Medicaid Work Reporting Requirements Would Increase Uninsurance Among Manufacturing, Agricultural, and Service Workers

Congress is currently negotiating the details of a budget reconciliation bill that is expected to include the largest cut to Medicaid in the program’s history. As a way to achieve those cuts, Republican congressional leadership—including House Speaker Mike Johnson (R-LA) and Energy and Commerce Chair Brett Guthrie (R-KY)—have expressed strong support for Medicaid work reporting requirements. Past experience shows that Medicaid work reporting requirements are a failed policy that primarily kick eligible people off coverage. They have the potential to be especially harmful for workers in sectors with high rates of turnover or proportions of seasonal jobs. A new analysis from the Center for American Progress estimates that implementing a federal Medicaid work reporting requirement could cause 2.7 million workers from across the manufacturing, agricultural, and service sectors to become uninsured in the first year of implementation, rising to an average of 3.4 million workers each year thereafter.

Millions of manufacturing, agricultural, and service workers would lose coverage because of Medicaid work reporting requirements

Medicaid work reporting requirements are a counterproductive and harmful policy. According to KFF, the majority of Medicaid enrollees are already employed, and nearly all Medicaid enrollees who can work are already working. All evidence of work reporting requirement implementation to date has indicated that, rather than promote employment, such requirements only result in significant coverage losses due to bureaucratic obstacles—primarily among people eligible for Medicaid—and tremendous administrative waste. A Congressional Budget Office (CBO) analysis of the Limit, Save, Grow Act of 2023 estimated that Medicaid work requirements would save the federal government $109 billion over 10 years but impose $65 billion in implementation and administrative costs on states. A May 2025 Commonwealth Fund report by Leighton Ku and colleagues also finds that implementing a nationwide Medicaid work reporting requirement would actually eliminate between 320,000 and 449,000 jobs.

An April 2025 analysis from the Brookings Institution estimates that work reporting requirements would lead to a 27 percent reduction in Medicaid enrollment in the first year of implementation and a 34 percent reduction in subsequent years on average. This comports with an analysis from the Urban Institute estimating that work requirements would lead to 34 percent to 39 percent of all Medicaid expansion enrollees losing coverage. (See Methodology for details)

Coverage losses from Medicaid work reporting requirements could be felt most acutely by workers in the manufacturing, agricultural, and service sectors. A recent analysis from KFF shows that of the 16.6 million employed adults covered by Medicaid in 2023, a combined 61 percent (10.1 million) worked across these industries. Workers in retail; wholesale; and leisure and hospitality services, which have high rates of turnover, as well as agriculture, where employment is often seasonal, are particularly vulnerable to losing coverage even if they are working. Requiring frequent submission of documentation of employment or job search efforts would disproportionately affect and harm these workers.

While it is unclear whether the federal Medicaid work reporting requirement policy under consideration by Republicans in Congress would apply to expansion enrollees only or to all adults with Medicaid coverage, states with a high proportion of Medicaid enrollees working in manufacturing—including Tennessee, Kentucky, and Ohio—and in agriculture or services—including Utah, North Dakota, and Hawaii—could be particularly hard hit by such coverage losses.

For example, Table 1 shows that in Kentucky, almost 23 percent of working adult Medicaid enrollees were employed in the manufacturing sector in 2023 while nearly one-quarter of all adults aged 19 to 64 living in the state were covered by Medicaid. Table 2 shows that, in West Virginia, half of working adult Medicaid enrollees were employed in the agricultural or services sector in 2023, and nearly one-quarter of all adults aged 19 to 64 in the state were covered by Medicaid.

Conclusion

In 2023, 10.1 million workers employed in the agricultural, manufacturing, and service industries relied on Medicaid to access essential health care services. Imposing burdensome work reporting requirements on that population would lead to significant coverage losses, which could be felt most acutely in states with larger proportions of workers in these industries.

Methodology

Marketplace enrollees with household incomes between 100 percent and 150 percent of the federal poverty level are currently eligible for $0 premium plans as a result of the enhanced premium tax credits through the Inflation Reduction Act. However, as of this column’s publication, the enhanced premium tax credits are set to expire at the end 2025 unless Congress acts to extend them. This analysis incorporates  Urban Institute’s assumption that individuals losing Medicaid coverage will not have access to affordable marketplace plans as an alternative coverage option.

KFF estimates there were 26.1 million Medicaid-covered adults (age 19 to 64) who do not receive benefits from Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) and were not also covered by Medicare in 2023 and that 16.6 million of those (64 percent) were employed. 10.1 million (61 percent) of those 16.6 million people were employed in the manufacturing and agriculture/service sectors. KFF’s definition for agriculture/services includes agriculture, construction, leisure and hospitality services, and wholesale and retail trade, while its definition for manufacturing includes mining, manufacturing, and transportation and utilities. KFF’s original analysis relies on 2023 data from the March 2024 Current Population Survey (CPS) ASEC Supplement for ages 19 to 64.

The Brookings Institution estimated that work reporting requirements would lead to a 27 percent reduction in Medicaid enrollment in the first year of implementation and an average 34 percent reduction in subsequent years. To estimate the impact of work reporting requirements on coverage losses on manufacturing and agricultural/service workers, the author multiplied the 10.1 million manufacturing and agriculture/service workers from KFF by 27 percent and 34 percent and calculated that Medicaid work reporting requirements would result in 2.7 million uninsured in the first year of implementation and 3.4 million uninsured in subsequent years.