The GOP tax bill has passed the House.

From Marketplace, I'm Subri Ben Ashore, in for David Brancaccio.

The GOP tax and spending bill passed the House this morning by one vote.

It extends the 2017 tax cuts and would increase deficits.

It would also start forcing most adults enrolled in Medicaid to work.

Marketplaces, David Brancaccio spoke with

Ryan Levy about this. Levy is with the nonprofit health policy news organization tradeoffs.

So you have to work in exchange for the health care plan. What would be some of the rules?

So the GOP plan says that in order to qualify for Medicaid, adults under 65 must either work, volunteer, go to school, or be in a work training program for at least 80 hours every month. Now, there are exceptions if you're pregnant, for folks who are disabled or caregivers.

And the latest analysis, which is still preliminary, from the nonpartisan congressional budget office, says that this policy would save the federal government $280 billion over the next

decade. And nearly 5 million people would lose their health insurance as a result.

Big cost, savings, and vision, but also five million low-income people losing health coverage. But I don't get it.

I've seen research showing 90% of people on Medicaid now are either working already or would qualify for one of those exemptions you listed.

Given that, why would this policy kick so many people off of Medicaid?

Two words. Red tape. Back in 2018, Arkansas became the first state to impose work requirements in Medicaid.

And Ben Summers, who's a Medicaid researcher at Harvard, he told me that studies suggest most of the

18,000 people who lost coverage under that policy were still eligible. People just didn't

know about the work requirements or they struggled to figure out how to report their hours.

It's really hard to craft a work requirements policy in Medicaid that's going to move the

needle substantially on employment without catching a lot of people up in red tape because so many folks are already

doing what you want them to do. So, Ryan, would Republicans in Congress take a more streamlined

approach, less hoops than the Arkansas model studied there? So it depends who you ask.

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