Trump’s Big Medicaid Cuts Are About to Get Very Real (OBBB Biting Back!)
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When will you Trump supporters realize you've been played for a fool!!! Nebraska first, then so much more of rural america is gonna realize they've been betrayed by Trump & Co. And they probably won't care, as long as Trump "owns the libs" and hates who they hate. SAD!!!
Trump’s Big Medicaid Cuts Are About to Get Very Real
Nebraska will be the first test of how many people lose insurance—and who they are.
-Jonathan Cohn, May 3
OMAHA, NEBRASKA HAS BEEN BUSTLING with activity these past few days thanks to the annual Berkshire Hathaway weekend, when tens of thousands of investors from around the world gather to hobnob with Warren Buffett while they figure out how to maximize their portfolios.
But inside one office, a woman named Amy Behnke has been preoccupied with something very different and much more urgent. She has been furiously working the phones with state officials, trying to figure out how to keep some of Nebraska’s poorest residents from losing their health insurance.
Behnke is CEO of the Nebraska Health Center Association, which represents clinics that provide care to the state’s underserved population. Since 2020, she tells me, the percentage of total patients showing up to member clinics with no insurance at all—the ones who represent the biggest drain on clinic finances—has dropped from half to one-third.
That’s a sign of progress, and it’s no mystery what’s behind it. In October 2020, Nebraska officially became part of the Affordable Care Act’s Medicaid expansion. By taking advantage of federal funding that the state’s GOP officials had long refused—but that voters eventually approved via ballot measure—Nebraska was able to open up its program to any citizen or qualifying legal resident with income below 138 percent of the federal poverty line.
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More than 70,000 Nebraskans are now on Medicaid because of the expansion. But as of May 1, they are also subject to new “work requirements” that became law last summer as part of the broader Medicaid cuts in President Donald Trump’s “One Big Beautiful Bill.” That legislation calls on states to impose their work requirements by January 1, 2027. Nebraska decided to go first, thanks to Republican Gov. Jim Pillen, who has said the rules will make sure Medicaid is a “hand up, not a hand out.”
Just how big that change will be in practice is impossible to say right now. As in the rest of the country, the majority of non-elderly adult Nebraskans on Medicaid expansion already work or are in school, according to estimates by KFF. In theory, they should have no problem getting and staying on the program. And of those who don’t work, many have a disability or caregiving responsibilities or something else that is supposed to exempt them from the requirement.
But what is supposed to happen and what will happen are two very different things.
Electronic verification systems might not function properly, as sometimes is the case with government websites. People trying to sign up for Medicaid—or to stay on the program—might not be able to obtain the necessary documentation to prove they are in compliance with the new requirements, or even to figure out what they need to upload.
And even if they do everything right, they might get caught in Kafkaesque, soul-crushing bureaucratic snafus—the kind that are endemic to private and public health insurance alike.
Behnke and other advocates have been in contact with state officials for months, both to offer input and to learn about what’s coming. But in a series of conversations with me this week—including one e-mail exchange Thursday evening, the night before the requirements took effect—Behnke said she still lacked answers to key questions.
How far back will the state check records to verify somebody qualifies as “medically frail”? What geographical distance from a care provider—a big problem in such a rural state—will qualify as a hardship? Behnke told me she still didn’t know.
“We’re kind of building this plane and flying it at the same time,” she said.
What happens next doesn’t matter just in Nebraska. The state’s introduction of work requirements represents one of the first real-world tests of how Republican cuts to Medicaid will play out across the country.¹
Trump and his allies have insisted the cuts will only reduce waste, fraud, and abuse—catchall terms that, in their telling, include scads of lazy young gamers getting free health care while they play Fortnite. Advocates for the poor and people with disabilities say that’s a gross distortion of who’s actually on Medicaid and of what will happen to some of the most vulnerable people in America once they are dumped into a system designed to make enrollment difficult.²
Nebraska will offer some of the first clues about which side was right.