Pa. Medicaid recipients fear potentially devastating cuts

Correction: This story was updated on July 1 at 12:18 p.m. to correct the spelling of Brittanny Groover’s name.

It wasn’t until she was 20 years old and pregnant with her son that Brittanny Groover first applied for Medicaid. Growing up in a working class, western Pennsylvania household before the Affordable Care Act was passed in 2010, Groover’s father was insured through work, but she and her mom weren’t.

“My parents were the people that made just a little too much money to qualify for assistance,” she said. “I don’t recall going to the doctors for checkups. We would only go to urgent care if I had an ear infection or something.”

Once she was covered, the safety net allowed her peace of mind during her pregnancy. And six years later, in 2021, it allowed her to get treatment when she was diagnosed with stage 3a melanoma that spread to her lymph nodes. 

“I looked this up recently, because this has been a big, hot topic,” she said. “One immunotherapy treatment was $42,000. I had to do 18 of them.”

After 18 sessions of immunotherapy and three surgeries, Groover is in remission. And the experience led her to take up advocacy. Last year, she began working with the American Cancer Society’s Cancer Action Network, where she encourages healthy habits and tries to educate people on the importance of Medicaid.

But now, Groover, 31, is worried about what could come next.

She is one of more than three million Pennsylvanians — over one in five people — who are insured through Medicaid. According to the Cancer Action Network she is also among the one in 10 Americans with a history of cancer who are insured through the program, including one in three children newly diagnosed. So, she is paying close attention to whether Congress moves forward with steep cuts to the programs being pushed by the Trump administration.

“I’ve been thinking about this non-stop,” Groover said. “If I lose my Medicaid, and my appointment comes up for a PET scan, I would genuinely be thinking, ‘If I go to that and put myself in debt, then how am I going to pay for food, or put a roof over my head or take care of my son?’ That’s what every single person on Medicaid is dealing with.”

The proposed cuts are part of a sweeping budget bill that will enact many of President Donald Trump’s domestic policy priorities. The proposal, which only needs a simple majority vote, has already passed the U.S. House along partisan lines.

As it stands, senate Republicans spent Monday voting on a series of amendments in an attempt to unite divided factions of their party, with some concerned about the bill’s overall price tag, and others worried about the impacts of cuts to programs like Medicaid and food assistance. If passed, the bill will be returned to the House for a final vote or additional changes

The nonpartisan Congressional Budget Office (CBO) has estimated the bill could result in nearly 12 million fewer Americans having health insurance by 2034. 

At the state level, the commonwealth’s Department of Human Services says cuts could result in more than 300,000 Pennsylvanians losing Medicaid coverage. Another 270,000 could lose access to marketplace plans or face steep premium increases, Val Arkoosh, the department’s head, has said.

Pennsylvania’s 10 Republican congressmen unanimously voted in support of the House version of the bill that passed last month. In a recent town hall, Sen. Dave McCormick, Pennsylvania’s only Republican in the Senate, also signaled support for reining in Medicaid spending. 

McCormick said the aim was not to reduce Medicaid spending from current levels, but to curb the program’s growth and refocus it on helping children, the elderly, the mentally ill and the disabled.

“Medicaid has been spiraling out of control,” he said. “We want to ensure that Medicaid protects the vulnerable people for whom it was designed”

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As the bill stands, this is primarily accomplished through new work requirements that would mandate most Medicaid recipients prove they work or volunteer at least 80 hours a month, or qualify for an exemption. McCormick said the goal is to ensure that healthy, able-bodied adults are not using the service. Critics say it’s a disguised effort to decrease spending by throwing up bureaucratic red tape for people who would otherwise be covered.

The next largest source of cuts would stem from a provision forcing states to lower taxes on health care providers like hospitals and nursing homes that help raise additional funding for Medicaid. The bill would require states to incrementally lower those provider taxes from a maximum of 6% down to 3.5% by 2032. 

Critics of provider taxes say they’re an accounting trick that allows the state to get additional Medicaid match funds from the federal government, with the revenue often returning to the health care providers that paid them in the first place. But defenders say they’ve become a critical source of funding.

The state Department of Human Services said the change could result in $2.7 billion in lost funds when they take full effect in 2032. That includes both the state revenue from the taxes as well as the federal Medicaid matching funds.

‘I felt so helpless’

Patrick Keenan, the director of policy at the Pennsylvania Health Access Network, an advocacy group, says a large majority of people on Medicaid who can work already do.

“Our analysis shows that 4% of folks on Medicaid aren’t working or qualified for an exemption to work requirements,” Keenan said. It’s a number that’s roughly in line with the national unemployment rate.

Moreover, Keenan said that, in practice, work requirements primarily result in a lot of people who should qualify for Medicaid not receiving it. 

“A lot of folks that are working and eligible get cut from the program, because it’s very difficult to get all the documentation, on one hand,” he said. “On another hand, it’s very difficult for all that documentation to be processed correctly, and there’s no additional funding for that — or very little — from Congress.”

Keenan pointed to Arkansas and Georgia, the only two states that have implemented Medicaid work requirements. In Arkansas, the requirement led to thousands losing insurance who previously qualified for Medicaid expansion, an Affordable Care Act program that allowed states to offer Medicaid to low-income adults. Arkansas’ work requirement program ultimately ended in 2019, after a judge declared it “arbitrary and capricious.”  In Georgia, the rollout of a program to offer expanded Medicaid coverage to a small group who could prove they met work requirements resulted in far fewer than expected actually enrolled. While the state estimated 246,000 people would be eligible, only 6,500 ended up actually enrolled, and it ultimately cost more per person to enroll them than it would have in other states that offered blanked Medicaid expansions.

For context, the U.S. House bill’s work requirements would apply to an even larger share of the Medicaid population than Georgia’s.

The CBO estimated that the proposed work requirements alone will result in five million fewer Americans receiving Medicaid by 2034. The report added only a few would likely be able to get insurance through an employer afterward.

The bill would also make it harder for anyone who can’t meet work requirements to get a plan through the federally funded health care marketplace. That’s because they would become ineligible for premium tax credits. Those tax credits are a mechanism in the Affordable Care Act that keeps marketplace prices down for low- and middle-income families. They can be paid directly to an insurance provider to lower monthly costs, and often lower premiums by hundreds of dollars.

But, the burden of ensuring Medicaid recipients all qualify for the program will ultimately fall on the state officials who oversee it. The bill would require Medicaid administrators to ensure enrollees are meeting work requirements at least every six months.

Brandon Cwalina, a spokesperson for the state Department of Human Services, said the new reporting requirements could “create an unprecedented and unfunded increase in the administrative burden on DHS that will strain existing operations and divert resources from mission-critical service delivery across the Medicaid and SNAP Programs.”

Even without that added strain, administrative errors can already lead to people losing health care.

In 2010, Lauren Stuparitz, a Pittsburgh native, was assaulted and suffered a head injury. For years, she struggled to read and concentrate, and was regularly in pain.

After three years, she gave up her teaching job and qualified for Medicaid, which she said helped her receive treatment that otherwise would have been unattainable. While she still suffers side effects, it was an enormous help.

“It’s been lifesaving,” Stuparitz, 40, said of Medicaid. “I feel like people use that word a lot, but I’m not actually sure what else to use because I don’t know if I’d have much of a quality of life without it.”

When her first son was born in 2020, he also received insurance through Medicaid. The safety net has been essential, especially since he was diagnosed with autism.

But, last year, Stuparitz hit a roadblock when she tried to recertify her Medicaid eligibility. 

At the time, she was doing temp work for the U.S. Census Bureau and making more money than usual. She says the Pennsylvania Department of Human Services incorrectly used that temporary pay to determine her annual income. 

As a result, she was told she no longer qualified and that her son was being switched to CHIP, a program for children in households that earn too much to qualify for Medicaid. 

“I felt so helpless, honestly,” she said. “If I have to lose my insurance, that’s fine, but I need my son to be able to get what he needs.”

Her son had come to rely on regular appointments with early development specialists, who she learned didn’t accept his new insurance.

“For kids who are on the spectrum, having the routine is a critical thing,” Stuparitz said. “When things are in flux, it throws them off. It was probably one of the most stressful things I’ve ever had to deal with in my life.”

So for weeks, Stuparitz built up medical debt while she tried to get the situation rectified. She struggled to get through to a person in the Medicaid office who could help, and when she did, she said she was usually told to resubmit documents online.

Eventually, Stuparitz said she was able to prove she qualified for Medicaid, and was also able to bill the insurance for her son’s unpaid appointments.

While Stuparitz doesn’t blame the Department of Human Services or hold a grudge, she worries that what happened to her may become far more common if the amount of bureaucracy for people on Medicaid is increased.

“It’s just something that happens when you have a large system,” Stuparitz said. “But if your income’s not very cut and dry, I think it’s easier to happen. I feel like it has to be common, especially if you’re dealing with people who have a health condition that prevents them from working steady hours.”

A spokesperson for the department did not comment on the specifics of Stuparitz’s case when asked, but said “DHS works diligently to ensure the benefits DHS administers get to the eligible Pennsylvanians who need and qualify for them.”

“If it’s cut, it’s almost going to be like killing people.”

Jennifer Rabe-Coulibaly, 42, has lived her life between Middletown, in Dauphin County, and west Africa. Her parents were missionaries, and she followed in their footsteps. That means traveling back and forth every few months or years. 

Rabe-Coulibaly asked that the specific country not be named because of threats emanating from conflict there.

In 2021, Rabe-Coulibaly married a west African man, Emmanuel Coulibaly. In 2023, after he got a green card, they flew to Pennsylvania, where they’ve been living since. 

Overseas, both can be insured through the mission, but when they came to the U.S., they were unable to afford the premiums themselves. They both applied for Pennie, Pennsylvania’s marketplace option that provides more affordable insurance for low- and middle-income people who don’t qualify for Medicaid.

Almost immediately, they put their plans to use.

For Coulibaly, it meant receiving care for an issue he dealt with almost his entire life. As a child in west Africa, he was injured and his two legs developed to be different sizes. In America, with insurance, he was finally able to get treatment.

Coulibaly’s leg required major surgery and a hip replacement. When he failed to recover properly, he needed another operation.

“Without Pennie, my husband wouldn’t have been able to go through these operations,” Rabe-Coulibaly said. “One of the doctors said if he didn’t, in 10, 20 years, he’d be in a wheelchair.”

Meanwhile, Rabe-Coulibaly had become pregnant, which qualified her for Medicaid.

At 40, this meant more frequent doctor’s visits. At the same time, she was helping her husband recover, and had to go to his doctor’s appointments to translate. He speaks French and is still learning English.

“My (obstetrician), she’s like, ‘You need to take it easy,’” Rabe-Coulibaly said. “I said, ‘I wish, but I can’t.’ It was a lot.”

At eight months, Rabe-Coulibaly developed preeclampsia, and her baby was delivered with a cesarean-section. While both she and her baby are now healthy, things seemed so bad initially, Coulibaly later told her he thought she or the baby was going to die.

“Medicaid literally saved my life and my daughter’s life,” Coulibaly said. “I don’t want to be dramatic, but if it’s cut, it’s almost going to be like killing people.”

The experience has informed her perspective on Medicaid, Pennie and the potential impacts of Congress’ budget bill.

To start with, Rabe-Coulibaly isn’t sure that she’d be able to prove she meets work requirements, given the nature of her job. While in Pennsylvania, Coulibaly works for the mission, answering phone calls and emails, and making presentations at churches.She logs hours and files her taxes as self-employed, but is paid different amounts monthly, depending entirely on donations.

“It would depend on what Medicaid wants as far as documentation,” she said. “What I’ve been doing is just writing down on a piece of notebook paper what I’m doing.”

It’s also opened her eyes to how tenuous health care can be. 

In a previous version of the bill, many legal migrants, like Coulibaly, would have been barred from receiving premium tax credits that help pay for Affordable Care Act plans like Pennie, until they’ve been in the country for five years.

Without the additional funds, Rabe-Coulibaly said, her husband would not have been able to afford insurance.

That part, however, was struck down by the Senate parliamentarian on the grounds that such a move would require 60 votes, and not the 51 allowed by the reconciliation process.

A number of Republicans, as well as Trump, called for the parliamentarian to be overruled, but Senate Majority Leader John Thune (R-South Dakota) and others said they had no intention to do so.

Still, the attempt has been on Rabe-Coulibaly’s mind.

Rabe-Coulibaly understands why people think non-citizens shouldn’t have access to social services generally, but she worries about what the future may hold for legal immigrants like her husband.

“The U.S. has a reputation of welcoming people from other cultures,” Rabe-Coulibaly said. “Part of that welcoming is to help them out in times of need. I’m not talking about taking advantage of the system, because I know there’s that out there, but I’m talking about in times of need, letting people like my husband benefit from some of these programs.”

It’s been another concern that’s kept her watching, like Brittanny Groover and Lauren Stuparitz, as Congress debates the fate of health care programs that all three described as life saving.

“I was never a political person before all this,” Groover said about how she was affected by threats to Medicaid. “I wasn’t even registered to vote until last year.”

It’s one reason Groover wants to share her story, which she does on a YouTube channel and with the Cancer Action Network.

“All these people, they keep saying people are fraudulently on medicaid.” she said. “That is not a real thing that’s happening. I’m the person you’re talking about. I’m not abusing the system. I’m using the system exactly how it was designed, because it’s a lifeline for me.”