Lori Kelly’s Struggles with Work and Health Coverage
Lori Kelly, a 59-year-old resident of Harrisburg, North Carolina, faces challenges finding stable employment due to her declining eyesight. Last year, she had to shut down her nonprofit circus arts school because she couldn’t manage the paperwork. After that, she picked up a few hours making dough at a pizza place and now mostly separates recyclables at local concert venues, which doesn’t provide a steady income throughout the year.
“This place knows me and loves me,” Kelly remarked about her current job. “There’s no need to explain why I can’t read.”
Living in a camper and surviving on less than $10,000 annually, Kelly relies on Medicaid for her arthritis treatment, anxiety medication, and managing high blood pressure. Yet, she’s anxious about potentially losing this coverage soon. Starting next year, many like Kelly will face new requirements, needing to work, volunteer, or engage in qualifying activities for at least 80 hours each month.
“I’m scared right now,” she admitted.
Prior to the recent changes, Republican lawmakers suggested that some young unemployed individuals were exploiting a health insurance program designed for low-income and disabled individuals. They insisted that Medicaid shouldn’t be for “a 29-year-old man sitting on the couch playing video games,” as stated by House Chairman Mike Johnson.
However, Jennifer Tolbert, an associate director at KFF, pointed out that adults aged 50 to 64, particularly women, are going to be heavily impacted by these new rules. She explained that many find job requirements pose significant barriers to maintaining their coverage, which could jeopardize their health and financial stability.
Beginning in January 2027, about 20 million low-income Americans in 42 states and Washington, D.C., will have to meet activity requirements to keep their Medicaid health insurance. States like Alabama, Florida, and Texas won’t enforce these work rules since they haven’t expanded their Medicaid programs as per the Affordable Care Act.
The Congressional Budget Office estimates that these work requirements may reduce Medicaid enrollment by at least 5 million over the next decade. Critics argue that this labor rule is part of a budget law that sacrifices health coverage in favor of tax cuts benefiting wealthy individuals.
“We’re talking about saving money at the expense of people’s lives,” commented Jane Tavares, a researcher at the University of Massachusetts Boston, describing these work requirements as merely a means to this end.
Andrew Nixon, a spokesperson for the Department of Health and Human Services, stated that mandating work for “able-bodied adults” would help ensure Medicaid’s long-term sustainability, while maintaining coverage for vulnerable groups such as caregivers and those facing medical hardships.
According to a report, Medicaid expansion has provided essential assistance to middle-aged adults who struggle to obtain insurance. Research shows that one in five Americans aged 50 to 64 rely on Medicaid before they qualify for Medicare at age 65.
Kelly and others in her age group often have difficulty maintaining their coverage and require more healthcare services compared to younger individuals, noted Tolbert. Many women in this demographic might struggle to work the necessary hours due to family caregiving duties or health issues.
Interestingly, eight percent of the overall Medicaid population is classified as “able-bodied” and not participating in the workforce, mostly comprising women who have become caregivers due to poverty. A quarter of this group is over 50.
Despite these challenges, Tolbert stressed that unfortunately, those dealing with untreated health issues might find it even harder to work, and chronic conditions will still need management regardless of coverage. Often, adults face health complications before hitting the Medicare age.
Experts warn that if individuals lack the means to address their health issues before aging into Medicare, many may encounter worsening conditions that could incur higher costs for the program later on.
Many adults in their 50s and early 60s aren’t working because they are busy caring for children or elderly family members, a situation referred to as the “sandwich generation.” Although the Republican budget law allows for some exceptions to the work rules for caregivers, the criteria are quite narrow. Nicole Jolwick from Caring Across Generations expressed concern that those deserving exemptions might be overlooked.
Paula Wallace, a 63-year-old from Chidester, Arkansas, shared her experience of working for most of her life while now dedicating her time to helping her husband manage severe health issues. While she recently gained Medicaid coverage due to state expansion, the new work requirements are causing her confusion as to how she can comply while being his sole caregiver.
Though her husband receives Social Security Disability Insurance, the federal government has yet to clarify what it means to be exempt from work rules, given her caregiving role. Past experiences in Arkansas and Georgia have shown that many people find navigating the benefits system overwhelming.
“I’m very concerned,” Wallace expressed.
