Nebraska has begun implementing Medicaid work requirements, a policy mandated by congressional Republicans' One Big Beautiful Bill Act, which is projected to strip health coverage from millions of the working poor and deepen the precarity of their lives. This move, which makes Nebraska the first state to enforce such a rule, directly impacts workers already struggling within a system that fails to provide adequate wages or employer-sponsored health benefits.
Schmeeka Simpson of Omaha, a 46-year-old worker holding three jobs—as a patient navigator for the American Civil Liberties Union, an administrative assistant at Nebraskans for Peace, and picking up shifts at a Dunkin' shop—exemplifies the class dimension of this policy. Simpson, who has relied on Medicaid since her divorce in 2014 because none of her employers offer health coverage, expressed worry about losing her health coverage. She previously lost government food assistance due to technical problems and fears similar bureaucratic failures will recur, stating, "Adding more barriers won't make the program work any better."
Crystal Schroer, 30, who has been on Medicaid since 2022 and unemployed since 2024, also voiced profound concern. Schroer reported difficulty finding work near her home in Kearney that accommodates her psychiatric service dog, Tarot, which assists with her anxiety. She stated, "I am insanely worried," adding that the situation "It's made my depression way worse."
The State's Enforcement of Poverty
The federal law, signed by President Donald Trump less than one year ago, requires 42 states and the District of Columbia that expanded Medicaid to implement a work requirement starting next year. The Congressional Budget Office estimates that 4.8 million people will become uninsured over the next decade as a direct result of this work requirement. Centers for Medicare & Medicaid Services Administrator Mehmet Oz applauded Nebraska's early implementation, acknowledging the state is "working out the kinks" but expressing hope they "will get into a more sophisticated place" by the end of this year. Oz also stated, "we don't like self-attesting" and that "documentation is critical," signaling the state's preference for bureaucratic control over worker autonomy.
In Nebraska, approximately 70,000 Medicaid enrollees will need to meet the new requirement to work or volunteer at least 80 hours a month, attend school part-time, or participate in job training. The state plans to tap into various databases, including Medicaid claims information and data controlled by credit rating agencies, to monitor compliance. Despite this extensive surveillance, the Nebraska Medicaid agency is not adding any employees to implement the work requirement, suggesting a system designed for automation and potential failure for those without resources to navigate it.
Workers Bear the Brunt
Historically, such policies have proven to be administrative hurdles rather than incentives for employment. In 2018, Arkansas implemented a similar policy, resulting in over 18,000 people losing coverage in nine months, nearly one in four of those subject to the requirement. Most lost coverage not for failing to meet the work requirements, but for failing to correctly submit paperwork in time. Georgia's partial Medicaid expansion, which included a work requirement since the third year, saw only about 8,000 sign-ups in its first two years, far fewer than predicted, with many denied benefits due to paperwork issues. In Nebraska, about two-thirds of Medicaid expansion enrollees already work or attend school, and the state's unemployment rate is 3%, one of the lowest in the nation, indicating that the vast majority of those who can work, are working.
Health policy analysts, advocates for the poor, and health industry groups remain skeptical, fearing thousands of Nebraska Medicaid enrollees will lose coverage, and with it, access to health services and protection from medical debt. Kelsey Arends, senior staff attorney for Nebraska Appleseed, noted that the state's list of medical conditions for exemption is still not long enough and does not include different levels of illness severity. Advocacy groups like the American Diabetes Association and the National Bleeding Disorders Foundation had requested broader exemptions, warning that losing coverage would mean losing access to life-sustaining medications.
Capital's Calculated Costs
Jeremy Nordquist, president and CEO of the Nebraska Hospital Association, voiced concern that an increase in uninsured patients will hurt hospitals' bottom lines. Andrea Skolkin, CEO of Omaha-based One World Community Health Centers, stated that losing 10% of their Medicaid expansion patients would mean $500,000 less in revenue for the nonprofit centers. The federal law also reduces retroactive eligibility from three months to one month for expansion enrollees, leaving hospitals to cover costs when people lose coverage, effectively shifting the burden of capital's failures onto healthcare providers and, ultimately, the public. While Nebraska Medicaid officials claim they are trying to make compliance easy, and will allow self-attestation for some conditions, the overarching framework of work requirements, applauded by federal administrators, remains a mechanism for surplus extraction by forcing workers into precarious labor while denying them essential social protections.