When I began my career as a pulmonologist, my days were dedicated to patient care—listening to their concerns, researching treatments, discussing options, and monitoring outcomes. Today, the profession has shifted toward extensive paperwork. I now spend hours daily managing prior authorizations, contesting insurance denials, and fighting for reimbursements, all to ensure my patients receive the care they need.
A new federal rule imposing work reporting requirements for Medicaid beneficiaries will only intensify this administrative burden. Congress must act to address these regulations, as failure to do so risks exacerbating challenges for both patients and healthcare providers.
In April 2025, I encountered a compelling story from a woman diagnosed with lung cancer. After losing her job shortly before her diagnosis, she faced the daunting prospect of unaffordable treatment. However, Medicaid enabled her to access critical biomarker testing and therapies. She conveyed to lawmakers that Medicaid had saved her life.
During debates over H.R. 1—which included significant healthcare cuts and Medicaid work requirements—lawmakers assured protections for individuals with serious illnesses. Yet, in June, the Centers for Medicare & Medicaid Services (CMS) issued an interim final rule that undermines this promise. The rule complicates medical exemptions from work requirements and introduces unnecessary administrative hurdles for patients with serious conditions, such as cancer or chronic lung disease.
Under the new rule, having a severe illness no longer guarantees exemption from work mandates. Instead, state Medicaid programs must now confirm that a condition “significantly impairs” a patient’s ability to comply with work requirements. Unanswered questions remain about who will make these determinations—physicians, who may feel unqualified for such assessments, or additional administrative staff—adding strain to an already overburdened system.
Individuals managing chronic conditions like lung cancer, COPD, or pulmonary fibrosis already juggle complex treatments, hospital visits, and frequent medical appointments. Requiring them to navigate arduous paperwork processes risks losing critical healthcare access when they need it most.
Removing Medicaid coverage does not eliminate these health challenges. Patients will still require care, yet they may face higher out-of-pocket costs and delayed treatment. Rural hospitals and underserved clinics already struggle financially; further cuts to public health programs and Medicaid threaten to deepen systemic inequities and compromise patient safety.
State-level experiments with Medicaid work requirements reveal little benefit. These policies have reduced coverage for eligible populations and incurred substantial administrative costs without increasing employment rates. A nationwide rollout will likely magnify these failures on a larger scale.
Work reporting requirements inherently jeopardize access to life-saving healthcare. The latest CMS rule intensifies this harm, overburdening clinicians and endangering vulnerable patients. I urge Congress to intervene swiftly by directing CMS to revise or rescind these provisions, prioritizing patient well-being over bureaucratic obstacles.
