This article is part of our ongoing series on Medicaid Eligibility Series where we’re exploring the far-reaching implications of the One Big Beautiful Bill Act (H.R.1).
Being uninsured is one of the strongest predictors of delayed or foregone care. When Medicaid enrollees lose coverage, they often skip medications, avoid preventive care, and wait until conditions worsen because cost becomes the barrier.
Arkansas’s early evidence confirms this pattern. After the state implemented work requirements:
Over time, the health consequences compound. Conditions like diabetes, hypertension, and asthma—manageable with steady care—can escalate without routine treatment or prescription refills. Preventive services are often the first to go when people lose insurance, leading to later-stage diagnoses and more severe illness.
A modeling study published in The Lancet projected that widespread work requirements could cause “widespread health harm,” including increased mortality and deteriorating chronic disease outcomes, as millions lose coverage.
There’s a built-in contradiction at the heart of the policy: good health is often a prerequisite for stable employment, yet work requirements can strip away the very coverage that keeps people healthy enough to work.
Research shows:
In short, Medicaid is not a passive benefit, it’s a work support. Removing it puts many low-income workers one illness away from job loss.
Even people who meet the work criteria can lose coverage not because they fail to work, but because they fail to navigate the bureaucracy.
Work requirements create new layers of administrative complexity:
Low-income adults juggling multiple part-time jobs, caregiving responsibilities, or unstable hours may struggle to keep up. States themselves have acknowledged this risk; many Medicaid directors have voiced concern that confusion, limited awareness, and accelerated implementation timelines could trigger widespread unintended disenrollment.
This raises serious health equity concerns. Those most likely to be caught in procedural pitfalls—people with lower education, rural residents without broadband, the homeless, and individuals with cognitive limitations—are also those who can least afford to lose coverage.
The impact of coverage losses won’t stop at individual health, it will radiate across communities.
Community health centers and public hospitals will face an influx of uninsured patients with no ability to pay. Already operating on thin margins, these providers may be forced to reduce services or capacity, affecting access even for those who remain insured.
As more people delay care and conditions worsen, emergency room visits rise. ERs must treat all patients regardless of ability to pay, increasing uncompensated care costs. National estimates suggest providers could face $31 billion in additional uncompensated care by 2034, straining already vulnerable hospitals.
This crowding affects wait times, care quality, and system stability for entire regions.
A drop in insurance coverage can lead to:
When local hospitals or clinics struggle financially, access declines for everyone not just Medicaid enrollees.
Healthcare providers are major employers. Cuts to staffing, service lines, or full hospital closures (particularly in rural areas) ripple outward, impacting local economies and shrinking the region’s healthcare safety net.
While the federal mandate sets the rules, states can take steps to protect access to care:
Compliance does not have to come at the expense of community health but it will require thoughtful planning, transparent processes, and compassion-driven design.
Infocap partners with agencies and healthcare organizations to build intelligent, scalable process automation that reduces administrative burden and protects access to care. Reach out to learn how we can help you translate complex policy requirements into operational AI that works.