Republicans say Medicaid work requirements target the lazy. Here’s who could be collateral damage in Colorado. ...Middle East

GREELEY — On paper, Lydia Cruz appeared to be exactly the kind of person congressional Republicans say they want to remove from Medicaid: a jobless, childless adult without a disability.

In reality, her situation could not have been more different.

A genetic connective tissue disorder left Cruz, now 33, too fatigued to finish even her part-time shifts as a barista in 2020. The most basic movements, like flushing the toilet and swatting a gnat, pulled her muscles and dislocated her joints. Her fingers became too sore too quickly to finish the artwork she sold.

For two years, Cruz navigated the labyrinth of government paperwork to acquire a disability designation, which comes with modest monthly payments and more robust public health care coverage.

While she waited for the government to review her proof, she regularly visited a physical therapist to move her joints back into place and an occupational therapist to maintain strength in her hands so she could continue to make artwork for sale.

Medicaid covered the costs.

Now, Republicans are proposing work requirements for Medicaid they say will get lazy Americans off the couch and into the office, protecting the program for those who really deserve it.

Had the work requirements Republicans are proposing been in effect for the two years while Cruz was waiting on the designation, she likely would have lost Medicaid coverage, right at a time when she needed medical care the most.

“If I didn’t have access to the care that I needed, it’s not a major extrapolation to say that I would currently be in a wheelchair,” she said on a recent weekday at her book- and art-filled apartment just a few blocks from the University of Northern Colorado in Greeley. 

“Expecting people to be able to work, and if they can’t work, cutting their access to the thing that could help them be able to work doesn’t make any sense.”

Paperwork is the point

Medicaid, started in the 1960s, provides government-funded health insurance to poor adults and children. The program has saved tens of thousands of lives since the government expanded it to include more poor adults, like Cruz, in 2010.

The work requirements touted by House Republicans as part of the “One Big Beautiful Bill Act” would force childless adults ages 19-64 without disabilities on Medicaid to prove that they have worked, volunteered or attended school for at least 80 hours in the month before enrollment. Certain people can apply for exemptions, including those who can prove they are “medically frail.” A proposal from Senate Republicans would subject more people to the requirements, including some parents.

Republicans say they are cutting only the “waste, fraud and abuse” from Medicaid.

“It’s able-bodied, working-aged adults with no dependents who choose not to work, volunteer or go to school part time, but that is their choice,” said Rep. Gabe Evans, a Fort Lupton Republican, at a news conference last month. “They 100% are in the driver’s seat.”

Evans and the three other Colorado Republicans in the U.S. House, Lauren Boebert of Windsor, Jeff Hurd of Grand Junction and Jeff Crank of Colorado Springs, voted for the bill when it cleared the House in June, while all four Democratic representatives from Colorado voted against it.

The Senate passed its version Tuesday morning; Colorado senators, both Democrats, voted against it.

Now back in the House, it’s not clear how Colorado’s four Republican representatives will vote — and they haven’t said. President Donald Trump wants Congress to pass the bill by Friday.

The Congressional Budget Office, a nonpartisan, independent agency that is part of the legislative branch, estimates about 5.2 million people would lose Medicaid coverage over the next 10 years because of the work requirements in the House version.

But there are only about 300,000 people subject to the requirements who could work and are choosing not to, studies from the Urban Institute and Brookings Institution show. 

Colorado’s Department of Health Care Policy and Financing, which administers Medicaid, estimates about 377,000 people in Colorado would have to prove they meet the requirements.

The Center on Budget Policy and Priorities estimates that 185,000 to 289,000 people in the state would lose Medicaid coverage by 2034 due to work requirements. 

Most of those who would lose coverage would be eligible for the program but would fail to comply with the added paperwork, studies show. And there is no evidence that Medicaid work requirements actually get more people to work.

“The work requirements are going to make the process for everybody who relies on Medicaid harder,” said Adam Fox, deputy director of Colorado Consumer Health Initiative, a liberal-leaning nonprofit. “That is what they are counting on, that is how they’re achieving savings. It is kicking people off who are eligible but can’t make it through the administrative hurdles.”

That’s exactly what happened in Arkansas.

Research from Benjamin Sommers, a doctor and a professor of health policy and economics at Harvard University, shows that after Arkansas implemented more lenient work requirements in 2018, about 18,000 people lost coverage, mostly because they did not understand the requirements or know about them, and the number of poor people in Arkansas who were working did not increase.

“It sounds good on paper: ‘We’re going to make sure everyone in Medicaid is working,’” Sommers said. “The reality is, if they can, nearly all people in Medicaid already are working, and what you’re doing instead is creating this wasteful administrative system of red tape and taking coverage away from people who really need it.”

The mass Medicaid exodus would mean about $280 billion to $317 billion in savings for the federal government over 10 years, the CBO estimates, part of the bill’s larger unprecedented cut to the public health insurance program.

The money saved would partially fund tax cuts in the bill that overwhelmingly benefit the wealthiest Americans.

Health care experts warn the Medicaid cuts would lead to tens of thousands of preventable deaths.

Caroline Creager, Cruz’s physical therapist in Berthoud, said most of her patients with Cruz’s condition wait years to get their disability designation. Losing Medicaid would be “catastrophic” for them, Creager said.

“Without proper care they could easily be bed-bound the majority of the time,” she said.

Prove you deserve it (over and over)

Like most healthy young people, Cruz said she rarely visited the doctor after graduating from college in 2014. She moved home to Greeley and began working part-time as a barista, a job that did not come with health insurance. Her low income qualified her for Medicaid. 

Adults in Colorado can qualify for Medicaid if their income is less than around $21,000.

Everything changed one day in 2018 when Cruz woke up with her forearms covered in swollen bruises after months of persistent back pain.

Two visits to specialists later and she had a diagnosis: hypermobile Ehlers-Danlos syndrome, a genetic connective tissue disorder that causes unstable joints, chronic pain and fatigue, among other symptoms, and results in unpredictable injuries.

Still, Cruz continued to work brewing coffee and selling her art until even part-time hours left her couch-bound for the remainder of the day. Injuries piled up.

One time, after lifting her arm to massage her neck, one of Cruz’s vertebrae dislodged, sending a lightning-like pain through her spine. Another time, back pain became so severe that for two weeks, Cruz was unable to sit up, walk or stand for longer than a few minutes. An MRI years later would reveal that a disc in her lower spine had disintegrated.

She stopped working in 2020. The government officially designated her disabled in 2023. Medicare, a similar program for people with disabilities and elderly people, now covers about 80% of her medical costs, while Medicaid covers 20%.

Cruz already spends much of her time proving she deserves Medicaid. Every year, she submits “mountains of paperwork” about her condition to the government to requalify. And her medical specialists require her to requalify for their care as frequently as every three months. She estimates in the last year she drove about 3,000 miles to doctor’s appointments and attended about 130 virtually and in-person.

Each time she opens her Medicaid portal on the state’s website, she’s struck by a terrifying spike of anxiety that the page will say “closed,” instead of “active.”

Because one time it did.

When the government ended the pandemic emergency declaration in 2023 and required people on Medicaid to requalify, Cruz submitted her paperwork early.

Still, she said she received a notice she would be losing coverage. When she called, the case manager said her application was complete, but had not yet been reviewed. The system was overwhelmed.

Cruz was faced with an impossible choice: cancel an upcoming surgery to place a stent in her iliac vein that had severely compressed or go into debt.

She went ahead with the surgery because her parents were able to front her the money: about $1,800. She said her Medicaid was reinstated the next day but it took about nine months to get reimbursed.

She worries about a system that is predicated on people having family help when impossible decisions like this arise. As a highly educated person with no kids in a stable housing situation, she’s uniquely positioned to be able to navigate the system. 

And still, she failed.

“Even if you … do everything that you’re supposed to do, you could still get kicked out because there isn’t the infrastructure to support the current amount of paperwork that everybody has to submit for Medicaid, let alone double or triple,” she said.

Based on Arkansas’ experience, Colorado estimates the state would have to spend about $57 million per year to administer work requirements. Cruz would rather see more investment in the program.

“This idea that people just want to game the system,” she said, sighing. “Instead, maybe they just need help.”

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