Republican lawmakers may be looking at substantial cuts to Medicaid in upcoming reconciliation legislation.

But one method of restricting access to coverage — work requirements — could have disastrous results for Americans, based on efforts in Arkansas and Georgia to implement such policies, according to a new report issued by Sen. Raphael Warnock, D-Ga. Those rules typically require people to meet certain thresholds, such as a set number of hours of work per month, to qualify for Medicaid coverage.

While labeled as “work requirements,” they would be more correctly called “work reporting requirements” because they involve so many rules, forms and other red tape that they can prevent working Americans from accessing coverage, according to Warnock.

“These work reporting requirements are not incentivizing work; there’s no evidence of that,” Warnock said in an interview with CNBC.com.

“What we see is that this is a good way to kick a lot of people off of their health care — hardworking everyday Americans who are struggling,” Warnock said.

A Republican House budget resolution included about $880 billion in spending cuts through 2034 from the House Energy and Commerce Committee. In a March report, the Congressional Budget Office found Republicans cannot achieve their budget goals without cutting Medicaid.

House Republicans on Sunday released draft legislative language of the reconciliation bill. Work requirements are among the eligibility policies on the table.

Based on the current proposal, 9.7 million to 14.4 million people would be at risk for losing Medicaid coverage in 2034 if they are unable to show they meet the work requirements, according to a new report from the Center on Budget and Policy Priorities.

Rep. Brett Guthrie, R-Ky., who is chairman of the House Committee on Energy and Commerce, wrote an op-ed for The Wall Street Journal in support of the work hurdles.

“When so many Americans who are truly in need rely on Medicaid for life-saving services, Washington can’t afford to undermine the program further by subsidizing capable adults who choose not to work,” Guthrie wrote in the op-ed published on Sunday.

“That’s why our bill would implement sensible work requirements,” Guthrie wrote.

Those requirements would be in line with current policies, according to Guthrie, where working adults, seniors on Medicare and veterans have all worked in exchange for health coverage eligibility.

However, Warnock argues that thinking is backwards. By providing health care coverage without those requirements, that will then help encourage people to work because they are getting the care they need to be healthy, he said.

“If you provide basic health care to the people who are eligible, you actually have more people working,” Warnock said. “You have a stronger economy.”

Georgia Gov. Brian Kemp and some other state Republicans have spoken about the program as a success.

Georgia is among the states that opted not to expand Medicaid, and therefore make coverage more accessible, following the passage of the Affordable Care Act.

Meanwhile, Arkansas did implement Medicaid expansion in 2014 and subsequently put work requirements in place from 2018 to 2019. However, those efforts failed, with 18,000 people losing Medicaid coverage in the first seven months and only a small share of people able to get coverage back the following year, according to a 2023 report from the Center on Budget and Policy Priorities.

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Low compliance with work requirements may come from a variety of factors that have nothing to do with employment, according to research from the Urban Institute. That may include limited access to the internet or transportation, health limitations or disabilities and low education levels.

Others may simply not quite meet the requirements their states have set out.

That is the case for Heather Payne, 52, of Dalton, Georgia, who suffered a series of strokes in 2022. As a result, Payne can no longer work as a traveling nurse and has opted to enroll in graduate school to become a nurse practitioner, a role that will be less physically grueling.

“I really do love nursing so much, and I cannot continue to do it the same way that I used to do it since my strokes,” Payne said.

While Payne is considered a full-time student, she is just short of the hours to qualify for Medicaid under Georgia’s work requirements. As a result, she is paying for private health care coverage with her tuition, which is adding to the debts she will have to pay off once she graduates.

Because her health insurance plan doesn’t cover all her care, she estimates she’s incurred “tens of thousands of dollars” in medical debt.  

Payne, who said she is “not very savvy on politics,” attended President Joe Biden’s 2024 State of the Union Address in Washington, D.C., as Warnock’s guest in an effort to draw attention to the coverage gap.

The U.S. is one of the few industrialized countries without universal health coverage, which is “really kind of embarrassing,” Payne said.

“And instead of trying to go toward that, we’re trying to yank it away from everyone possible,” Payne said.

The Social Security cost-of-living adjustment for 2026 is on pace to be the lowest annual benefit increase in five years, according to new estimates.

But that may change depending on the pace of inflation in the coming months.

The 2026 COLA may be 2.4% in 2026, according to new projections from both Mary Johnson, an independent Social Security and Medicare policy analyst, and The Senior Citizens League, a non-partisan senior group.

If that increase goes into effect next year, it would be lower than the 2.5% boost to benefits Social Security beneficiaries saw in 2025. It would also be the lowest cost-of-living adjustment since 2021, when a 1.3% increase went into effect.

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The Social Security COLA provides an annual inflation adjustment to all of the program’s beneficiaries, including retirees, disabled individuals and family members.

The annual adjustment for the next year is calculated by comparing third quarter inflation data for the current year to the previous year. The year-over-year difference determines the annual increase. However, if there is no increase in the the Consumer Price Index for Urban Wage Earners and Clerical Workers, or CPI-W, from year to year, the COLA may be zero. 

The CPI-W, used to calculate Social Security’s COLA, increased by 2.1% over the past 12 months, according to data released Tuesday by the Bureau of Labor Statistics.

In the months ahead, two factors may affect retirees’ cost of living, experts say.

Inflation, as measured by the broader Consumer Price Index, sank to its lowest 12-month rate at 2.3% in April since 2021.

Yet tariffs may push the inflation rate higher in the months ahead, if those taxes imposed on imported goods go into effect.

Tariffs would prompt higher consumer prices and inflation. If that happens in the months ahead, the Social Security cost-of-living adjustment estimate for 2026 may move higher.

“This year will be a closer year to watch because of the tariffs,” Johnson said of the 2026 COLA estimate, which is recalculated every month with new inflation data.

The official COLA for the following year is typically announced by the Social Security Administration in October.

The policy would apply to Medicare and Medicaid, in addition to the commercial market, according to the White House.

Changing drug prices would be unlikely to impact the COLA estimate, according to Johnson. But retirees would see an impact to the personal budgets if drug prices came down, she said.

Many details of the executive order still need to be fleshed out, noted Leigh Purvis, prescription drug policy principal at AARP Public Policy Institute. Yet the nonprofit organization, which represents Americans ages 50 and up, praised the Trump administration’s efforts to curb big drug companies’ ability to charge retirees high prices for necessary prescriptions.

“A lot of people are aware that prescription drug prices are too high, and I think a lot of people are aware that we’re paying a lot more than other countries,” Purvis said.

“So any efforts moving us in the direction of paying less and paying something that’s more comparable to the rest of the world, I think is something that people could probably get behind,” she said.

Between their credit card balances, mortgages, auto loans, home equity lines of credit and student debt, Americans owe a record $18.2 trillion, according to a new quarterly report on household debt from the Federal Reserve Bank of New York.

Still, for the most part, borrowers are managing that debt relatively well — with one exception.

“Transition rates into serious delinquency have leveled off for credit card and auto loans over the past year,” Daniel Mangrum, research economist at the New York Fed, said in a statement. “However, the first batch of past due student loans were reported in the first quarter of 2025, resulting in a large jump in seriously delinquent borrowers.”

The delinquency rate for student loan balances spiked after a nearly five-year pause due to the pandemic, the New York Fed found. Nearly 8% of total student debt was reported as 90 days past due in the first quarter of 2025, compared to less than 1% a year earlier.

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Although the student loan delinquency rate is “likely to go up a little bit more,” it is “still comparable to what it was in 2020,” the New York Fed researchers said on a press call Tuesday.

However, in a blog post, the researchers noted that “the ramifications of student loan delinquency are severe.”

Currently, around 42 million Americans hold federal student loans and roughly 5.3 million borrowers are in default, according to the U.S. Department of Education. Another 4 million borrowers are in “late-stage delinquency,” or over 90 days past due on payments.

Among borrowers who are now required to make payments — not including those who are in deferment or forbearance or are currently enrolled in school — nearly one in four student loan borrowers are behind in their payments, the New York Fed found.  

“For many, this had grave consequences for their credit standing,” the New York Fed researchers said.

The Education Department restarted collection efforts on defaulted student loans on May 5, which includes the garnishment of wages, tax returns and Social Security payments.

Until last week, the Education Department had not collected on defaulted student loans since March 2020. After the Covid pandemic-era pause on federal student loan payments expired in September 2023, the Biden administration offered borrowers another year in which they would be shielded from the impacts of missed payments. That on-ramp officially ended on Sept. 30, 2024 and delinquencies began appearing on credit reports in the first quarter of 2025.

Both VantageScore and FICO reported a drop in average scores starting in February as early- and late-stage credit delinquencies rose sharply, driven by the resumption of student loan reporting.

The Federal Reserve Bank of New York also cautioned in a March report that student loan borrowers who are late on their payments could see their credit scores sink by as much as 171 points as collection activity resumes. 

A separate analysis by TransUnion found that consumers who faced default in recent months have seen their credit scores fall by 63 points, on average. For super prime borrowers — or those with credit scores above 780 — who were seriously delinquent, scores sank as much as 175 points. Credit scores typically range between 300 and 850.

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