The Trump administration’s rule implementing Medicaid work requirements formally takes legal effect Friday, July 31, the same day the public comment period on the nearly 400-page regulation closed. With this deadline, the machinery for the most sweeping restructuring of Medicaid since the program’s founding six decades ago has locked into place, stripping coverage from millions of people.
The vehicle for this liquidation is the “One Big Beautiful Bill Act” (OBBBA), signed into law by President Trump on July 4, 2025. The legislation cuts federal Medicaid spending by an estimated $911 billion over 10 years and is projected by the Congressional Budget Office (CBO) to leave 7.5 million more Americans without health insurance by 2034.
The single largest source of “savings” is the work requirement provision now taking effect, which the CBO estimates will cut $326 billion and strip coverage from 5.3 million adults. The Center on Budget and Policy Priorities warns that as many as 15 million people could be placed at risk once the full apparatus is operating. States are now legally bound to begin building the verification systems that will strip healthcare coverage from millions of working class people and must complete the first round of notices to tens of millions of enrollees by August 31.
This seismic change in how Medicaid benefits are distributed has largely flown under the radar. There has been no primetime address, no congressional showdown, no sustained media coverage. The transformation is being carried out through the gray channels of administrative rule making precisely because its architects understand that the policy is deeply unpopular and its consequences lethal. The Democratic “opposition” has facilitated this broadside against the working class through its refusal to fight Trump’s class war policies and support for the ruling oligarchy’s drive to war that is literally robbing Medicaid recipients of life-saving healthcare services.
Medicaid was signed into law by President Lyndon B. Johnson on July 30, 1965—61 years ago this week—as part of the Social Security Amendments that also created Medicare. Jointly funded by the federal government and the states, Medicaid has grown from an appendage to the Medicare legislation into the largest single source of healthcare coverage in the United States, insuring one in five Americans. As of February 2026, an estimated 74.9 million people were enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), including 35.7 million children. The program pays for 40 percent of all births, covers 60 percent of nursing home residents and is the nation’s largest payer of both behavioral health services and long-term care.
It is this program that President Trump, speaking at a closed White House Easter lunch in April, dismissed—along with Medicare and Social Security—as “little scams.” The federal government, Trump declared, should stop paying for daycare, Medicaid and Medicare because “we’re fighting wars,” insisting that Washington’s only legitimate concern was “military protection.” The remarks, delivered before an audience of Christian nationalist clergy and fascistic political operatives, expressed with unusual candor the priorities now written into policy: Every social obligation of the state is to be liquidated to feed the war machine.
The policy compels adults aged 19–64 enrolled through the Affordable Care Act’s Medicaid expansion to document at least 80 hours per month of work, community service, education or job training—or, alternatively, monthly income of at least $580, the equivalent of 80 hours at the $7.25 federal minimum wage—or lose their coverage. More than 20 million adults are enrolled through the expansion in the 41 states that adopted it. Verification is required at least every six months, with states free to demand monthly reporting.
In one of the legislation’s cruelest provisions, the work rule does not apply to a “parent, guardian, caretaker relative, or family caregiver of a dependent child 13 years old or under or a disabled individual,” but a parent whose youngest child is age 14 through 17 is fully subject to the requirement, same as a childless adult.
The Centers for Medicare and Medicaid Services (CMS) estimates the amount an adult received in recent years in Medicaid expansion funds at $6,000–$6,500 annually. This means the benefit these recipients “earn” for their 80 hours a month, if they can prove their eligibility, works out to somewhere between $6.25 and $6.75 per hour—well below the federal minimum wage of $7.25, and a fraction of any state minimum wage where these people actually live.
These sums must be measured against war spending. The administration is demanding $200 billion for its illegal war against Iran and has advanced a $1.5 trillion military budget proposal for Fiscal Year 2027, up from the roughly $1 trillion level reached last year. The $326 billion to be extracted from Medicaid recipients over an entire decade—purchased with the health and lives of millions—amounts to barely a fifth of what the Pentagon will consume in a single year. The money stripped from the sick does not disappear; it flows upward through the tax provisions of the same legislation to the corporations and the financial oligarchy, and outward into war.