My Job Has Become Mounds of Paperwork. Work Requirements Will Make it Worse.

When I started my career as a pulmonologist, my time was spent caring for patients — listening to their concerns, researching care, talking through treatment options, and monitoring their progress. Now the profession has devolved into mounds of paperwork. I spend hours each day completing prior authorizations, battling insurance denials, and fighting for reimbursements, just so my patients get the recommended care and treatments they need.

A new federal rule implementing work reporting requirements for many people with Medicaid coverage will make this problem significantly worse. Congress must step in to advocate for major changes to this rule. Otherwise, patients will suffer and physicians will be even more burdened with unnecessary paperwork.

Last summer, Congress passed H.R. 1, which included more than $1 trillion in healthcare cuts and imposed new work requirements for Medicaid. Just 3 months prior, in April 2025, I met a woman who shared a particularly impactful story in an effort to urge Congress to protect her access to Medicaid. She’d lost her job just a few weeks before she was diagnosed with lung cancer, leaving her to face a cancer diagnosis without an income or healthcare coverage. But because she qualified for Medicaid, she was able to access the biomarker testing and treatments she needed. Carla told members of Congress that Medicaid saved her life.

When H.R. 1 was being considered, lawmakers repeatedly promised that people with serious health conditions, like Carla, would be protected from losing coverage due to the work requirements. But in June this year, the Centers for Medicare & Medicaid Services (CMS) released an interim final rule that threatens Medicaid access for millions of people with serious or complex health conditions, including lung cancer and chronic lung disease.

The rule makes it much harder for patients to qualify for medical exemptions from work requirements and adds unnecessary red tape. Under the new rule, having a serious condition is not enough to qualify for an exemption — state Medicaid programs are required to verify that the condition “significantly impairs” the patient’s ability to comply with work requirements.

There are many unanswered questions about how this will work in practice. On the clinician side, will physicians and other healthcare providers be expected to make these determinations? Many providers, like me, may feel these determinations are outside of our areas of expertise. This will also be a huge administrative burden for clinicians, who are already overburdened with paperwork that pulls our time and attention away from what’s most important: caring for patients.

Meanwhile, people living with conditions such as lung cancer, chronic obstructive pulmonary disease (COPD), and pulmonary fibrosis are already dealing with complex health challenges, including ongoing treatments, hospitalizations, and frequent medical appointments. Requiring them to repeatedly navigate confusing, burdensome paperwork requirements will lead many to lose healthcare coverage when they need it most.

Loss of Medicaid coverage will not make these patients’ chronic medical conditions go away, and ultimately, they will still require care at a higher cost to an already burdened healthcare system. We are already seeing many hospitals and healthcare systems struggle to maintain financial viability, particularly in underserved rural and inner-city locations. The loss of a robust health safety net combined with other ongoing cuts to public health puts us all at risk.

Prior efforts at instituting Medicaid work requirements at the state level have shown that these requirements take away coverage from eligible people and lead to substantial administrative costs. They also fail to boost employment. We will likely see the same results when implementing these requirements nationwide, with coverage losses on a much larger scale.

There is no way to implement work reporting requirements that does not hurt people’s access to critical healthcare coverage. And this new rule makes an already harmful policy even more unworkable for both physicians and our patients. I call on members of Congress to take immediate action by asking CMS to fix this rule and protect patients’ access to Medicaid coverage.