WASHINGTON (AP) — Republicans are currently considering significant reductions to Medicaid funding, which could jeopardize health care access for approximately 80 million individuals, including both adults and children, participating in this critical assistance program in the U.S.

The Biden administration’s expansion of taxpayer-supported health coverage like Medicaid and the Affordable Care Act’s marketplace has been celebrated by Democrats as a significant achievement. However, Republicans, aiming to reduce federal expenditures while providing tax cuts to businesses and wealthier citizens, view the $880 billion Medicaid program as a prime target for budget cuts. A considerable portion of Medicaid funding—up to 80% in certain states—is derived from federal taxpayers. Additionally, various states have indicated that they are struggling to cover the costs associated with increased enrollment and a growing number of patients with complex health needs who rely on Medicaid.

To balance the budget, the Republican-controlled Congress is contemplating the introduction of work requirements for Medicaid recipients and a shift to a fixed, reduced payment model for states. Over the upcoming decade, this strategy could lead to billions of dollars being diverted from crucial health care support for some of the country’s most vulnerable individuals.

In the weeks leading up to Congress’s discussions, Republican governors in states such as Arkansas, Ohio, and South Dakota have taken steps to implement their own Medicaid work requirements, which are expected to align with the policies of President Donald Trump’s administration.

Moreover, additional cuts may be on the horizon. Just recently, the Republican administration announced a drastic 90% reduction in funding for the Affordable Care Act’s navigator program, slashing the annual budget down to $10 million. Navigators play a vital role in assisting individuals seeking Medicaid and ACA coverage, significantly contributing to increased enrollment in health care programs.

Proposed Republican Changes

Speaker of the House Mike Johnson from Louisiana has proposed linking work requirements to Medicaid eligibility. “It’s common sense,” Johnson remarked, emphasizing that such measures could positively impact not only budgeting but also community morale. Work, he argues, provides a sense of purpose and dignity.

However, it’s important to note that around 92% of Medicaid beneficiaries are already either employed, in school, or providing care, as highlighted by research from KFF, a health policy analysis organization.

Suggestions for a work requirement mirror those for the Supplemental Nutrition Assistance Program (SNAP), where individuals aged 16 to 59 must work or volunteer for at least 80 hours each month unless they fall into exempt categories such as being a caretaker for a child under six or experiencing homelessness. Typically, a household receiving SNAP benefits has an average monthly income of $852, resulting in benefits of around $239.

During a GOP House retreat at Trump’s golf resort in Doral, Florida, party members expressed that such requirements could encourage individuals to seek employment, potentially gaining jobs that provide health insurance.

Rep. Darrell Issa, R-Calif., stated that budget cuts should prioritize those who are abusing the system rather than affecting the truly needy. He recalled a case from his constituency to illustrate this point.

Other proposals include restructuring federal reimbursement to adopt a per-person limit, which would shift financial burdens onto states and could force them to make difficult decisions regarding coverage options. Joan Alker, executive director of the Georgetown Center for Children and Families, cautioned that health care needs persist regardless of coverage changes. “Cutting coverage doesn’t eliminate health care needs,” Alker stated.

Many Americans appear to oppose significant cuts to Medicaid, with recent polling showing more than half believe the government invests “too little” in the program, while only 15% feel that spending is excessive, according to a January Associated Press-NORC Center for Public Affairs Research survey.

State-Level Developments

While the Biden administration blocked several states from enforcing their own work requirements, some Republican-led states are forging ahead. Arkansas, Iowa, and Ohio are seeking approval from the federal Centers for Medicare and Medicaid Services to reinstate these work requirements, and South Dakota voters supported a similar initiative last fall.

When Arkansas enacted work requirements previously, approximately 18,000 individuals lost their Medicaid coverage—a regulation which was later rescinded by a federal judge and prevented by the Biden administration. Some individuals faced difficulties navigating the system, leading to unintentional loss of coverage, according to Trevor Hawkins, an attorney with Legal Aid of Arkansas.

“The complications are substantial,” Hawkins explained, noting that many individuals faced genuine hardships. Some, like 47-year-old Paul Mikell in Georgia, have encountered significant challenges reporting work hours to remain eligible for Medicaid.

In Idaho, where work requirements and time limits for Medicaid benefits are under consideration, family physician Peter Crane reported that a large proportion of his patients rely on the program. Many of these patients work demanding jobs, and without Medicaid expansion—common in most states—they often delayed critical medical care.

Democrats are sounding alarms over the potential adverse effects such cuts could have on healthcare facilities, especially rural hospitals and nursing homes, which rely on Medicaid for patient reimbursement. “If hospitals close, it will affect everyday Americans, including children, seniors, and individuals with disabilities,” House Democratic leader Hakeem Jeffries of New York cautioned in a recent House address.

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This article has been updated to clarify that the work requirement mentioned is 80 hours per month, not weekly.

___ DeMillo contributed to this report from Little Rock, Arkansas, with contributions from Associated Press polling editor Amelia Thomson-DeVeaux in Washington and writers Charlotte Kramon in Atlanta; Rebecca Boone in Boise, Idaho; and Jack Dura in Bismarck, North Dakota.