Article Summary –
The Urban Institute’s report highlights that millions of Americans could lose Medicaid coverage due to changes in eligibility requirements and new work mandates introduced by President Trump’s budget law, H.R. 1, also known as the One Big Beautiful Bill Act. Specific concerns arise in Wisconsin, where around 63,000 people may be at risk of losing coverage, and individuals like Barbara Lockington, who is disabled, express fears of being unable to meet new requirements, potentially leading to increased personal financial burdens. The law’s work requirements, set to affect those aged 19-64 starting in 2027, could extend to an estimated 18.5 million people nationwide, causing further strain on the healthcare system as many might forgo necessary care due to unaffordable insurance options.
A new report from the Urban Institute indicates millions of Americans reliant on Medicaid could lose benefits due to eligibility changes in President Donald Trump’s latest budget law.
Trump signed H.R. 1, or the One Big Beautiful Bill Act, into law in July 2025, demanding states perform bi-annual eligibility reviews and enforce new Medicaid work requirements.
The Urban Institute predicts these requirements might cause a coverage loss for 4.9-10.1 million individuals by 2028.
According to the Wisconsin Department of Health Services’ ForwardHealth portal, 1.2 million people in Wisconsin use Medicaid. An analysis before the bill’s signing suggested around 63,000 Wisconsinites might lose coverage, largely due to new work mandates.
Barbara Lockington from Holman, Wisconsin, is disabled, receiving Social Security Disability Income via Medicaid, based on income specifics in Wisconsin. SSDI is available to those with severe long-term disabilities.
Fifty-year-old Lockington, who has metabolic dysfunction-associated steatohepatitis, fears losing coverage due to inability to meet work requirements.
Lockington said, “I cannot fulfill work requirements physically. The fear with this Big Beautiful Bill is real.” She already owes $500 to a local hospital due to uncovered copays.
“I’ll have to reduce my electricity bill to pay them, and skip part of the hospital payment next month — it’s about robbing Peter to pay Paul,” Lockington said.
Lockington feels being on Social Security Disability Insurance, Medicare, and Medicaid can be degrading. Formerly a phlebotomist for nearly 20 years, she expressed anxiety over potential loss of coverage.
The Commonwealth Fund highlights that work requirements apply to those aged 19-64 in expanded Medicaid programs from Jan. 1, 2027. States must set systems for compliance. Recipients need to prove at least 80 hours per month of work or volunteer activities, with exceptions for those disabled, pregnant, or caring for young children. The Congressional Budget Office estimates these rules might affect 18.5 million nationally by 2034.
ForwardHealth projects 16% of Wisconsin enrollees will face work requirements or must prove exemption eligibility.
Christine Hyde, a nurse practitioner in Green Bay, notes many patients lack jobs offering health insurance or face high deductibles.
“Forcing patients off Medicaid to use employer insurance often incurs high costs, leading some to forgo coverage,” said Hyde. “Most on Medicaid are employed; work requirements might push them to go uninsured, straining the healthcare system.”
If able to speak to lawmakers, Lockington would say: “You’ve signed thousands of death warrants — people won’t afford doctors, medicines, or treatments like chemo or anti-rejection meds.”
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