As Congress debates the future of Medicaid, millions of Americans—particularly older workers—face an uncertain future. Proposed cuts to Medicaid, combined with renewed efforts to impose work requirements in this program, threaten to strip away essential healthcare and long-term care coverage for those who need it most.
Older workers would be hit especially hard by these cuts—both because they represent a substantial and growing segment of the U.S. workforce (around 11 million total or 37% of all workers), and because many rely on Medicaid for health coverage before becoming eligible for Medicare at age 65.
Additionally, 70% of people ages 65 and older will require some form of long-term care in their lifetimes, a need primarily funded by Medicaid, though many beneficiaries may not realize they benefit from this program due its varied names across different states.
Healthcare and long-term care also are major financial burdens for older adults, many of whom already face age-related job discrimination and other profound employment barriers. Without Medicaid, many older workers would be forced to forgo care or scrounge to pay for it out of pocket, pushing them into medical debt. As we all are aging, a weakened Medicaid system puts not just today’s older workers at risk, but all of us in the future.
Older Workers Sustain Our Economy, and Rely on Medicaid
Medicaid provides health coverage to low-income people and their families and helps cover long-term care costs, such as home healthcare, personal care and residential care in nursing homes.
A worker without employer-sponsored health coverage—nearly 40% of workers in today’s economy—will likely rely on Medicaid to ensure they can cover their healthcare costs. This largely explains why the uninsured rate among people ages 18 to 64 plunged from 22.3% in 2010—when the Affordable Care Act became law and began expanding healthcare access to working people—to 12.4% in 2016. Medicaid ensures the workers who fill these roles, including millions of older people, can stay healthy and continue contributing.
Additionally, when older people need support for activities of daily living—bathing, dressing, mobility, and much more—Medicaid will help cover these services, helping them remain healthy and independent wherever they live. Instead of cutting Medicaid, Congress should strengthen it to reach more people and better support working families. Without this safety net, many older adults would face severe life risks with few, if any, alternative interventions at this stage in life.
Work Requirements Disproportionately Harm Older Workers
Recent Congressional proposals are aiming to cut Medicaid by doubling down on Medicaid work requirements, an approach that the National Skills Coalition, my organization, has long challenged. The Center on Budget and Policy Priorities estimates that 36 million people would risk losing coverage if they don't meet these “unnecessary and burdensome” requirements, which, as one example, include monthly work reporting through complex systems.
‘Older workers would be especially vulnerable to Medicaid work requirements that restrict access to healthcare.’
Older workers would be especially vulnerable to Medicaid work requirements that restrict access to healthcare. Like many others, they could lose coverage due to bureaucratic hurdles—failing to meet a single reporting deadline could mean losing the vital medical care they depend upon.
But also, because older people are disproportionately affected by chronic and serious health conditions, which makes them more reliant on medical care. As people age, the likelihood of developing conditions such as heart disease, diabetes, arthritis, hypertension and respiratory diseases increases significantly. With nearly 95% of adults ages 60 and older managing at least one chronic illness—compared to 51.8% for all U.S. adults—Medicaid is often the only way many of them can afford essential care.
When considering that nearly half of households led by older workers lack retirement savings, Medicaid is often the only safeguard against financial ruin.
A Smarter Approach: Investing in Older Workers and Medicaid
The National Skills Coalition urges Congress to take a different approach—one that invests in workers and businesses instead of punishing them. Congress should fully fund essential safety net programs like Medicaid, SNAP, and TANF to ensure people can afford basic needs while pursuing better job opportunities. Lawmakers also should reject efforts to expand work requirements, which force individuals into low-wage jobs and limit access to education and training.
In addition to investing in Medicaid, Congress should expand access to affordable skills training, career pathways to good jobs, and supportive services such as transportation and coaching that help all working people—including older workers—prosper in the long term. For instance, an older worker who, out of choice or necessity, moves from a career in construction to one in tech will need access to good training and a credential to make the transition seamless. These types of programs benefit workers and businesses that want to compete in a rapidly evolving economy.
And in a deeply polarized political environment, these approaches hold widespread and increasingly rare bipartisan appeal; our 2023 polling found that 82% of voters indicated support to increase government funding for skills training in America.
The future of millions of older workers is on the line. Congress must protect Medicaid, invest in workforce training, and ensure long-term care remains accessible. The time to act is now—before these cuts devastate families, communities and our entire economy.
Robert Espinoza is the CEO of the National Skills Coalition, which envisions a future where every person in America is guaranteed skills training, good jobs and economic prosperity. He also chairs the board of directors for the American Society on Aging, and hosts the award-winning podcast, A Question of Care, which explores the many challenges facing our country’s caregiving system.
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