The U.S. social safety net would be jolted if the budget bill backed by President Donald Trump and passed Thursday by the House of Representatives becomes law. It would impose work requirements for low-income adults to receive Medicaid health insurance and increase them for food assistance. Supporters of the bill say the moves will save money, root out waste and encourage personal responsibility. A preliminary estimate from the nonpartisan Congressional Budget Office said the proposals would reduce the number of people with health care by 8.6 million over a decade. The measure, which also includes tax cuts, passed the House by one vote and could have provisions reworked again as it heads to the Senate. Here’s a look at the potential impact. Work would be required for most people to get Medicaid health insurance Starting next year, many able-bodied Medicaid enrollees under 65 would be required to show that they work, volunteer or go to school in exchange for the health insurance coverage. Some people who receive Medicaid were worried Thursday that they could see their coverage end, even if it is not immediately clear whether they might be covered by an exception. Raquel Vasquez, a former cook who is battling two types of cancer and has diabetes, said she believes she could be affected because she has not been able to qualify for Social Security disability benefits. “I cannot even afford this life now because of my disabilities,” said the 41-year-old Bakersfield, California, resident. “But my country won’t even help me.” About 92% of people enrolled in Medicaid are already working, caregiving, attending school or disabled. That leaves about 8% of 71 million adult enrollees who would need to meet the new requirement. An estimated 5 million people are likely to lose coverage altogether, according to previous estimates of the bill from the Congressional Budget Office. Only Arkansas has had a work requirement that kicks people off for noncompliance. More than 18,000 lost coverage after it kicked in 2018, and the program was later blocked by federal courts. “The people of Arkansas are generous and we want to help those who cannot help themselves, but we have no interest in helping those who are unwilling to help themselves,” said Arkansas Senate President Pro Tempore Bart Hester, a Republican. “I’m glad the federal government is starting to align with our thinking.” Work requirement could hit harder in rural areas Increased eligibility checks and red tape related to work requirements may result in some people wrongly getting booted off, said Eduardo Conrado, the president of Ascension, a health care system that operates hospitals across 10 states. That could spell trouble for rural hospitals, in particular, who will see their small pool of patients go from paying for their emergency care with Medicaid coverage to not paying anything at all. Hospitals could have to eat their costs. “Adding work requirements is not just a policy change, it’s a shift away from the purpose of the program,” Conrado said of the rule. That is also a concern for Sandy Heller, of Marion, Massachusetts. Her 37-year-old son, Craig, has Down syndrome and other complicated medical needs. She worries the changes would make it harder for hospitals in out-of-the-way places like hers to stay afloat and offer the services he could need. If they don’t, he would have […]