Lori Kelley鈥檚 deteriorating vision has made it hard for her to find steady work.
The 59-year-old, who lives in Harrisburg, North Carolina, closed her nonprofit circus arts school last year because she could no longer see well enough to complete paperwork. She then worked making dough at a pizza shop for a bit. Currently, she sorts recyclable materials, including cans and bottles, at a local concert venue. It is her main source of income 鈥 but the work isn鈥檛 year-round.
鈥淭his place knows me, and this place loves me,鈥 Kelley said of her employer. 鈥淚 don鈥檛 have to explain to this place why I can鈥檛 read.鈥
Kelley, who lives in a camper, survives on less than $10,000 a year. She says that鈥檚 possible, in part, because of her Medicaid health coverage, which pays for arthritis and anxiety medications and has enabled doctor visits to manage high blood pressure.
But she worries about losing that coverage next year, when rules take effect requiring millions of people like Kelley to work, volunteer, attend school, or perform other qualifying activities for at least 80 hours a month.
鈥淚鈥檓 scared right now,鈥 she said.
Before the coverage changes were signed into law, Republican lawmakers suggested that young, unemployed men were taking advantage of the government health insurance program that provides coverage to millions of low-income or disabled people. Medicaid is not intended for 鈥29-year-old males sitting on their couches playing video games,鈥 House .
But, in reality, adults ages 50 to 64, particularly women, are likely to be , said Jennifer Tolbert, deputy director of the Program on Medicaid and the Uninsured at KFF, a health information nonprofit that includes 杨贵妃传媒視頻 Health News. For Kelley and others, the work requirements will create barriers to keeping their coverage, Tolbert said. Many could lose Medicaid as a result, putting their physical and financial health at risk.
Starting next January, some 20 million low-income Americans in 42 states and Washington, D.C., will need to meet the activity requirements to gain or keep Medicaid health coverage.
Alabama, Florida, Kansas, Mississippi, South Carolina, Tennessee, Texas, and Wyoming didn鈥檛 expand their Medicaid programs to cover additional low-income adults under the Affordable Care Act, so they won鈥檛 have to implement the work rules.
The nonpartisan Congressional Budget Office predicts the work rules will result in at least 5 million fewer people with Medicaid coverage over the next decade. Work rules are the largest driver of coverage losses in the GOP budget law, which slashes nearly $1 trillion to offset the costs of tax breaks that mainly benefit the rich and increase border security, .
鈥淲e鈥檙e talking about saving money at the expense of people鈥檚 lives,鈥 said Jane Tavares, a gerontology researcher at the University of Massachusetts Boston. 鈥淭he work requirement is just a tool to do that.鈥
Department of Health and Human Services spokesperson Andrew Nixon said requiring 鈥渁ble-bodied adults鈥 to work ensures Medicaid鈥檚 鈥渓ong-term sustainability鈥 while safeguarding it for the vulnerable. Exempt are people with disabilities, caregivers, pregnant and postpartum individuals, veterans with total disabilities, and others facing medical or personal hardship, Nixon told 杨贵妃传媒視頻 Health News.
Medicaid expansion has provided a lifeline for middle-aged adults who otherwise would lack insurance, according to . Medicaid covers 1 in 5 Americans ages 50 to 64, giving them access to health coverage before they qualify for Medicare at age 65.
Among women on Medicaid, those ages 50 through 64 are more likely to face challenges keeping their coverage than their younger female peers and are likely to have a greater need for health care services, Tolbert said.
These middle-aged women are less likely to be working the required number of hours because many serve as family caregivers or have illnesses that limit their ability to work, Tolbert said.
Tavares and other researchers found that of the total Medicaid population is considered 鈥渁ble-bodied鈥 and not working. This group consists largely of women who are very poor and have left the workforce to become caretakers. Among this group, 1 in 4 are 50 or older.
鈥淭hey are not healthy young adults just hanging out,鈥 the researchers stated.
Plus, making it harder for people to maintain Medicaid coverage 鈥渕ay actually undermine their ability to work鈥 because their health problems go untreated, Tolbert said. Regardless, if this group loses coverage, their chronic health conditions will still need to be managed, she said.
Adults often start wrestling with health issues before they鈥檙e eligible for Medicare.
If older adults don鈥檛 have the means to pay to address health issues before age 65, they鈥檒l ultimately be sicker when they qualify for Medicare, costing the program more money, health policy researchers said.
Many adults in their 50s or early 60s are no longer working because they鈥檙e full-time caregivers for children or older family members, said caregiver advocates, who refer to people in the group as 鈥渢he sandwich generation.鈥
The GOP budget law does allow some caregivers to be exempted from the Medicaid work rules, but the carve-outs are 鈥渧ery narrow,鈥 said Nicole Jorwic, chief program officer for the group Caring Across Generations.
She worries that people who should qualify for an exemption will fall through the cracks.
鈥淵ou鈥檙e going to see family caregivers getting sicker, continuing to forgo their own care, and then you're going to see more and more families in crisis situations,鈥 Jorwic said.
Paula Wallace, 63, of Chidester, Arkansas, said she worked most of her adult life and now spends her days helping her husband manage his advanced cirrhosis.
After years of being uninsured, she recently gained coverage through her state鈥檚 Medicaid expansion, which means she鈥檒l have to comply with the new work requirements to keep it. But she鈥檚 having a hard time seeing how that will be possible.
鈥淲ith me being his only caregiver, I can鈥檛 go out and work away from home,鈥 she said.
Wallace鈥檚 husband receives Social Security Disability Insurance, she said, and the law says she should be exempt from the work rules as a full-time caregiver for someone with a disability.
But federal officials have yet to issue specific guidance on how to define that exemption. And experience from Arkansas and Georgia 鈥 the only states to have run Medicaid work programs 鈥 shows that many enrollees struggle to navigate complicated benefits systems.
鈥淚鈥檓 very concerned,鈥 Wallace said.
