A budget reconciliation bill under consideration by the U.S. Congress this week would require some 670,000 adult Oregonians to prove they are working or volunteering 80 hours a month in order to keep their health coverage. The requirement would apply to nearly half of the 1.4 million Oregonians enrolled in the Oregon Health Plan, the state’s version of Medicaid.
Students, parents of young children, people with disabilities, those who are medically fragile, and tribal members would be exempt from the work requirement.
Current law prohibits states from imposing a work requirement for Medicaid benefits, though some states have received waivers to that law.
If the bill becomes law, Oregon would also be at risk of losing more than $1 billion in the 2027-2029 biennium and more than $7 billion dollars over a 10-year period due to a provision that penalizes states that provide health insurance to undocumented immigrants.
The state pays for about 100,000 immigrants to be on the Oregon Health Plan using state funds only and no federal dollars. The program, called Healthier Oregon, covers people without citizenship, including some immigrants with legal status, like green card holders, and some without it.
Under the bill, the federal government would reduce the matching dollars available for all Oregonians on Medicaid unless the state rescinds its program insuring immigrants.
The work requirement and the penalty are part of the health section of President Donald Trump’s “big, beautiful bill,” which extends 2017 tax breaks and cuts social services.
The bill is also notable for what it does not include. The legislation does not include an extension for enhanced tax credits that have reduced the cost of buying individual and small group health plans on the Affordable Care Act Marketplace. Without it, premiums in Oregon — which have gone up 8% on average this year — could increase significantly more in 2026. The Oregon Health Authority says more than 100,000 people will be affected by higher monthly payments.
Republicans passed the bill out of the Energy and Commerce Committee, which has oversight over Medicaid, earlier this week on a party line vote.
The bill now goes to the budget committee. If it passes, most key provisions wouldn’t go into effect until after the November 2026 midterm elections. The work requirement would take effect in January 2029.
“We make no apologies for prioritizing Americans in need over illegal immigrants and those who are capable but choose not to work,” Committee Chair Brett Guthrie (R-Ky) said in opening remarks before a marathon mark-up of the bill that started Tuesday and ran late into the night.
The hearing was repeatedly disrupted by protesters. Democratic lawmakers held up posters with the faces of Medicaid patients in their districts. They said Republicans were paying for tax breaks for billionaires by cutting an essential service, and accused Trump of lying when he promised not to touch the program.
Republicans accused the Democrats of lying about who will be impacted by the bill. They said that they are preserving Medicaid for the core populations it is intended for, children, pregnant women and people who are disabled, while targeting fraud and abuse.
Rep. Cliff Bentz, the lone Republican in Oregon’s congressional delegation, sat listening through much of the Tuesday night debate. Bentz represents Oregon’s 2nd Congressional District, east of the Cascade Mountains. There, 38% of the population is on Medicaid, one of the highest rates of any district in the nation.
In his remarks on the bill, Bentz said Medicaid has had strict eligibility rules since its inception in 1965, and needs more accountability.
“This program is costing us billions and billions of dollars,” he said. “If we want to continue to have any chance of maintaining this essential and necessary program, we better make sure that those who are utilizing it actually meet the criteria established so long ago.”
Bentz said the work requirement is supported by the taxpayers who fund Medicaid.
“People may have all kinds of excuses for why it’s not going to work for them. Guess what? We’re paying somewhere around $9,000 for each person on that program,” Bentz said during the Tuesday meeting. “Better be trying to get a job.”
At the same time, he defended the need to extend tax cuts for the wealthy, saying the top 10% of earners pay 70% of all taxes and millions of jobs will be lost if the tax cut expires.
Democrats in Oregon and health policy experts have expressed dismay over the bill, which is 160 pages long and includes a wide range of new policies — many of them partisan, like a provision cutting off funding from Planned Parenthood.
Former Democratic Gov. John Kitzhaber, an emergency room doctor and one of the architects of Oregon’s approach to Medicaid, said he agrees with Republicans that the federal government is spending too much on health care. But he said the bill will not address that issue, calling it “punitive” and “immoral.”
“It will not reduce cost, it will increase cost, and it will have huge economic ripples, particularly in rural parts of America,” he said.
Kitzhaber said that the Republicans’ bill did not make any real structural changes to Medicaid that would tackle medical inflation, instead opting for an approach that will make it harder for people to stay enrolled and drive up the number of uninsured people.
The result, he said, would be hospitals spending more on uncompensated care for the uninsured and underinsured, and higher monthly premiums for people who get their health care through their employers.
“This is a big cost shifting scheme that’s dressed up as accountability and work requirements and redetermination and things like that,” Kitzhaber said.
Those uninsured people will still need care and get it in the emergency department, he said. Federal law requires emergency rooms to treat anyone who walks in, regardless of their insurance status.
“We are going to pay for strokes rather than managing hypertension,” Kitzhaber said.
Emma Sandoe, director of the Oregon Health Authority’s Medicaid division, said the bill is antithetical to Oregon’s current approach to Medicaid, which has been to reduce red tape and make it easy for people to stay enrolled.
In Oregon, children who qualify for Medicaid now stay enrolled through their 6th birthday, without needing to complete additional eligibility checks. Older children and adults who qualify stay enrolled for two years in between eligibility checks.
That work has been supported by two Democratic governors and was driven by studies looking into churn, the problem of people who disenroll from Medicaid only to come back on shortly after.
Research has found that people often lose coverage due to small fluctuations in their income or oversights like missing a renewal notice in the mail. According to OHA, about 20% of people on Medicaid lose their coverage during the enrollment process due to administrative hurdles.
If passed, the bill would require Oregon to check participants’ eligibility and compliance with the work requirement every six months, starting in October 2027. Sandoe said that would amount to forcing people to prove over and over that they are poor.
“Oregon would be required to implement that by the federal government. That’s just really a paperwork burden,” she said.
The work requirement and more frequent eligibility checks will also likely add significantly to the administrative cost of Medicaid nationally and in Oregon, Sandoe said, meaning tax dollars will go to pay for information technology and program staff.
That’s what happened in Georgia, Sandoe said, where an effort to expand Medicaid while imposing a work requirement cost more than $80 million but enrolled only 6,500 people.
Lucy Dagneau, with the American Cancer Society Action Network, said congressional Republicans appear to have modeled their work requirement after the one in Georgia.
While other states, like Arkansas, have allowed people to access health benefits and then prove they’re working later, the current bill would require people to show they’re working or volunteering in order to complete their initial enrollment in Medicaid.
“This would put that barrier to entry right at the start,” she said, discouraging some people from applying in the first place.
The bill also requires states to charge some adult Medicaid enrollees copays of up to $35 for many kinds of services.
Currently, people on the Oregon Health Plan are not required to pay any copays. Providers can waive those fees, but they would be allowed to turn away Medicaid patients who show up and cannot pay under the bill’s framework. The bill maintains a current cap on out-of-pocket costs at 5% of family income.
