How Medicaid work requirements have failed before

Summary

Apple News Today: How Medicaid Work Requirements Have Failed Before

Release Date: June 30, 2025
Host: Shemitah Basu

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1. Republican Tax and Spending Bill: Narrow Passage and Controversies

The Senate narrowly advanced the Republican tax and spending bill with a 51-49 vote on Saturday night. This close vote set the stage for extended debates, as Senate Democrats insisted on reviewing the entire 940-page bill on the Senate floor. The effort to read the bill spanned through the night and into Sunday afternoon, highlighting the deep divisions not only between Democrats and Republicans but also within the Republican ranks themselves.

Economic Impact and Opposition: The Congressional Budget Office (CBO) projected that the bill would increase the national debt by $3.3 trillion over the next decade. Only two Republican senators opposed the bill: Rand Paul of Kentucky, citing concerns over the national debt, and Tom Tillis of North Carolina, who was worried about the loss of funding critical to his constituents.

In a critical moment during the debate on Sunday night, Tillis expressed his discontent:
Tom Tillis (Senate Floor, [04:05]): "The president is breaking his promise on Medicaid."

Following President Trump's declaration to support a primary challenger aimed at unseating Tillis, the senator announced he would not seek reelection. Tillis criticized the declining presence of independent thinkers within the party, stating,
Tom Tillis ([04:05]): "Independent thinkers are becoming an endangered species."

2. Medicaid Work Requirements: Structural Issues and Past Failures

A cornerstone of the bill involves creating work requirements for Medicaid recipients, a measure supported by Tillis. The intent is to prevent abuse of the program and ensure that assistance is directed to those in genuine need.

House Bill vs. Senate Proposal: Gene Whalen, economics reporter with the Wall Street Journal, elucidates the House's stance on work requirements:
Gene Whalen ([02:02]): "Republicans want to create work requirements for Medicaid... ensuring that it would be available for those that truly need it."

Detailed Structure: Ben Summers, Harvard Economist ([02:22]): "Most childless adults without disabilities between the ages of 19 and 64 would need to spend 80 hours a month either working or engaging in job training or community service in order to qualify for Medicaid and in order to keep their Medicaid if they already have it."

Exceptions:
There are exemptions for parents of minor children, individuals with substance use disorders, and a few other specific groups.

Implementation Challenges: Historical attempts to implement such requirements have faced significant hurdles. In Arkansas, a program introduced in 2018 was swiftly halted by a judge and eventually scrapped due to technical and bureaucratic issues. According to Summers:
Ben Summers ([03:12]): "We didn't see a big leap in employment in that population. Many of the people in the intended population were already working or meeting the requirements in some other way."

Technical glitches further exacerbated the situation:
Ben Summers ([03:48]): "Believe it or not, the website wouldn't accept submissions after a certain time of night like the website shut down, which I didn't realize is a thing websites could do. But that is what happened."

A similar scenario unfolded in Georgia with a pilot program launched in 2023, where only about 8,000 of the projected 25,000 people enrolled within two years, falling far short of expectations.

National Implications: A national analysis by the Health Policy Research Organization KFF revealed that as of 2023, 44% of Medicaid recipients under 65 were working full-time, and 20% were working part-time. The CBO estimates that the House bill's work requirements could affect over 18 million low-income adults, with more than 5 million likely to lose coverage within a decade. Additionally, the Senate bill's provisions could lead to even greater cuts and increased numbers of uninsured Americans.

3. Supreme Court Ruling on Birthright Citizenship: Legal Uncertainties Loom

On Friday, the Supreme Court delivered a 6-3 ruling favoring the Trump administration's stance on birthright citizenship. However, the decision did not directly address the constitutionality of the executive order aimed at ending a citizenship right entrenched in the Constitution for over 150 years. Instead, the Court limited federal judges' ability to issue nationwide injunctions that could block executive actions.

Expert Analysis: Ankush Kodori, legal affairs columnist for Politico and former federal prosecutor, commented on the ruling:
Ankush Kodori ([06:07]): "There are a lot of moving pieces and variables that could affect the way that this all unfolds."

Immediate Consequences: The ruling will not take effect for 30 days, creating a window of uncertainty as legal experts and advocates navigate the implications. Kodori anticipates a surge in legal maneuvers from both plaintiffs and the government:
Ankush Kodori ([06:17]): "I think actually this week we could see sort of a flurry of moves on the part of both the plaintiffs and the government as they sort of try to reckon with this ruling."

Class Action Suit Adjustments: In response to the ruling, civil rights groups are restructuring their class action lawsuits to align with the new legal framework. Individual states, such as New Jersey, are pushing for nationwide injunctions rather than state-specific ones to ensure comprehensive relief for affected individuals. Kodori explains:
Ankush Kodori ([06:52]): "They need a nationwide injunction. Because people move in and out of states all the time... a localized state-specific injunction will not provide them with the complete relief that they require."

Potential Nationwide Impact: If subsequent litigation does not alter the current legal landscape within the 30-day grace period, Trump’s executive order could be enforced across 28 states that have not directly challenged it. This would result in disparities where children born in certain states could be denied constitutional citizenship rights, reminiscent of the fragmented abortion rights landscape post-Roe v. Wade.

4. Florida’s Alligator Alcatraz: Environmental Concerns and Political Resolve

Florida is expediting the construction of a new immigration detention center, infamously dubbed Alligator Alcatraz, located on an environmentally sensitive airstrip deep within the Everglades. The 1,000-bed facility is set to open imminently, with infrastructure such as trucks with portable restrooms and industrial generators already on-site.

Public and Environmental Backlash: Environmental activists have raised alarms about the facility’s impact on the Everglades.
Daniel Mlotozenich ([08:53]): "It's not good for the water. It's not good for the wildlife and the habitats... it totally undermines and undoes a lot of the brilliant restoration work that's been going on."

Governor DeSantis’s Commitment: Despite protests, Governor Ron DeSantis is moving forward using emergency powers to fast-track the project. Miami Herald reporter Ana Ceballos provides insight into the governor’s motivations:
Ana Ceballos ([09:19]): "He has tried to do really everything he can to make the Trump agenda a functional agenda in the state."

Operational Details and Costs: The facility is projected to cost around $450 million annually, with the state eligible for reimbursement from the federal government via the Department of Homeland Security. The inclusion of a functioning runway indicates potential uses beyond detention, although primarily intended for training and practice flights.
Ana Ceballos ([10:39]): "The facility in the Everglades does have a functioning Runway... state officials have expressed an interest in doing that."

Security Measures: The Florida National Guard is deploying approximately 100 soldiers to secure the site, underscoring the state’s commitment to integrating this facility into broader federal immigration enforcement efforts.

5. Additional News Highlights

a. Idaho Firefighter Ambush: A Tragic Attack Two firefighters were killed, and another remains critically injured after being ambushed by gunfire while responding to a blaze in Coeur d'Alene.
Kootenay County Sheriff Robert Norris ([12:00]): “We believe that there was only one shooter. We do believe that the suspect started the fire, and we do believe that it was an intentional ambush.”

Over 300 law enforcement officers, including federal agents, were involved in the hours-long gunfight that ultimately led to the discovery of the suspect’s body. Governor Brad Little expressed his devastation, calling the attack a "heinous assault."

b. Iran’s Nuclear Program Post-US Strikes Rafael Grossi, head of the UN's nuclear watchdog, indicated that Iran could resume enriching uranium within months following recent American strikes, contradicting President Trump’s assertions that Iran’s nuclear capabilities had been entirely dismantled.
Rafael Grossi ([13:15]): “At some point the IAEA will have to return, although our job is not to assess damage, but to reestablish the knowledge of the activities that take place there.”

c. Beyoncé’s Mid-Show Flying Car Malfunction During a stadium concert in Texas, Beyoncé experienced a malfunction with her flying car, cutting her performance short as the vehicle began to tilt. Despite the disruption, she adeptly continued her show:
Beyoncé ([14:26]-[14:41]):
"I want to thank y'all for loving me. If ever I fall I know y'all catch me."

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Conclusion

In this episode of Apple News Today, host Shemitah Basu delves into the contentious Republican tax and spending bill, highlighting the failed history of Medicaid work requirements and the potential nationwide ramifications of the Supreme Court's recent ruling on birthright citizenship. Additionally, the episode covers Florida's controversial Alligator Alcatraz detention center project, a tragic ambush of firefighters in Idaho, developments in Iran’s nuclear program, and an unexpected incident during Beyoncé’s concert performance. Through in-depth reporting and expert analysis, the episode provides listeners with a comprehensive overview of these significant and diverse news stories.

For more detailed coverage and updates, listeners can access the full episode on the Apple News app.

Transcript

[Shemitah Basu]

Good morning. It's Monday, June 30th. I'm Shemitah Basu. This is Apple News today. On today's show, the fallout from the Supreme Court's ruling on birthright citizenship. Florida gets to work on a detention center dubbed Alligator Alcatraz. And Beyonce was left dangling mid air during a stadium show when her flying car malfunctioned.

[Gene Whalen]

But first, the latest on the Republican tax and spending bill. The Senate narrowly voted to advance it on Saturday night by 51 to 49 votes. That led to Senate Democrats insisting on reading the entirety of the 940 page bill on the Senate floor, a marathon effort that spanned through the night and into Sunday afternoon before giving way to debate. All this comes as there's still significant discord over the bill's proposals, even among some Republicans. Over the weekend, the independent Congressional Budget Office estimated the bill will add $3.3 trillion to the national debt over the next decade. Only two Republican senators voted against the bill, Rand Paul of Kentucky, who said he was concerned about the national debt, and Tom Tillis of North Carolina, who cited concerns over the loss of funding for his constituents. After Trump made it clear that he would back a primary challenger to push Tillis out, Tillis announced his decision to not seek reelection, saying that independent thinkers were becoming an endangered species. During debate on the Senate floor on Sunday night, Tillis attacked planned cuts to money states get to fund Medicaid and said the president was breaking his promise on Medicaid.

[Daniel Mlotozenich]

But I'm telling the president that you have been misinformed. You supporting the Senate, Mark, will hurt people who are eligible and qualified for Medicaid.

[Gene Whalen]

Republicans want to create work requirements for Medicaid, a measure Tillis actually supports, arguing that it would stop abuse of the program and ensure that it would be available for those that truly need it. Gene Whalen is an economics reporter with the Wall Street Journal. She told us about how the work requirements that passed in the House version of the bill are structured.

[Ben Summers]

Most childless adults without disabilities between the ages of 19 and 64 would need to spend 80 hours a month either working or engaging in job training or community service in order to qualify for Medicaid and in order to keep their Medicaid if they already have it. There would be some exceptions for parents of minor children for people with substance use disorders, and a few other groups would be exempt.

[Gene Whalen]

The Senate version has included a similar proposal. While lawmakers in Washington debate this point, Whelan has been looking at states that have already taken this approach and what lessons we can learn from them. In Arkansas, there was a short lived program that began in 2018 that introduced work requirements. It was halted by a judge the following year before it was scrapped.

[Ben Summers]

There was a lot of evidence that many, many people were losing their Medicaid and the employment rates within the intended group didn't really change much. We didn't see a big leap in employment in that population. That's according to a Harvard economist, Ben Summers, who studied the program there in Arkansas and found that many of the people in the intended population were already working or meeting the requirements in some other way.

[Gene Whalen]

There were also major technical and bureaucratic problems with the plan. For example, residents had a difficult time reporting their work status on the state websites.

[Ben Summers]

Believe it or not, the website wouldn't accept submissions after a certain time of night like the website shut down, which I didn't realize is a thing websites could do. But that is what happened.

[Gene Whalen]

Another pilot program that began in Georgia in 2023 is having similar issues with the challenge of monthly reporting requirements.

[Ben Summers]

The enrollment has been pretty dismal compared with what the state was projecting. So they projected 25,000 people would enroll in the first year and they had as of the two year mark, only about 8,000 people enrolled. So it's been far of even the state's expectations.

[Gene Whalen]

The Republican governors of Arkansas and Georgia stand behind the idea of creating work requirements for Medicaid, but the Journal reports that both states are in the process of easing those requirements due to low enrollment and problems with the program. And on the national level, the data shows that many people who can work do. According to a national analysis done by the health Policy Research Organization KFF, 44% of Medicaid recipients under the age of 65 were working full time in 2023, and about 20% were working part time. The Congressional Budget Office has estimated that the work requirements imposed in the House bill would apply to over 18 million low income adults, with more than 5 million likely to lose coverage in the next decade. And on Saturday, the CBO said that the overall Medicaid changes in the Senate bill would lead to even deeper cuts and more Americans becoming uninsured than the House vers.

[Shemitah Basu]

Legal experts and advocates are still sorting through how Friday's major Supreme Court ruling on birthright citizenship could impact the future of citizenship in this country. The 6:3 ruling in favor of the Trump administration's position did not directly rule on the constitutionality of his executive order seeking to end a right that has been part of the Constitution for more than 150 years. Rather, the court issued a ruling that limited the ability of federal judges to issue nationwide injunctions, which have been used to block executive actions in the past. The Supreme Court ruling will not take effect for 30 days, but the legal landscape ahead is uncertain.

[Ankush Kodori]

There are a lot of moving pieces and variables that could affect the way that this all unfolds.

[Shemitah Basu]

That's Ankush Kodori, legal affairs columnist for Politico and a former federal prosecutor.

[Ankush Kodori]

I think actually this week we could see sort of a flurry of moves on the part of both the plaintiffs and the government as they sort of try to reckon with this ruling.

[Shemitah Basu]

Now, the Supreme Court did provide a carve out of sorts for different legal challenges via class action suits. And in the hours after the ruling, a number of civil rights groups did exactly that, reconfiguring their cases around the new legal outlook. Individual states like New Jersey are also saying that lawyers representing them are likely to continue to push for a nationwide reprieve from the executive order order. Kadori explained some of the logic there.

[Ankush Kodori]

They've said that they cannot proceed simply on an injunction that applies within their state. They need a nationwide injunction. Because people move in and out of states all the time. And because of the implications for the order on the state government's mechanisms, a localized state specific injunction will not provide them with the complete relief that they require.

[Shemitah Basu]

If additional litigation doesn't change the current legal landscape in the next 30 days, Trump's executive order could take effect in the 28 states that have not directed directly challenged it, meaning that, practically speaking, children born in different parts of the country might be denied a constitutional right that others would have.

[Ankush Kodori]

You can't have a situation in place where the order only applies to certain states and not to residents of other states. And that would be a very messy situation. Now, we've seen this in other contexts already, right? With the overruling of Roe, we have a patchwork of abortion rights now in this country.

[Shemitah Basu]

On Friday, President Trump and his attorney general, Pam Bondi, celebrated the Supreme Court ruling as a victory, but largely dodged questions about how such an executive order would be enforced. As part of a nationwide class action lawsuit filed on Friday, the ACLU is seeking to create a protected class of children who could be impacted by the order at birth. And now on to Florida, which is racing ahead with building a new immigration detention center on an airstrip tucked deep into the Everglades, dubbed by officials Alligator Alcatraz. It's been reported that the 1,000 bed facility will open within days on environmentally sensitive land owned by Miami Dade County Trucks with portable restrooms and industrial generators began arriving last week to start work on the facility. Over the weekend, protesters assembled on a highway that runs through the Everglades as dump trucks with materials passed through. Daniel Mlotozenich explained to the AP why he was there.

[Daniel Mlotozenich]

It's not good for the water. It's not good for the wildlife and the habitats. Why is it here? It totally undermines and undoes a lot of the brilliant restoration work that's been going on and has been so heavily funded through the years. And it doesn't. It shouldn't be here.

[Shemitah Basu]

But Governor Ron DeSantis is determined to make it happen and has fast tracked the project under an emergency powers act. Here's Miami Herald reporter Ana Ceballos, who covers politics and immigration.

[Ana Ceballos]

There's wildlife all around. There's a lot of alligators, a lot of pythons, mosquitoes that are, you know, maybe not the size of fish, but they're pretty large.

[Shemitah Basu]

The harsh optics of a detention facility surrounded by hostile elements is meant to send a message to migrants who are in the country illegally. You can choose to self deport or else be sent to a facility like.

[Ana Ceballos]

This when you feel the hostility in the environment and just the conditions that detainees would be held in. It's also so the middle of summer in Florida. It's hot. It's not a pleasant environment to be in.

[Shemitah Basu]

DeSantis has been outspoken about wanting Florida to play a bigger role in the Trump administration's aggressive deportation policy. He and other Florida lawmakers have been lobbying the federal government to give them the authority to detain, house, and deport immigrants.

[Ana Ceballos]

He has tried to do really everything he can to make the Trump agenda a functional agenda in the state. He has pushed local and state police to participate in a federal immigration program known as 287, for example, that pretty much deputizes local officers to be able to perform some of the duties of federal immigration agents.

[Shemitah Basu]

Ceballos reported that Florida will run the facility at a cost of around $450 million annually, though the state will be able to seek reimbursement from the federal government, according to the Department of Homeland Security.

[Ana Ceballos]

We are seeing a more proactive collaboration, if you will, and DeSantis not only having a role with the enforcement on the ground, but also the detention and possibly the deportation of these individuals. Because the facility in the Everglades does have a functioning Runway. What we know is that descientists and state officials have expressed an interest in doing that.

[Shemitah Basu]

While the Runway is mostly used for training and practice flights, the state attorney general has claimed that it could accommodate large planes. Starting this week, the Florida National Guard is expected to deploy around 100 soldiers to secure the site. Before we let you go, a few.

[Gene Whalen]

Other stories we're following. Two firefighters in Idaho were killed and another is fighting for his life after being ambushed by gunfire while responding to a blaze in the mountainous city of Coeur d' Alene, which authorities say they do not believe. Stars. Here's Kootenay County Sheriff Robert Norris speaking with reporters last night.

[Daniel Mlotozenich]

Based on the information that we've been able to collect, we believe that there was only one shooter. We do believe that the suspect started the fire, and we do believe that it was a ambush and it was intentional. These firefighters did not have a chance.

[Gene Whalen]

Over 300 law enforcement officers rushed to the scene and a gunfight lasted several hours. Eventually, with the help of federal agents, responders pinpointed a mobile phone signal to find the dead body of a man with a firearm nearby. Governor Brad Little said he was heartbroken by the news and described the attack as a heinous assault. Because of the protracted gunfight, firefighters were delayed in tackling the fire itself, which had burned over 20 acres of land on Sunday night. As of this morning, authorities have not released information about the victims or the suspect. In international news, the head of the UN's nuclear watchdog said that Iran could begin enriching uranium within months following American strikes on the country. This contradicts President Trump's claims that Iran's nuclear sites had been completely destroyed. In an interview on cbs, the head of the UN watchdog group, Rafael Grossi, said that at some point they would have to return to Iran to inspect more.

[Rafael Grossi]

I think we can speculate still until of course, the Iranians themselves will have to go there and sift through the the rubble and look at what is the exact degree of the damage. At some point the IAEA will have to return, although our job is not to assess damage, but to re establish the knowledge of the activities that take place there.

[Shemitah Basu]

His comments appear to align more with an early assessment from within. The Pentagon reported in CNN and other outlets that the strikes did not fully wipe out Iran's nuclear capabilities. And finally, Beyonce may deliver a stadium show like no other.

[Gene Whalen]

But she was forced to hit the.

[Shemitah Basu]

Brakes mid show in her home state of Texas. As the flying car she entered on began to tilt. Beyonce was singing her song. Sixteen carriages on top of a red Cadillac prop hoisted high above her fans. But as you'll hear in a video captured by concertgoers, she cut the song short after detecting that something was wrong. Stop, stop, stop, stop, stop, stop. She was slowly lowered to the ground and like a pro, went on with the show.

[Beyonce]

I want to thank y' all for.

[Rafael Grossi]

Loving me.

[Gene Whalen]

If ever I fall I.

[Ben Summers]

Know y' all catch me.

[Shemitah Basu]

You can find all these stories and more in the Apple News app. And if you're already listening in the news app right now, stick around. For the latest episode of Apple News in Conversation, I speak with journalist Megan Greenwell about how private equity has crept into seemingly every corner of American life. From taking over retail chains to hospitals, even housing.

[Beyonce]

Private equity guys sell themselves as these sort of swashbuckling heroes who are willing to take the risks nobody else will take to save these companies. It's almost like a heroic thing, even though they are also making gazillions of dollars off of it. And the truth of the matter is, the more you read, the more you realize there's no risk for them at all.

[Shemitah Basu]

If you're listening in the podcast app, follow Apple News in Conversation to find that episode. And I'll be back with the news tomorrow.