing that the entire program must be “re-invented.” (We dismantled Boccia’s argument in a book review last year.)
The sharks are circling Social Security because of the projected shortfall in the program’s trust fund in the early 2030’s, which will result in an automatic benefit cut if Congress takes no action. We have repeatedly demanded that Congress take action. As our CEO Max Richtman told CBS News, “My takeaway from all of this is we don’t have much time to spare to address the shortfall.”
That doesn’t mean the program should be cut or radically transformed. We have endorsed legislation introduced by congressional Democrats to bring more revenue into the Social Security system by adjusting the payroll wage cap – so that the wealthy contribute their fair share.
Rep. John Larson (D-CT) and Sen. Sheldon Whitehouse (D-RI) are two of the Democrats who have introduced legislation to strengthen Social Security without cutting benefits
Unfortunately, the political right proposes to raise the retirement age, institute ‘means testing’ (which is antithetical to the concept of Social Security as an ‘earned benefit’), and gamble workers’ payroll contributions on Wall Street (privatization).
Meanwhile, the Trump administration seems to be abusing and misusing executive power to wreck the Social Security Administration, which delivers benefits to some 70 million Americans.
Just this week, the administration reportedly has closed at least 12 field offices in mostly rural areas – making it harder for seniors, people with disabilities, and families to access benefits in person.
There has been significant public backlash since the Trump regime began decimating the Social Security Administration (SSA), including DOGE’s copying and misusing Americans’ personal Social Security data. But the response from the right has been to continue trying to de-legitimize the entire program so that it can be cut and privatized — while Trump continues to sabotage it from within. Senator Elizabeth Warren’s “Social Security War Room” has just issued a new report documenting the impact of Trump administration recklessness at SSA, concluding that severe cutbacks at the agency are having a “catastrophic” effect on seniors and people with disabilities.
The Trump administration reportedly has shuttered at least 12 rural Social Security field offices around the U.S.
Despite Tuberville’s (and others’) rhetoric, Social Security is not a “scam.” It is a social insurance program paid for by workers in exchange for benefits that replace a portion of their income when they most need it — upon retirement, disability, or the death of a family breadwinner. Every year, Social Security keeps tens of millions of our most vulnerable citizens from slipping into poverty.
It is not perfect and has been strengthened over the years (as Congress did in 1983). But Social Security has been working for 90 years and remains overwhelmingly popular with the public. Sorry, Senator Tuberville: If Social Security were a scam, it surely would be the longest-running, most popular, universally beneficial, and victimless ‘scam’ ever.
(For more on actual scams, see: Trump University, Trump Steaks, Trump Sneakers, and TrumpRx.)
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Watch our documentary about Social Security’s 90-year history here.
Listen to our podcast with former Alabama Senator Doug Jones HERE.
Trump Throws Medicare, Medicaid Under The Bus for War in Iran
We always knew Trump wasn’t sincere about protecting Medicare and Medicaid. But he just betrayed his own lie by saying that the two programs – which provide 140 million people with health coverage – should NOT EXIST on the federal level. Why? Because defense should be the federal government’s only priority.
Trump didn’t run as a libertarian. But his (poorly worded) declaration would make the Cato Institute blush:
“It’s not possible for us to take care of… Medicare, Medicaid. They have to do it on a state basis. All these little scams… you have to let states take care of them. We have to take care of one thing: military protection.” – President Donald Trump, April 1, 2026
Trump clearly is using his undeclared war on Iran to justify cutting health care for older and lower income Americans. In other words: we apparently can afford $200 billion for a senseless war in the Middle East, but not for our country’s social safety net programs.
Trump’s remarks — specifically that these landmark programs can be solely administered at the state level — are ludicrous. (So what else is new?) Medicare is by definition a federal program available to all Americans equally. The states could not possibly run Medicare — let alone afford it.
As our senior health policy expert Anne Montgomery explains:
“Sending Medicare to the states is a terrible idea that will never happen. The program doesn’t work that way. It’s a federal guarantee that ensures seniors everywhere receive the same care and protections, no matter where they live.” -Anne Montgomery, NCPSSM
As for Medicaid, it already is a federal-state partnership. But Medicaid depends on the federal government for about 70% of its funding. The states are already scrambling to mitigate the damage from Trump’s “Big, Ugly Bill,” which cut nearly $1 trillion from Medicaid to fund a tax cut for the wealthy and big corporations.
Advocates worry that Trump and Congressional Republicans are laying the groundwork for another ugly bill using the same budget reconciliation process as last time.Anne Montgomery fears that such a bill would take a scalpel to even more critical health care funding:
“A second reconciliation bill would do a lot more damage — programs like Medicaid, SNAP, and possibly even Medicare are certainly at risk. What we’re seeing is a clear assault on the nation’s major health care programs.” – Anne Montgomery, NCPSSM
This all amounts to what Montgomery calls “a war on seniors and their earned benefits.” In 2024, a majority of voters 65+ backed Trump at the ballot box. Today, only 14 months after his inauguration, 57% of that group disapproves of his performance in office.
In the face of this, why should any senior (other than the wealthy) support Trump-aligned GOP candidates in the upcoming 2026 elections?
Trump and his minions claim that our crucial social insurance programs are rife with ‘fraud,’ in order to justify gutting them. But Montgomery, who previously worked at the Government Accountability Office (GAO) analyzing waste, fraud, and abuse, calls BS on that:
“If this administration were serious about fiscal responsibility, they’d target real cost drivers like defense spending — not vital health programs.” – Anne Montgomery, NCPSSM
After DOGE inflicted trauma and chaos on the Social Security Administration, a devastating Big, Ugly Bill, and exorbitant military misadventures, forgive us for observing that none of Trump’s real agenda feels very “America First.”
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Watch Anne Montgomery take apart TrumpRx here.
Listen to our podcast about how the Trump administration is mucking with traditional Medicare here.
Fortune Columnist Would Rather Cut Social Security Than Make Payroll Wage Cap More Fair
The right-wing barrage of anti-Social Security propaganda continues. In fact, we’re finding ourselves having to shoot down at least one misleading (or misguided) opinion piece every month. Today’s response was provoked by a recent column in Fortune: “Social Security has 6 years left. The fix that sounds cruelest may be the smartest.”
Let’s start with the headline. Social Security does not have six years left. The program will go on indefinitely as long as people are working and paying into the system. It’s accurate to say that Social Security’s trust fund reserves will become depleted in some six years — in the unlikely event that Congress takes no pre-emptive action.
The Fortune piece, written by business editor Nick Lichtenberg, leans on a new study by the Penn Wharton Budget Model (PWBM), and argues that aggressive benefit cuts — including raising the retirement age to 69 — are the best cure for Social Security’s financial ills.
Lichtenberg acknowledges that public opinion is strongly in favor of revenue side solutions like raising (or even scrapping) the payroll tax cap – so that the wealthy pay their fair share. He even goes as far to call benefit cuts “politically radioactive.” How silly of the public to prefer solutions that favor the average worker over the country’s financial elites!
Despite this, the author insists that “dynamic economic modeling” shows aggressive cuts will produce the most economic growth, as though the resulting gains will inevitably find their way back to seniors. This framing ignores the fact that Social Security contributes $2.6 trillion to the economy on an annual basis and supports over 12 million jobs.
The Wharton model that Lichtenberg loves contains five options, from tax‑heavy (Option A) to cuts‑heavy (Option E). Of those, Lichtenberg all but endorses Option E: No new taxes, deeper benefit‑formula reductions, and a Social Security full retirement age raised to 69.
Dan Adcock, Director of Government Relations and Policy at NCPSSM, says Option E is a non-starter for Social Security advocates:
“Option E is the worst. Raising the retirement age is a benefit cut, plain and simple. Not everyone is living longer, and it ignores the realities of people who retire early or work in physically demanding jobs. Claiming benefits at age 62 already means a 32 percent cut in benefits; raising the full retirement age to 69 would push that reduction up to nearly two‑thirds of a full benefit.” – Dan Adcock, NCPSSM
Dan Adcock, NCPSSM’s Director of Government Relations and Policy
The idea that everyone can simply “live longer and work longer” is a myth. Physical laborers exit the workforce earlier than their white collar counterparts. Some marginalized groups are experiencing declining age expectancies. Many people in their 60s already struggle to find or keep employment, thanks to layoffs and age discrimination.
In what might be the most laughable argument of the whole piece, Lichtenberg asserts that smaller Social Security checks will create an “incentive to save.”
That fairy tale only works if you assume most households can ramp up savings at will. In reality, only about a third of Americans are close to saving enough for retirement. The rest live paycheck to paycheck, grappling with the rising costs of housing, health care, and student debt.
Cutting Social Security benefits will not turn America into a nation of savers, and will certainly not reverse skyrocketing costs of living. Instead, it will push more seniors into poverty, which will deepen their reliance on SNAP, Medicaid, and other safety‑net programs.
“If Social Security benefits are gutted, it will only shift the burden onto other parts of government like SNAP and Medicaid, which means taxpayers will still be on the hook — just in a different, more damaging way.” – Dan Adcock, NCPSSM
Of course, Trump and the Republicans in Congress have already cut those safety net programs by more than $1 trillion.
Meanwhile, the Wharton study shows that slightly adjusting the payroll wage cap would preserve trust fund surpluses until 2058! But Lichtenberg dismisses this as the “wrong” move, arguing that Option A does not deliver as much ‘economic growth’ as deep cuts. (Again, cutting benefits would diminish the stimulus effect of Social Security on the economy at large.)
Democratic lawmakers (including Senator Sheldon Whitehouse and Congressman Brendan Boyle, Senator Elizabeth Warren, Representative John Larson, and others) already have proposed lifting the payroll wage cap to bring more revenue into the system – without cutting benefits. Senator Bernie Sanders (I-VT) and Representative John Larson (D-CT), for example, have both offered bills that would apply the payroll tax to all wages above $400,000.
Senator Sheldon Whitehouse (D-RI) has a bill to adjust the Social Security payroll wage cap
The Fortune piece dismisses Option A as politically expedient but economically wrong. But it is morally wrong – or, to borrow from the title of the Fortune piece, downright cruel – to cut the benefits of seniors on fixed incomes in order to spare the wealthy from contributing their fair share.
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Read our CEO Max Richtman’s recent Letter to the Editor of the Washington Post HERE.
Listen to our podcast HERE
Medicare Advantage Is Costing Traditional Medicare Patients Even More Money
It’s more than a little ironic that the for-profit Medicare Advantage program – which was supposed to save taxpayers’ money – is actually increasing costs for people in traditional Medicare. Congressional investigators blame this year’s spike in Medicare Part B premiums on Medicare Advantage overbilling the government by billions of dollars.
Fresh reporting from the Wall Street Journal (WSJ) details how those overpayments translated into an estimated $13.4 billion in Part B premium costs in 2025 alone. In other words, every person with traditional Medicare Part B medical insurance is effectively subsidizing excess payments to private insurers. This revelation is only the latest in a series of Medicare Advantage scandals.
Once a darling of conservatives who championed a privatized version of Medicare, MA now faces bipartisan scrutiny. The Joint Economic Committee affirmed that MA insurers are bilking the government using a practice known as “systemic upcoding.” This sketchy and misleading tactic involves exaggerating patients’ diagnoses so that insurers can bill for higher payments. 
We have been sounding the alarm on upcoding for years. Our senior health policy expert, Anne Montgomery, laid out how insurers go about it in a 2023 edition of our “You Earned This” podcast:
“Medicare Advantage plans encourage providers to find every chronic condition and billable diagnosis for each enrollee — far more aggressively than doctors do in traditional Medicare. This upcoding lets them extract higher payments from the government per patient, adding up to massive overpayments.” – Anne Montgomery, NCPSSM
MA’s shady practices extend beyond overbilling. Older TV viewers would be hard-pressed to go 30 minutes without being bombarded by relentless Medicare Advantage ads. These misleading ads have featured mainstays of mid-20th century culture, including Joe Namath, William Shatner, and Jimmy Walker, extolling the ‘benefits’ of Medicare “Part C” (as MA is officially known).
Historically, these TV ads have conflated Medicare Advantage with traditional Medicare, so that viewers may not even know that the traditional version still is an option. They promise low-to-no premiums and extra goodies like gym memberships and free rides to the doctor, without disclosing that MA is like an HMO with limited networks of doctors, onerous ‘prior authorizations’ for care, and hidden out-of-pocket costs.
The Biden administration began cracking down on MA insurers, issuing rules demanding greater transparency and accuracy in advertising. More recently, Reps. Mark Pocan (D-WI), Ro Khanna (D-CA), and Jan Schakowsky (D-IL) re-introduced the “Save Medicare Act,” with similar aims.
“Private, so-called ‘Medicare’ plans run by private insurers undermine traditional Medicare and create confusion. They often leave patients without the benefits they need while overcharging the federal government for corporate profit. This bill makes clear what is – and what is not – Medicare, and ensures this essential program will continue to serve seniors and other Americans for generations to come.” – Rep. Mark Pocan, 3/4/2026
As John Oliver said in his 33 minute takedown of MA last fall: “Honestly, it probably shouldn’t have the word Medicare anywhere near it, because it’s misleading. It’s kind of like the mountain chicken. Picture what a mountain chicken looks like in your head right now. You’re wrong, because it’s this. It’s a ****ing frog!”
While scrutiny intensifies, Medicare Advantage is capturing a growing share of market enrollment, even as Centers for Medicare and Medicaid Services (CMS) proposes stricter guardrails. With overpayments estimated at $76 billion this year alone and major insurers subject to federal investigation, Medicare Advantage faces mounting pressure from both parties to begin putting patients ahead of profits.
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Listen to our podcast episode on Medicare Advantage with NCPSSM senior health policy expert Anne Montgomery HERE