MICHEL MARTIN, HOST:
Democrats take the majority in Congress next year. They say there's one thing at the top of their agenda. Here's minority leader Hakeem Jeffries talking on CNN soon after the election.
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HAKEEM JEFFRIES: We should reverse these Medicaid cuts, which are going to result in ripping healthcare away from people all across the country, in rural America, in small-town America, in urban America.
MARTIN: What exactly are the Medicaid cuts, and what can Democrats do about them? NPR's Selena Simmons-Duffin reports.
SELENA SIMMONS-DUFFIN, BYLINE: Medicaid is a public health insurance program for low-income people. Right now it covers about 70 million Americans. Republicans' One Big Beautiful Bill Act passed last year, cut nearly a trillion dollars from Medicaid over 10 years by requiring beneficiaries to prove that they're working or volunteering or going to school, or that they have a condition that makes them unable to do those things. If they can't prove either, they could lose their health coverage.
LARRY LEVITT: These work requirements start January 1, and there's enormous uncertainty swirling around them.
SIMMONS-DUFFIN: Larry Levitt is the executive vice president for health policy at KFF, a nonpartisan health research organization. Democrats have vowed to reverse the cuts when they take over the majority in Congress.
LEVITT: If there's a lot of chaos as these work requirements start in Medicaid and people start losing coverage, that could be an impetus for Congress to act and put some pressure on President Trump.
SIMMONS-DUFFIN: Chaos seems pretty likely based on the experience of the two states that have implemented it early - Montana and Nebraska - which had its work requirements take effect on May 1.
SARAH MARESH: I would say the biggest issue that we are seeing is just massive confusion about the policy.
SIMMONS-DUFFIN: Sarah Maresh works with Nebraska Appleseed, a nonprofit social justice organization.
MARESH: We had one individual earlier this year reach out, and they had been told by a state worker that the work requirements were going to apply to them, and they are a blind mom.
SIMMONS-DUFFIN: This mom had an implanted port for medication infusions. Maresh says they made an appointment to remove the port, since they believed they were about to lose Medicaid.
MARESH: It took an hour and a half on the phone with three different caseworkers for that person to find out the work requirements weren't even applicable to them. That just demonstrates the depth, I think, of confusion and concern and the lack of communication from our state.
SIMMONS-DUFFIN: Now, there is the possibility that the January 1 start date gets pushed back either by the current Congress or the courts. There are several lawsuits pending. The Trump administration could also delay the start, but that seems unlikely. Here's Dr. Mehmet Oz, who runs the health agency that oversees Medicaid, on CNBC on Election Day.
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MEHMET OZ: This matters because we need to figure out who should be eligible to get Medicaid and who is able-bodied and should go to work and try to either work 20 hours a week or participate in volunteer activities or go get educated. You know, have agency over your future. Go change the world, which is why you're put on the planet in the first place.
SIMMONS-DUFFIN: Research shows that most adults on Medicaid who can work already do. Sarah Maresh in Nebraska has been getting calls from other advocates all around the country, asking for advice as January 1 approaches. She tells them...
MARESH: Make sure you're communicating all the time in so many different ways to folks, and then No. 2 is staff up and make sure your workforce and your state is prepared to take on this Herculean effort.
SIMMONS-DUFFIN: They're seeing how it goes without clear communication and enough staff in Nebraska, and she says people are getting hurt.
Selena Simmons-Duffin, NPR News, Washington.
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