AYESHA RASCOE, HOST:
Agriculture Secretary Brooke Rollins says the immigration crackdown on farms will continue. Speaking at a press conference last week, she said there would be no amnesty under any circumstances.
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BROOKE ROLLINS: Mass deportations continue, but in a strategic and intentional way as we move our workforce toward more automation and toward a 100% American workforce.
RASCOE: And Rollins suggested who could replace migrants in the fields.
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ROLLINS: There are 34 million able-bodied adults in our Medicaid program. There are plenty of workers in America.
RASCOE: Under President Trump's new tax and spending law, many Medicaid enrollees will now have to meet work requirements. More than 18 million Americans will be affected, according to the Congressional Budget Office. Reaction from farm country to Rollins' idea has been skeptical.
MANUEL CUNHA JR: Flat out, they're not going to work in my industry at all. I don't care what you pay them.
RASCOE: Manuel Cunha Jr. is the president of the Nisei Farmers League. He represents over 500 farmers in California's Central Valley. He says he's seen this movie before. In the '90s, welfare reform brought new work requirements for people on government assistance. Cunha participated in a program trying to pair people on welfare with farm jobs. Officials identified 560 with relevant work experience and reached out to them. Out of those, Cunha says three actually took a job. One...
CUNHA: Showed up for half a day and then quit because it's too hard.
RASCOE: Another...
CUNHA: Got lost in the direction of going.
RASCOE: And the third person...
CUNHA: He never showed up at the job site.
RASCOE: In 1999, Cunha testified before Congress about the results of the program.
CUNHA: In my industry, it was a hundred percent disaster.
RASCOE: He says any efforts to staff farms from the Medicaid rolls would also fail, and he worries the Trump administration's immigration raids will create a labor crisis.
CUNHA: The uncertainty every morning is a nightmare for the worker to know he gets in his car or her car, and what route do they take so that they don't get picked up? Are they going to be arrested at the farm?
RASCOE: On a recent farm visit, he talked to one man.
CUNHA: The worker asked, should I shave my mustache off and my beard so that I won't look like a Mexican?
RASCOE: That fear among workers ripples through the community.
CUNHA: Those big raids on those farms. Yeah, you may have just raided that farm, but what you did is you harmed all the other farmers around. And if that happens in the San Joaquin Valley, it's over. There's a $24 billion industry that will be hit hard, along with all the rural communities, and the upstream and downstream of other businesses will be hammered.
RASCOE: We invited Agriculture Secretary Brooke Rollins to join the show but did not receive a response. Now, to hear more about the changes to Medicaid and who's impacted by the new work requirements, we turn to Robin Rudowitz. She's vice president at KFF, a health policy research and news organization. She's also the director of KFF's program on Medicaid and the uninsured. Welcome to the show.
ROBIN RUDOWITZ: Thanks so much for having me.
RASCOE: The Trump administration has floated this idea of replacing migrant farm workers with able-bodied Medicaid recipients. What do they mean by able-bodied when it comes to Medicaid?
RUDOWITZ: So that's not a legal term. And we know that when we look at people in this group that would be subject to these new requirements, these are individuals with low incomes. So for an individual, incomes up to about $21,000 annually but may have a number of health conditions. We know that individuals in this group are largely working already. So 6 in 10 are working already, and a number of individuals that aren't working in that group tend to report that they're not working because they have an illness or a disability or caretaking responsibilities, or they might be in school.
RASCOE: And so what would be the requirements under this bill? How many hours would they have to work and are there, like, exemptions?
RUDOWITZ: Yeah, so that would be 80 hours of work monthly. And the law also requires specific exemptions. So individuals who might be medically frail or have some other disabling condition might be exempt. I think the problem comes when individuals need to verify their work or exemption status. And we know from other implementation in both Arkansas and Georgia that sometimes the verification of their status is sometimes a problem and creates red tape or barriers. So it's not that individuals are not working or don't meet some type of exemption.
RASCOE: How realistic are these requirements?
RUDOWITZ: It will be quite a challenge for states to implement these new requirements. So state Medicaid programs are typically not set up to track work hours or to have these other criteria as part of the application process. So that will be challenging and could be costly for states. And we know for individuals, it could create more burdens in terms of applying or having more paperwork, documentation in order to show that they're meeting some of these requirements. And we know that the Congressional Budget Office, so the sort of scorekeeper in Washington, estimates that these provisions will result in quite a bit of federal savings because many people are expected to lose their coverage, mostly because of these reporting requirements.
RASCOE: The argument that Republicans say is that they're not cutting Medicaid benefits. They're making it stronger because able-bodied adults, they should be working. They shouldn't be, you know, a drain on the program. It sounds like what you're saying if most of the people are working, why is it so hard to just document that? Why would this have such a big impact?
RUDOWITZ: I think some of the examples of how it might be difficult is some individuals might have not regular work or unstable work. So individuals that are self-employed or doing gig work, those hours might be not as consistent and might be hard to document. I would also say there are a number of examples of people who might have health conditions that would make it difficult to meet the work requirements. So for example, people with a mental health condition may have gaps in their work status and may have conditions that make it much more difficult to do things like submit paperwork on a monthly basis.
RASCOE: Some states have already tried Medicaid work requirements, and you mentioned that. What's happened there? What's been the impact on the program?
RUDOWITZ: During the first Trump administration, Arkansas was one state. We know that ultimately 18,000 people wound up losing coverage because mostly it was hard to report that they were either meeting the work requirement. So among people who had to do active reporting, about 70% of them wound up losing their coverage because they couldn't follow through with that reporting.
RASCOE: Did more people end up working in Arkansas because of the requirements?
RUDOWITZ: So no, the data did not show that the work requirements contributed to increases in employment. So what we did see was more people lost their Medicaid coverage, more people became uninsured, but there was no change in employment.
RASCOE: That's Robin Rudowitz, vice president at KFF. Thank you so much for joining us.
RUDOWITZ: And thank you for having me. Transcript provided by NPR, Copyright NPR.
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