[xp84]

Can you point out what aspects of the bill relating to Medicaid are most concerning? I don't just mean the DNC talking points, but rather specific provisions. When I read through the actual provisions[1] they are far less scary than what I hear being used as DNC fundraising fodder. For instance, I can't just show up in the UK without any legal status and automatically have all free healthcare from the NHS[2]. But the provisions removing federal tax money support to provide free healthcare to the undocumented is one of the things being pointed to by opponents of the bill as being especially evil. If you feel that way, why is the US the only country that ought to do that?

[1] https://www.kff.org/tracking-the-medicaid-provisions-in-the-...

[2] https://www.nhs.uk/nhs-services/visiting-or-moving-to-englan...

[postpawl]

The work requirements force people to file paperwork proving 80 hours of work monthly, and Arkansas showed this paperwork maze caused 18,000+ people to lose coverage even though 95% already met the requirements or qualified for exemptions. Arkansas spent $26.1 million just on administration with no increase in employment, and Georgia has spent over $40 million with 80% going to bureaucracy, not healthcare.

For rural hospitals, the bill cuts $58 billion in Medicaid funding over 10 years but only provides a $25 billion rural fund that covers less than half the losses. This puts 300+ rural hospitals at immediate risk of closure since they're already operating on thin margins.

For elderly people, the bill blocks nursing home staffing rules until 2034 and freezes home equity limits at $1 million permanently, plus adds more verification requirements.

The evidence shows these aren't about efficiency. They're about creating barriers that cost more money to administer than they save, while cutting care for people who already qualify.

[xp84]

Why can't people without disabilities or dependents work 20 hours a week?

[postpawl]

It's not about whether they can work 20 hours. Most already do. Arkansas found 95% of people either met the requirements or qualified for exemptions, but 18,000+ still lost coverage due to the paperwork maze.

The requirements are designed to create barriers through bureaucracy. You have to report every month through a specific online portal, track your hours precisely, navigate exemption processes. Miss one monthly filing deadline and you lose healthcare. It's the most socially acceptable way to kick people off coverage without saying "we don't want poor people to have healthcare."

And it's not just work requirements. The bill also adds income verification twice a year instead of once, more asset checks, and cuts the actual funding. Each new hoop is another chance for eligible people to fall through the cracks. The goal is reducing enrollment through administrative friction, not promoting work.

[xp84]

> saying "we don't want poor people to have healthcare."

I don't really think it's about 'poor people' at all. I think most people agree with me that poor people who do their best deserve plenty of help.

From ABC News: "Pew found that around half of Americans would favor creating work requirements for Medicaid, with 32% opposed." [1]

Polling shows (and Trump's popular vote victory also suggests, arguably) that American voters largely are not in favor of freeloaders who don't work and rely on government benefits paid for by those who do work. Given that this country still operates on democratic principles, it's a democratic move to give those voters what they want, even if it isn't the most efficient. I think if you asked those voters why, they'd say that they're concerned that training people to expect a welfare program to pay for you without you having any obligation back is bad for us as a society, and could encourage more and more 'dropping out' leaving a larger burden for those who work, who our society does need to keep working.

If you want universal healthcare, tell the DNC to run on a platform that includes that instead of running a terrible candidate and a bunch of culture-war stuff that's deeply unpopular with moderates. Or abandon that worthless party and start one that can win.

[1] https://www.msn.com/en-us/news/politics/polls-show-americans...

[ryandrake]

> Pew found that around half of Americans would favor creating work requirements for Medicaid, with 32% opposed.

To me, this is sad. Culturally, we need to stop attaching morality and nobility to “work.” You’re not better and/or more deserving of life and health than others simply because you have a job.

[frumplestlatz]

The reporting requirements don’t seem particularly onerous.

It’s on those individuals to not “fall through the cracks” if they truly need our money to fund their healthcare — I don’t see the problem.

[postpawl]

What's the point of making requirements even stricter if they cost more to administer than they save and don't increase employment? The Congressional Budget Office estimates 5.2 million people would lose coverage by 2034, with savings primarily coming from eligible people losing coverage due to paperwork barriers rather than increased employment.[1]

The new bill allows states to verify monthly instead of every three months, so people lose coverage faster. Even working people get tripped up because 43% of workers would fail to meet 80 hours in at least one month due to variable schedules common in low-wage jobs.[2] People with multiple jobs have to submit paystubs from each employer monthly. Seasonal workers and food service workers are especially vulnerable because their hours swing wildly due to factors beyond their control.

[1] https://ccf.georgetown.edu/2025/05/27/medicaid-and-chip-cuts...

[2] https://www.cbpp.org/research/health/medicaid-work-requireme...

[frumplestlatz]

The cost of government subsidies isn’t in just the subsidies or the administrative overhead alone. It’s in training people to rely on the government, in effectively subsidizing employers that pay less than a living wage, etc.

[xp84]

Seasonal workers are explicitly protected in the final bill as long as their average amount of work makes sense, so that argument is out.

Also, this "verify monthly" sounds like fearmongering. All I see is "requires individuals who are enrolled meet requirements for 1 or more months between the most recent eligibility redeterminations (at least twice per year)." Also: "Requires states to conduct eligibility redeterminations at least every 6 months for Medicaid expansion adults."

The Medicaid expansion is not everyone on Medicaid, just a subset who before expansion were presumed not to be entitled to a government subsidy since they don't have any dependents or any disability and could just work.

I do think it's probably not the worst thing if people who have no dependents or disability are motivated to go get a full-time job because it's kind of a hassle to have to prove eligibility.

The DNC is now advocating that taxpayers not only must pay for all the healthcare of people who don't want to work at all, but we also need to make it a maximally convenient experience. The reason Democrats keep losing elections is that they can't read the room -- most people who work and are not upper-middle-class levels of comfort don't like the emphasis on maximizing the comfort and convenience of groups like the voluntarily unemployed and undocumented immigrants when it comes at the expense of working taxpayers who follow the rules. This is why the Big Beautiful Bill passed: It actually throws a bone to people who work via things like tax breaks on overtime pay and tips, and via restoring the SALT exemption. Between these 3 policies, you can see a benefit to people across the wealth spectrum who share one thing in common: people who work hard. I know the Dems are still doing fine in rich areas, but there are two problems which are intertwined:

1. There aren't enough of those rich Democrats who just want to open the tax money spigot, the ones who wouldn't mind paying an extra $30,000 in taxes next year to put their money where their mouth is.

2. Even when there are enough to win, the rest of the population still pays most of the actual tax dollars and they are increasingly resentful of what they see as rich Democrats helping themselves (via the government) to everybody's money to bestow as favors on people who don't seem to need it. I know your heart is in the right place, but the policies are not connecting with the people, as evidenced by the fact that the Democrats keep losing ground among the non-wealthy working demographic (which, in the Democrat narrative, ought to be their strongest base).

Note: I certainly don't agree with everything in the "OBBB," but there are some good ideas in there.