Congressional Republicans’ efforts to slash federal spending by tying work requirements to Medicaid and SNAP would have far-reaching consequences for people with mental health issues, chronic health problems, and some people with disabilities if enacted, policy experts on anti-poverty programs say. 

They say the work requirements as laid out by House Speaker Kevin McCarthy’s “Limit, Save, Grow Act of 2023” — the Republican plan to raise the country’s debt ceiling —  would be devastating for many Americans and hard for states to implement, especially in the thick of the pandemic public health emergency ending. The bill narrowly passed the House in April, 217 to 211 with four Republicans joining Democrats in voting against it. If a deal isn’t reached, the U.S. will default on its debt as early as June 1.

Democrats have pushed back on the work requirements, but McCarthy has said they are non-negotiable. Reports that Biden is showing some flexibility on the issue have upset some Democrats. The House Freedom Caucus has also pushed for McCarthy to stop the discussions with the White House until the Senate passes the bill.

Ten million Medicaid expansion enrollees are at risk under the bill, according to the Center for Budget and Policy Priorities. The Health and Human Services Department estimated that 21 million people are vulnerable to the work reporting requirements. The Congressional Budget Office found that 1.5 million people would lose coverage and 600,000 would become uninsured. It’s possible that the CBO could be underestimating how many people would lose their coverage, some experts say. Although the requirements apply to every state, the CBPP explained in its analysis of the bill that “it would heavily impact people covered by the Affordable Care Act (ACA) Medicaid expansion.”

“People with mental health issues, people with substance use disorders, people with chronic health conditions and even forms of disability could be encompassed within the expansion population and would need to navigate an entirely new system that’s really not well-specified in the bill to get an exemption and we know that that sets up a massive coverage loss potential,” Allison Orris, senior fellow at the Center for Budget and Policy Priorities, told States Newsroom.

The bill includes work-reporting requirements for Medicaid that are even more severe than a 2018 Arkansas lawthat has since been blocked by the courts, said Edwin Park, a research professor at the Georgetown University McCourt School of Public Policy. Unlike other work requirement proposals, the bill would not exempt people during their pregnancy and into their postpartum period and there isn’t an automatic exemption for people receiving Supplemental Security Income because they have a disability or Social Security Disability Insurance. It would undercut gains made by Medicaid expansion because even people eligible could lose coverage because of the complexity of the “red tape” they would be forced to navigate, Park said. The unwinding of pandemic policies adds to the potential complications.

“You have all the coverage losses where some people are going to be inappropriately disenrolled, particularly for procedural reasons. They won’t return in the mail. They never got their renewal packet. … And then you have on top of that, this onerous work-reporting requirement with red tape and because states are so overwhelmed with unwinding over the next year or so, it’s hard to see how they could implement a work-reporting requirement that implements the exemptions,” he said.

Park added that House Republicans who characterize this provision of the bill, which requires recipients to work 80 hours per month, do community service or be involved in an employment program, as only affecting able-bodied adults without children is inaccurate.

“… Based on how this proposal has been designed, you know, it’s not targeted to that group at all,” he said.

He explained, “We know that many people who are disabled who are receiving disability benefits do work to a limited extent and they aren’t necessarily unfit for employment. There’s limits on how much they can work to maintain their benefits. But federal policy, up to this point, has been encouraging those with disabilities to work to increase their employment hours while being able to maintain their health coverage.”

Expanding SNAP work requirements

The SNAP work requirements are equally concerning to advocates. Currently 18- to 49-year-olds without children at home can only receive benefits for three months in any three-year-period unless they prove they’ve worked a 20-hour week. Under McCarthy’s bill, those work requirements would be expanded to include people up to age 55.

Craig Gundersen, an economics professor at Baylor University whose research focuses on food insecurity and food assistance, said it may look like that the work requirements are successful because cases will fall, but the reality will be different.

“What’s going to happen is if you impose work requirements you’re going to have an increase in food insecurity in our country,” he said.

He said the bill’s provision on SNAP doesn’t make sense.

“SNAP doesn’t discourage work. So why would you want to impose work requirements? The second thing is that SNAP is an anti-hunger program full stop,” he said. “That’s what it was designed to do. If that’s its main goal, why would we ever want to say to people that you have to work to get these benefits.”

Nine-hundred thousand people in the U.S. aged 50 to 55 are at risk of losing SNAP, according to CBPP.

The SNAP restrictions also make it harder for states to provide support for SNAP recipients dealing with unique circumstances that would exempt them from the three-month time limit to receive benefits. The number of exemptions states can use are currently tied to their caseloads and if they aren’t used, states can roll them over into the next year. McCarthy’s bill wouldn’t let states carry over unused exemptions.

​​Temporary Assistance for Needy Families (TANF) would also be affected by the stricter work requirements in the House debt ceiling legislation. Families subject to work requirements — 540,000 families — could potentially lose their cash benefits, the CBPP estimated, worsening child poverty.

Housing assistance, student loan forgiveness targeted

In addition to these effects on anti-poverty programs, many other services and benefits in housing and education would likely suffer from the huge cuts proposed in the bill. The CBPP’s analysis of this bill shows average cuts of 13% in 2024 even if cuts were evenly spread across discretionary programs.

The legislation would also kill Biden’s student loan forgiveness plans regardless of the outcome in the courts and nix student loan repayment plans that were designed to be more affordable for people with student debt. It would “likely eliminate Pell Grants altogether for 80,000 students,” according to the Department of Education.

“Here you are cutting one of the premier programs that serves low-income students who are trying to access this level of education, who have long been marginalized in the labor market,” said Katherine Gallagher Robbins, senior fellow at the National Partnership for Women & Families. “And what you’re saying to them is, ‘Oh, hey, by the way, we’re not even going to give you the support that will pay dividends for years to come in your own earnings.”

Department of Housing and Urban Development Secretary Marcia Fudge has estimated that nearly 1 million people could lose housing assistance and that nearly 120,000 people may be cut off from homelessness services.

“Stable housing is such an essential part of any family’s economic security,” Gallagher Robbins said. “ … The cuts that they’re talking about here …, you’re going to end up eliminating almost 300,000 families’ support for their housing. Not all of those families will end up being unhoused, but some of them will. It creates this downward spiral that is very challenging to recover from, especially as other benefits are cut …”

The ending of the pandemic public health emergency has already resulted in the loss of financial support for some families, and now with these potential cuts, the people who benefited most from the recovery would be hurt the most from this bill, Gallagher Robbins said.

“We’re already seeing things like less access to school lunch, less access to the child tax credit,” she said. “So families are already struggling with what that looks like and that has been mitigated to an extent, obviously not fully, by the current strength of the economy. Everything is up for grabs here, basically, in terms of harming families who are already absorbing this most recent kind of cut in support.”