As part of the continuing discussion regarding the One Big Beautiful Bill (OBBB), the continued availability of health insurance both for those who otherwise would be without and for those who regularly depend on it for coverage for routine and for critical care takes center stage. Health care decisions affect both American citizens and immigrants as well as the healthy, the young, the elderly, the well and the disabled.
The system, as complicated as it is also concerns funding for hospitals, physicians, and therapists. Hospitals, especially those close to the edge financially in rural areas but not limited to these are dependent on predictable funding mechanisms. If there is anything today that is predictable it is that as layer upon layer of administrative requirements are placed on approval of receipt of coverage, then time, effort and concern increase.
Government, of course, is not the only source of funding for healthcare but, with Medicare, Medicaid and coverage through Medicaid expansion also referred to as Obamacare, (in Pennsylvania known as Pennie) it is an important player. Government also becomes involved with funding for hospitals and special programs for those with special needs and, of course, seniors.
One significant question to ask might be “do we really need more complexity?” Such as, for example, another reporting requirement specified through the OBBB, and does it make financial sense anyway?
It is with this as background we can consider, among other things, work reporting requirements (not notably necessarily work requirements) under the One Big Beautiful Bill regarding whether they will make sense. We can also take a look at the health care system as it exists today.
The typical reporting system under the new law would require reporting each month to have completed 80 hours of approved work with an employer or substitute some other activity specified. In states where this has been tried the problem has been with the reporting as described below.
The American system now is a complex arrangement among private insurance paid for by policyholders, insurance secured through employer policies also from private insurance, and government coverages including Medicare and Medicaid as well as veterans and other benefits. These are a dizzying array of independent systems that require coordination. The monitoring and coordination of coverages consumes numerous workplace hours for individuals who likely would prefer spending time on more productive tasks like spending time with family.
Years ago, I remember going to our family doctor who then pointed to members of his staff.
“Remember,” he said, “when I had one or two people handling all of the administrative paperwork?” He swept his arms and pointed to the multiple employees behind him. “Everyone else is handling paperwork regarding insurance.”
This is common. Other physicians I know — including my cousin who is a retired physician — hospital administrators, nursing home administrators, specialty physicians trying to get answers whether a given procedure or a given medication is “covered” speak, often exhausted of their attempts to get a simple answer. They are placed on hold. There are no answers given. They are referred to another individual or another department or even another company or provider. The person is not in or has taken early retirement or has been replaced by someone who does not have experience.
It might be wondered how this relates to the work reporting requirement newly added to the OBBB. Notably it is a work reporting requirement. The complexity of the system is exacerbated. It might be assumed that the purpose of the requirement is to take what our office has sometimes referred to as a “wall too high to climb.” Notice might be taken that this experiment has been tried in other states.
In an article published by NPR, “Do work requirements in Medicaid work? Georgia’s been trying it for two years…”, the author pointed to experience from those who have tried including people who were accustomed to dealing with paperwork delays. They pointed to “logistical steps” required. It is assumed, for instance that a recipient has reliable internet access and/or transportation to the agency location. Multiple individuals reported difficulty with the dedicated web portal. Information would not be reported or would be lost.
The program is also a money loser. According to the NPR article and other sources, Georgia spent more than $50 million building and operating the reporting system. As of June 30, 2025, 8,078 people were enrolled.
Janet Colliton is a Certified Elder Law Attorney recognized by the American Bar Assn and Pa. Supreme Court and limits her practice to elder law, estate planning and administration, retirement planning, Medicaid and special needs, with offices at 790 East Market St., Suite 250, West Chester, 610-436-6674. She is a member of the National Academy of Elder Law Attorneys and, with Jeffrey Jones, CSA, co-founder of Life Transition Services LLC, a service for families with long term care needs.
