As Congress pushes for Medicaid cuts and new work requirements for the program, experts have warned more Tennesseans could lose their health coverage through TennCare.

The U.S. House reconciliation bill would slash federal Medicaid spending by at least $700 billion to fund a tax-cut extension and other Trump administration priorities.

Jane Dimnwaobi, attorney and Equal Justice Works fellow at the Tennessee Justice Center, said tying Medicaid eligibility to work requirements is the biggest potential threat for Tennesseans. She added most would have to work or volunteer at least 80 hours a month to stay covered.

"We know there are about 1.4 million people on Medicaid, on TennCare here in Tennessee, and 300,000 of them are the kind of adults that would be affected by the work requirements provision in the bill," Dimnwaobi explained.

According to KFF in one recent year, nearly two-thirds of working-age adults on Medicaid were employed, and close to three in 10 were not working due to caregiving duties, health conditions, disabilities or school attendance, circumstances which have qualified as exemptions from Medicaid work requirements.

Dimnwaobi noted Tennessee attempted to add work requirements to Medicaid in 2018 but the waiver was not approved by federal officials. She added today, it is essentially "lying in wait" and could be approved if the big budget bill passes in the Senate. She pointed out the proposed work rule targets able-bodied adults without young children and it ignores caregiving duties and barriers like job access or transportation.

"For Tennessee, there was a projection that about 68,000 people would lose coverage under the state work requirements proposal," Dimnwaobi underscored. "We have a state that's already wanting to implement work requirements at a very strict level and now the federal budget reconciliation bill has opened the door to our state doing that."

She noted similar work requirement policies in Georgia and Arkansas dropped eligible workers, putting them and their families at risk. If the bill passes, the policy would take effect in December 2026, just after the November midterm elections.


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Nevada groups concerned about affordability, clean air and health care are speaking out against the "One Big Beautiful Bill Act" recently signed by President Donald Trump.

The new law extends tax cuts from 2017, funded partially by huge cuts to Medicaid and SNAP food benefits.

Dr. Joanne Leovy, steering committee chair for the Nevada Clinicians for Climate Action, noted it also ends the tax credit for electric vehicles on Sept. 30, which drives up the price of an EV by $7,500 while promoting the sales of gas-powered vehicles.

"This bill will dump an extra 2.1 billion tons of climate pollution into the atmosphere over the next decade," Leovy pointed out. "Increasing greenhouse gas emissions by about 7% over prior projections; the equivalent of adding more than 400,000 cars to the road."

The new law also cuts tax credits for rooftop solar and energy efficient home upgrades. Backers said the savings were necessary to fund other administration priorities, such as increased funding for immigration enforcement.

Yolanda Kemp, a member of the American Federation of State, County and Municipal Employees Local 4041, said she worries about job losses in the public sector.

"When states, cities, towns, and schools lose essential federal funding, they will be forced to make cuts to their budgets as well, putting all public services and jobs at risk of being cut," Kemp stressed. "And let me tell you, the 'Big, Beautiful Bill' that is supposed to help hardworking Americans is nothing more than another billionaire giveaway paid for by us."

The change to Medicaid and SNAP are not immediate but will be phased in mostly in 2027 and 2028.


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More than 1,100 caregivers at Portland's Providence St. Vincent Medical Center have voted to unionize, joining the Service Employees International Union Local 49.

Hospital staffers, including certified nursing assistants, cooks, lab assistants, pharmacy techs, environmental workers and patient representatives, will soon begin collective bargaining with management over a new work contract.

Finn McCool, senior food service attendant at Providence St. Vincent Medical Center in Portland, said changes to working conditions in the hospital were a major driver to organize.

"There's a lot that makes St. Vincent a great place to work, but we've also seen just tons of changes over the years around staffing and benefits," McCool explained. "My fellow caregivers really knew that jobs were only going to get harder."

The St. Vincent caregivers will join thousands of other unionized workers at Providence hospitals in Oregon, Washington state and other parts of the country. Providence officials released a statement, recognizing the union and saying they were prepared to work with it toward a new contract.

McCool noted the company made several changes to staffing and work policies without feedback from its employees, with changes to the employees' health care benefits causing a major upheaval.

"It's been a recent change to our health care plan with Aetna switching over, and that was probably a very large reason why a lot of us decided to vote yes," McCool pointed out. "We had our own internal health care system. We changed to a different thing. Co-pays changed. Things were definitely a lot harder with increased deductibles."

McCool stressed political uncertainty, particularly in the government's health care policies, was also a significant concern.

"We're seeing a lot of changes going on with the government with cuts, especially right now," McCool observed. "What threatens us is cuts to Medicare and Medicaid. Our CEO said, 'These cuts are threatening the hospital.'"

The multistate Providence Health System announced it will close the maternity center at one of its Montana hospitals in October.

Opponents are hoping the corporation will reverse its decision at negotiations starting next week. The Family Maternity Center at Missoula's Providence St. Patrick Hospital has delivered about 450 babies each year over the last several, and serves many people from the surrounding small towns.

Robin Haux, labor program director for the Montana Nurses Association, said the layoff notification came as a big surprise and will affect moms and babies, nurses and Missoula's other hospital.

"Not only were the nurses provided just a four-month turnaround, so was the community, so was Community Medical Center," Haux explained. "This has triggered a pretty large scrambling of trying to get prepared."

The cut comes as U.S. lawmakers close in on the "One Big Beautiful Bill Act," the Republican budget megabill proposing cuts to Medicaid which could close rural hospitals. Providence said the closure is due to "declining birth volumes" and "workforce shortages."

Megan Carey, labor and delivery nurse in the Family Maternity Center at Providence St. Patrick Hospital, said no one from the Family Maternity Center was included in the decision.

"We were told there was a discernment team as well as external stakeholders," Carey pointed out. "It's just really disappointing that administration could not look inward to better go about this process."

Carey added Providence sent what she calls an "unsettling" message informing nurses they could apply to work in other departments at St. Patrick Hospital but there would not be enough jobs for them all.


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