Melannie Bachman, 39, of Charleston, South Carolina, is among the patients closely watching the sweeping Republican bill to overhaul Medicaid that’s been brought to the House. She was diagnosed with triple-negative breast cancer — an aggressive and difficult-to-treat form of the disease — in 2021. She said she had to apply for Medicaid multiple times and wasn’t approved until four months later, which meant she had to pay for multiple screenings while waiting.
Bachman no longer qualifies for Medicaid because she’s cancer-free. But she worries that the proposed revisions could make it harder for her or others in similar situations to get covered again, or even cause them to give up on the process altogether.
Bachman is still within five years of her diagnosis, and her doctors tell her that it’s essential for her to continue being monitored in case the cancer returns.
“It’s one of the hardest parts of this journey, besides fighting for your life,” Bachman said of applying for Medicaid. “The application process, the figuring how and when to find coverage, being someone who had no coverage at all.”
As House Republicans on Tuesday haggled over parts of a bill that proposes deep cuts and new restrictions on Medicaid, patients and doctors who rely on the program said they’re bracing for the worst, including overwhelming red tape and administrative hurdles that could prevent many people from getting the care they need.
The legislation, introduced Sunday by the Energy and Commerce Committee, proposes a slew of changes to the health program, such as work requirements, patient co-pays for doctor visits, tougher eligibility checks and citizenship verification. The panel began marking it up Tuesday and hopes to send it to the full House this week, with the goal of passing the entire bill by Memorial Day.
The legislation could lead to 8.6 million people losing Medicaid coverage, according to a preliminary estimate from the Congressional Budget Office. More than 70 million people currently get health coverage through the program.
The changes would make some people ineligible for coverage due to work requirements. Certain groups, such as the disabled, pregnant women and people who are in prison or rehabilitation centers, would be exempt.
Others — particularly those covered under the Affordable Care Act’s Medicaid expansion — could be forced to drop out as they face higher fees and additional paperwork to maintain their coverage.
Republicans say they’re fine with the new rules — including Sen. Josh Hawley, R-Mo., who has publicly and repeatedly warned his party not to slash Medicaid benefits.
“Based on the work requirement, anti-fraud provisions — there’s going to be coverage losses associated with that, which I’m OK with,” Hawley told NBC News. Republicans are proposing cutting spending to states that allow immigrants without proof of citizenship to be on Medicaid.
“But for people who are otherwise qualified, who are able bodied and are working and need Medicaid because they cannot otherwise afford health insurance, I just am opposed to cutting these people’s benefits,” he said.
Asked if he worries the red tape could end up removing rightful Medicaid recipients from coverage, Hawley downplayed the prospect saying his priority is “just no benefit cuts.”
The Medicaid provisions are expected to save the government over $715 billion over 10 years, which Republicans intend to use to pay for an extension of President Donald Trump’s 2017 tax cuts before they expire at the end of this year.
Democrats argue the added bureaucracy is a feature — not a bug — of the GOP plan.
Sen. Ron Wyden, D-Ore., the ranking member of the Finance Committee that oversees Medicaid, said Republicans want to throw people off the program by putting recipients through “bureaucratic water torture” that many won’t be able to navigate.
“This whole thicket of red tape bureaucracy is being deployed in order to keep people who are eligible from getting covered,” Wyden said in an interview. “It’d be one thing if they had found a pattern of fraud and abuse, and they were trying to root it out. But what they’re doing is they are targeting eligible people who are eligible for Medicaid now.”
“I think it’s really a despicable thing,” he said.
The bill, as it stood before Tuesday’s markup, did leave out some of the more controversial ideas Republican leaders had discussed — including limits on how much Medicaid can spend per person and making states pay more for expanded coverage under the Affordable Care Act’s Medicaid expansion, for which the federal government currently pays 90%.
Dr. Adam Gaffney, a critical care physician and assistant professor of medicine at Harvard Medical School, said the proposed changes to eligibility, even the possibility of additional paperwork, will cause people to fall through the cracks and lose their coverage.
“You don’t need to be a doctor to realize that this is dangerous,” Gaffney said. “If you’re facing multiple medical problems, the last thing you need to do is try to get through a lot of red tape and jump through hoops and bureaucracy, and that’s exactly what this legislation would do.”
People who want to work may not be able to because of health issues, lack of childcare or limited transportation options.
When people lose coverage, they typically have no other options, Gaffney said. He noted that in the early 2000s, when Tennessee implemented reforms to rein in Medicaid costs, thousands of people lost coverage.
“Most people who lost Medicaid went uninsured,” he said. “The reality is Medicaid covers some of the lowest-income folks in the nation, and when they lose coverage, they’re probably not going to be able to afford it.”
Likewise, in Georgia, following the implementation of Medicaid work requirements in 2023, fewer people chose to enroll, said Robin Rudowitz, director of the program on Medicaid and the uninsured at KFF, a health policy research group.
“Basically reporting and having to document that you’re working, or even if you’re a group that might be exempt from the requirements, sometimes it’s just hard to document that you might be in one of those groups,” she said.
Sen. Cory Booker, D-N.J., said the new rules are part of a “cruel” and “craven” plot.
“Any added bureaucracy will take people who are justifiably using these services and make it more difficult for them to get on, which will result in loss of coverage — again, for Americans who have sicknesses and illnesses,” Booker said.
Rudowitz said the bill proposes a provision that would require patient co-pays for people with incomes up to 130% to 138% of the federal poverty level— around $35,000 a year for a family of three. There’s also a provision, she said, that would reduce the amount the federal government gives states if they provide coverage for undocumented immigrants.
If the bill clears the House, it goes to the Senate, where some Republicans are eying changes.
Sen. Thom Tillis, R-N.C., who sits on the Finance Committee, said Republicans must take a close look at the new Medicaid rules and coverage impacts.
“That’s what we’re going through now. A lot of that has to do with the semi-annual versus annual affirmation, that sort of stuff. We got a lot of mechanics to work out,” said Tillis, who faces re-election next year in a purple state.
Tillis also said he wants to review how many North Carolinians are among the 8.6 million projected to lose coverage. “If you look at that distribution across the country, it probably means sizable numbers in North Carolina,” he said. “This false narrative that we’re going to pick up that bill and pass it as proposed — we got a lot of work to do.”
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