Pennsylvania state officials estimate that 570,000 Pennsylvanians could lose access to health insurance, if the Trump administrations “Big Beautiful Bill” passed as written.

The Pennsylvania Health Access Network hosted a webinar today to discuss the topic with the Department of Human Services secretary and the executive director for Pennie.

The federal legislation, which is currently being discussed in the U.S. Senate, would enact work requirements for able-bodied adults aged 19-64 on Medicaid. There are some exemptions. Proof of work status would be filed every 6 months. The Pennsylvania Department of Human Services says around 300,000 people currently enrolled in Medicaid could be at risk of getting pushed off Medicaid if they don’t meet the work requirements.

The Kaiser Family Foundation reports that of the people on Medicaid who would be impacted by work requirements: 64% work full or part time, 12% don’t work because they are caregivers, 10% have an illness or disability, and 7% attend school. 

The remaining 8% said they were retired, unable to find work, or not working for a different reason.

There are 3 million people on Medicaid in Pennsylvania. Around 1.4 million children and youth (0-21) are on Medicaid.

One work requirement exemption is for able bodied adults who are caring for a disabled or dependent child. Parental status alone is not an exemption. The Pennsylvania chapter of the American Academy of Pediatrics says if parents lose Medicaid coverage, it is much less likely for their child to be enrolled in health insurance— even if child specific options are available.

“No health insurance means no access to health care,” said Dr. Priscilla Mpasi, a primary care pediatrician who practices in Pennsylvania. “They can’t get in for a wellness check up, they can’t afford medications, parents might have to pay expensive out of pocket costs for medical emergencies."

“We need to put the focus back on what's happening with the kids,” said Dr. Toni Richards-Rowley, vice president of the Pennsylvania Academy of Pediatrics. "They're not ok, and we need them to be ok."

In addition, the bill ends a Pandemic era tax credit for people using Pennie— the state’s public insurance market place. Devon Trolley, executive director of Pennie, says around 150,000 Pennsylvanians might cancel their Pennie health insurance plans because they can’t afford them without the tax credit.

Without the tax credit, the average plan would increase by 82%. So a $300 a month plan would jump to $550 a month.

For both Medicaid and Pennie programs, the Big Beautiful Bill increases other administrative burdens on government workers and those applying for assistance.

Dr. Val Arkoosh, secretary for the Pennsylvania Department of Human Services, says she would need to hire 400-500 more employees to process work requirement paperwork. The department would also need a new IT system to manage the flow of data, which could cost around $25 million.

Trolley said Pennie’s cost of operations would increase by around 10% to manage administrative process— like plans not being allowed to be auto renewed. For Pennie, increased administrative burdens lead to eligible people not finishing the application process.

“There will be a really significant impact to how many extra steps people have to go through, to get their coverage to prove they're eligible,” Trolley said. "When we can already verify electronically. What we see is that every step you add, people drop off along the way.”

That administrative deterrence, among a few other policy changes, makes up the rest of the people state officials estimate will lose health insurance.

“Cuts to Medicaid and cuts to Pennie will harm every single Pennsylvanian,” Arkoosh said. The human services secretary says when people are uninsured, it drives up healthcare costs.

Without health insurance, people don’t go to the doctor for preventive check ups— and instead wait till they have a health issue serious enough for an emergency room.

“When hospitals see patients who don't have health insurance, they have no choice but to shift the cost of the care that they're providing to people who do have health insurance,” Arkoosh said. “To the people who can pay. And that translates into higher insurance premiums for private plans and employer based premiums.”

The United States government spent $6.8 trillion in 2024; they had a budget deficit of $1.8 trillion.

Republicans say they want to balance the budget— but their policy goals limit where they can turn to for savings. The caucus wants to keep taxes low for businesses, which will bring in less money. Military spending is the largest expense in the federal budget, but some Republicans are pushing to spend more in that area.

The second biggest expense in the federal budget is social welfare programs. This is where Republicans have turned to for savings, with some of the largest cuts coming to Medicaid and the Supplemental Nutrition Assistance Program (SNAP).