New Medicaid Requirements Galvanizing Dems in Battleground States

The reason Tucson resident Garrett Newell can walk is because of Medicaid. Speaking before reporters last week, he described how the program has allowed him to manage his cerebral palsy and lead a dignified life, one with more independence than would otherwise be possible. He is among the millions of Americans living with disabilities or chronic illness whose lives have been transformed by the program, and he wants to ensure everyone has access to it. When Republican lawmakers were threatening to severely slash Medicaid last year as part of the $1 trillion in health care cuts in their One Big Beautiful Bill law, Newell traveled to D.C. to advocate for the program.

But Republicans passed the bill with cuts intact, then used the money they saved to pay for tax breaks for the ultra-wealthy and yet another illegal forever war. Now, Newell and others who use Medicaid are bracing for one of the most devious and crushing policy changes: work requirements that take effect January 1, 2027. Under that new requirement, Medicaid users who are between 18 and 64 years old and without young children must clock 80 hours of work or other qualified activities a month, which is expected to cause up to 10.1 million Americans to lose coverage. Enrollees can seek an exemption, but patients and advocates say that paperwork is so convoluted and difficult to submit that it will kick people off their insurance even though they still qualify. The effect is intentional: Republicans get their health care cuts while being able to pretend it was their victims’ fault.

“Nobody should have to live with fear that a letter in the mail could mean losing their access to lifelong health care,” Newell said, in the first of three hearings to highlight the harm President Trump’s cuts will cause and already have. Unrig Our Economy, Honest Arizona, and the Committee to Protect Health Care hosted the call in Arizona; the other two will be in Iowa and New York. Advocates are calling out three Republican lawmakers in those states who voted for the cuts and are up for re-election: Reps. Juan Ciscomani (R-AZ), Mariannette Miller-Meeks (R-IA), and Mike Lawler (R-NY). All are in tight races, and all have Democratic challengers savaging them over their vote for the OBBBA.

In Arizona’s Sixth District, JoAnna Mendoza, Ciscomani’s opponent, is running on reversing the One Big Beautiful Bill health care cuts, protecting health care for people with pre-existing conditions, expanding Medicare coverage to include vision, hearing, and dental, and other measures. She says Ciscomani cast the deciding vote to pass Trump’s cuts and notes that southern Arizona health care facilities subsequently received one of the lowest amounts of federal health care support in the country, according to The Arizona Republic.

In Iowa’s First District, Christina Bohannan says Miller-Meeks’s support for Trump’s cuts resulted in more than 100,000 of the state’s residents losing their health insurance. “It is on health care that Miller-Meeks has failed Iowans most severely. And it is easy to see why—just follow the money. She has taken over $600,000 from the pharmaceutical and insurance industries, and voted against letting Medicare negotiate for lower drug prices,” Bohannan says on her website.

“She even took money from a group of insulin manufacturers on the same day that she voted against capping the price of insulin for our seniors on Medicare. She is clearly on their side and not ours.”

And in New York’s 17th Congressional District, Lawler’s challenger, Cait Conley, said she would restore the Affordable Care Act tax credits that Trump let expire, establish a public option for anyone to buy into Medicare at any age, and reverse the Medicaid cuts (she also says Lawler cast the deciding vote).

People with disabilities already face challenges without having to fight to maintain their medical coverage, Newell told the audience. “Losing that coverage doesn’t mean our medical needs disappear,” he said, it just means people are left with impossible choices that could delay treatment or cause treatable health problems to develop into medical emergencies. For him, that could mean losing his ability to walk and the independence he’s worked for his whole life. For someone else, that could mean the difference between receiving cancer treatment or not, or between managing a chronic illness and seeking care only when it becomes an emergency.

“These cuts aren’t just numbers on a spreadsheet,” Newell said. “They are decisions that have real consequences for people’s lives.”

ONE GROUP OF PEOPLE WHO ARE MAINLY CONCERNED with spreadsheets and numbers rather than the human consequences of Trump’s cuts are the executives who stand to make millions off taxpayers because of them.

Just days before advocates held their first call, Senate Finance Committee Democrats issued the initial results of a study on which companies are benefiting from the work requirements. States are throwing money at contractors to put systems in place that will track the required information in time for the deadline. Ranking member Ron Wyden (D-OR), and Sens. Raphael Warnock (D-GA) and Elizabeth Warren (D-MA), found that five multibillion-dollar, multinational corporations are the big winners: Conduent, Deloitte, Gainwell, General Dynamics Information Technology, and Maximus.

All of the companies dodged questions and provided little assurance that the systems have adequate oversight, the senators said. Executives failed to adequately explain how they test their systems for accuracy or give the number of people their systems mark as ineligible; they also failed to provide the contracts they signed to provide work requirement verification services or their top executives’ compensation, which is public information in some instances. The refusal to provide transparency, plus their “documented history of poor performance,” adds cement to the fear that Trump’s health care spending cuts will be catastrophic.

The five companies already hold million- and billion-dollar contracts with the federal government and have a history of waste, fraud, and abuse. Maximus, for example, is the world’s largest student loan company, operating under the name Aidvantage. In 2022, the Student Borrower Protection Center and Communications Workers of America tallied the company’s “growing list of scandals and abuses,” including sloppy and potentially illegal servicing practices, unfair and illegal debt collection methods, and stealing from borrowers whose loans the government canceled because they had been defrauded by for-profit colleges. In that last instance, Maximus failed to follow the Department of Education’s instructions and illegally seized tax refunds and garnished so many borrowers’ wages “that a federal judge ultimately held the then-Secretary of Education in contempt of court over the company’s failure.”

Maximus has rewarded CEO Bruce Caswell for this work by giving him multimillion-dollar raises. A proxy statement shows he took home $11.2 million last year, $4 million more than two years earlier.

Gainwell has likewise failed its end users, including through its insecure, buggy web portals for Medicaid providers, which have exposed private health information to unauthorized users, and ignored “obvious fraud and misspending” in its billing systems for years, including in Georgia, Rhode Island, New York, and Oklahoma. Earlier this month, the Kentucky Cabinet for Health and Family Services told 3,816 Medicaid users that unauthorized third parties had accessed sensitive personal information through Gainwell’s KY Health-Net Provider Portal; in two separate incidents in March and June, unauthorized parties accessed a similar system it runs for Connecticut’s HUSKY Medicaid portal.

Gainwell is owned by private equity firm Veritas Capital, whose CEO and managing partner Ramzi Musallam has so far spent $4.4 million on the Republican National Committee in this year’s midterm elections.

Conduent runs insecure systems, too, and has a long history of making false claims and violating worker and consumer protections, which have cost the company nearly $285 million in fines since 2000, according to Good Jobs First. Earlier this month, it agreed to pay $80 million to settle a lawsuit over a breach that exposed the personal information of about 62 million people, though it will only pay no more than $3,500 to plaintiffs, who must show proof that the exposure led someone to defraud them or steal their identity. The settlement isn’t an admission of guilt, a Securities and Exchange filing notes, nor will it make a material difference to the company’s overall financial standing, which last year included annual revenue of $3 billion.

General Dynamics Information Technology is a subsidiary of defense industry juggernaut General Dynamics. The subsidiary’s interim president and chief business officer, Paul Nedzbala, religiously donates to the General Dynamics political action committee, which in turn has donated thousands to conservative committees and races, including to Republican Maine Sen. Susan Collins, through her Dirigo PAC. (It has also given $60,000 to the Democratic Senate and congressional election funds.) Besides creating websites for states to deny people medical insurance coverage, it also has done more than $100 million worth of business with Immigration and Customs Enforcement over the last four years.

Deloitte, meanwhile, is a global juggernaut with fiscal year 2026 revenue of $74.5 billion, up 6 percent from the year before. Best known as the largest of the Big Four accountancies, it is also the purveyor of Medicaid processing systems that incorrectly denied disabled people coverage in multiple states, including in Michigan, Tennessee, and Texas. Like executives at the other companies, Deloitte’s are supporting Republicans who want to erode the health care system even further. The company’s global CEO Joseph Ucuzoglu, for example, donated nearly $9,000 this cycle to the Deloitte Political Action Committee, which in turn spent $10,000 on billionaire Vivek Ramaswamy, who is the current Republican candidate to become governor of Ohio. Besides spending millions on an attack ad exploiting the documented childhood sexual abuse of his opponent, Democrat Amy Acton, Ramaswamy also has a long history of undermining public health. He believes the creation of Medicare and Medicaid were mistakes, as he told Ezra Klein in 2024. Ramaswamy financially supported convicted biotech securities fraudster Martin Shkreli, and made money by pumping and dumping an Alzheimer’s drug that didn’t work.

(Deloitte’s PAC also paid Deloitte $160,000 for salaries, travel, and administrative expenses, FEC data shows.)

Indeed, Deloitte was involved in a previous failed experiment in Medicaid work requirements. In Georgia, the state gave Deloitte a $90 million contract to help eligible Georgians fill out the relevant paperwork. After two years, the result was … 8,077 enrollments, or 7 percent of the eligible population.

In any event, the historical failures of all five companies should serve as a warning about how they will institute the new work requirements next year, the senators said.

“Our report makes clear that errors and delays in state Medicaid eligibility systems are putting health care coverage at risk for vulnerable Americans while wasting taxpayer dollars,” Warnock said in a statement.

“As states prepare to implement new Medicaid work reporting requirements imposed by Congressional Republicans, these existing problems threaten to create even more barriers for working Americans who depend on this coverage. Our focus must be on making sure that eligible Americans do not lose access to coverage because of failures beyond their control.”