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Advocates for low-income southeast Ohioans see red tape, lost coverage and economic damage in the federal tax cut bill
< < Back toATHENS, Ohio (WOUB/Report for America) — On the day the House of Representatives passed its version of the major domestic policy bill now moving through Congress, freshman GOP U.S. Rep. David Taylor sent out a press release explaining his support of the federal tax cut bill.
“Today, I was proud to vote in support of the One, Big, Beautiful Bill, which will cut rampant waste, fraud, and abuse in critical government programs so they are protected for vulnerable Americans who need them for generations to come. Republicans are the ones making the Trump tax cuts permanent, defending Medicaid, and protecting SNAP,” wrote Taylor, whose district includes most of southern Ohio.
But people who work in southeast Ohio’s healthcare and emergency food systems see the tax cut bill differently. It would add new requirements to SNAP and Medicaid and shift some costs onto states, potentially putting a strain on local administrators who have more rules to follow and fewer resources to do so. Advocates think enrollment in both programs will go down — not because of waste or fraud, but because low-income people can’t navigate the mass of bureaucratic red tape that will ensue.
They also warn the bill could have ripple effects beyond low-income people themselves. SNAP and Medicaid enrollees spend their benefits at local healthcare providers and grocery stores. Those businesses rely on that revenue to operate. If that revenue stream shrinks, so could the region’s economy.
“It has the potential to be catastrophic, which means it affects everyone, not just the people who are on Medicaid,” said Muskingum Valley Health Centers CEO Dan Atkinson.
Rose Frech of Integrated Services for Behavioral Health said the bill would reduce Medicaid enrollment in two ways. The first is the addition of work requirements for anyone insured under the 2010 Affordable Care Act’s Medicaid expansion.
“Folks … would be required to participate in work, work training, school, volunteer work, something like that, for 80 hours per month in order to maintain their Medicaid coverage,” Frech said.
The second change involves how often the government assesses people for Medicaid eligibility.
For someone worried about waste, fraud and abuse, the idea that these new rules would cut enrollment may seem like proof they will root out bad actors. But Frech has a different prediction: Low-income people will lose coverage, not because they’re freeloading, but because the red tape just becomes too much.
Frech pointed to data from Arkansas’ Medicaid work requirements to support her concerns. A 2025 study from the Urban Institute has found those requirements did nothing to boost employment. The study’s authors argued implementing national work requirements “would worsen health outcomes and strains on medical systems.”
“If you’ve ever had a difficult time in your life, where maybe you’re struggling with your own mental health or you’re facing a lot of stress, maybe finances are tough — those are the times when it’s the hardest to navigate really complex bureaucratic processes,” Frech said. “You just don’t have the capacity or the bandwidth to do it.”
Atkinson concurred.
“These are folks that don’t necessarily have the means to go somewhere, to be able to volunteer or to be able to work,” he said. “If you’re battling a significant chronic disease and you have very limited to no resources, adding extra requirements to maintain your health insurance coverage is probably not going to be feasible for you.”
Frech said both Medicaid and SNAP are already hard to navigate.
“We do this stuff all the time, right? We help people fill out SNAP applications. We help people fill out Medicaid applications,” she said.
Work requirements will make this paperwork even more cumbersome. The same goes for twice-yearly eligibility screenings. For people struggling to get by — by definition, the people who tend to use Medicaid — it can be overwhelming.
Frech said this could hit southeast Ohio especially hard.
“We have a lot of folks who don’t have ready access to high-speed Internet. So if you need to get into a portal, perhaps to report something or upload a document, that can be really tricky to do. If you need to drop a piece of paper off at a local Job and Family Services agency and you live in one of our many communities where we don’t have access to public transportation, that’s a barrier,” Frech said.
That includes dental services; mobile health clinics, which Atkinson said are critical for reaching people in remote locations; addiction services; and transportation, which can be a major barrier for low-income people in a region with little to no public transit. At some point, staff reductions may also become necessary.
Frech said Integrated Services may also have to consider reductions in force if the changes become law. At the same time, it’s hard for the organization to know ahead of time exactly how much revenue it will lose until people actually start dropping out.
One silver lining for Frech: The House’s bill does not reduce the actual federal cost share for Medicaid. That matters because of an Ohio proposal to end Medicaid expansion in the state if that cost share changes. As things stand now, the proposal would not take effect.
Eva Bloom of HAPCAP said proposed work requirements for SNAP would have the same drawbacks as those for Medicaid: more paperwork for program administrators and more opportunities for low-income people to slip through the cracks. But SNAP is also facing another change Bloom said could make things worse.
Right now, the federal government provides all the money that goes on SNAP enrollees’ EBT cards — that’s the money they use to buy groceries. Under the House bill, states would have to pay between 5% and 25% of that themselves. States would also have to pay 75% of the administrative costs — up from 50% today.
“We … have been paying a lot of attention to the operational budget that’s currently being discussed in Columbus, and we are hearing from (state legislators) that the budget is really tight, there’s not room for additional support,” Bloom said.
That likely means SNAP just gets less money, period: less money on EBT cards, and less money for administrators dealing with much more paperwork. That’s concerning to Bloom, who said there are already issues with documents being lost in the system.
“(People) are actually, in most cases, walking into an office to get a receipt for that paperwork” so they can later prove they filed it, Bloom said. Otherwise “their benefits could be jeopardized, even though they’ve done everything correctly.”
Taken together, Bloom said, the changes to SNAP and Medicaid could have lifelong consequences, especially for young southeast Ohioans.
“We’re not providing them with food for their bodies to develop, for their minds to develop, for them to be able to focus in school. We’re not providing them with healthcare, so they may have conditions that aren’t addressed,” Bloom said. “This is really just making what is really hard for children and residents of our region … just so much harder.”
WOUB reached out to Reps. David Taylor and Troy Balderson for comment and did not receive a response.