While economists argue over whether President Trump’s “One Big, Beautiful Bill” (OBBB) will add to national debt or manage to offset the “largest tax break in history” with tariffs, some experts are worried about the practicality of the plan.
She told Fortune: “Medicaid is a federal and state partnership, they have to administer it and essentially build a machine to administer this new set of bureaucracy that the tax bill is putting on them.”
The question for consumers is how to gather the evidence to prove they meet these benchmarks. In many cases employees, students or volunteers will not have a timesheet proving the hours they clocked in and out in a given week. The question for government administrators is how to verify and process that information.
Gordon said at the moment there are a “tonne of unanswered questions” about the legislation, so much so that some states may even begin building systems to process the changes without the answers from central government.
The U.S. Department of Health and Human Services did not immediately respond to Fortune’s request for comment.
From her experience, Siegel has her suspicions about what happens next: “[Government] will try and build websites to do this, and I think there’s a good chance those web builds don’t work. When the websites break down, people call, when call centers are understaffed which they are likely to be, wait times are super long.”
“And when you can’t get through, you’re eight months pregnant and you want be covered by Medicaid, you call, your partner calls, your parents call, your grandparents, all start to call. That’s how these call centers go. People can’t get through, and so they show up at the local office and there’s a line around the block. Unfortunately I’ve been through these situations—not in a Medicaid context—and the customer service has been really poor while we’ve been trying to work through it. The staff have mandatory overtime which gets cancelled, they’re yelled at for a bunch of hours a day, and the attrition goes up.”
So begins a “vicious spiral” of overstretched staff trying to sift through millions of queries—some from individuals who simply no longer qualify for cover.
“I’m trying to save Medicaid,” he added. “That’s the president’s goal as well. He said over and over again, he wants to love and cherish these programs and we need to keep them viable.”
Gordon’s fear is that families and individuals simply don’t have the time or capacity to organize their coverage under the new scheme, saying: “People are very busy, they have a lot of strain in their lives, they have a lot of things to worry about that arise organically in their jobs and their families in their everyday lives and I think a good philosophy of government is not to add add to those burdens and those challenges, but that’s not the philosophy of this bill.
“And so, I I think there’s going to be a lot of of inevitable breakage, and it will be the job of government to minimize that breakage.”
Of course, the headache consumers may be barreling toward is not of the Trump administration’s volition alone. Some may argue that previous admissions could have invested and developed systems to improve the Medicaid service, meaning the OBBB would not pile more strain on an already stretched system.
“There’s a moment here for ‘State,’” Gordon, a visiting fellow at Georgetown University, added. “There is a moment for governors to step up and try not only to minimize coverage loss, but also to modernize, and that’s very hard to do because the most natural thing will be to pour new wine into old vessels.”
