With the longest U.S. government shutdown now over, the One Big Beautiful Bill (BBB) Medicaid work requirements are moving forward, with plans to take effect in January 2027. While policymakers assure work requirements will promote responsibility among able-bodied adults, one thing remains clea r: many politicians do not know what disability actually looks like.  Elizabeth Caldwell At the free clinic where I used to volunteer, I met a patient who could barely stand due to severe diabetic neuropathy. He wasn’t “disabled enough” to receive benefits. Yet, he was too ill to fill any position requiring physical labor, accounting for most non-degree positions available.  I know that reality too well. I have a physical disability, use a cane and wheelchair for mobility, and rely on a continuous glucose monitor for hypoglycemia management. With access to these interventions, I’ve been able to thrive while pursuing higher education. But I have seen others denied those opportunities.  So I founded a Mobility Aid Program. My friends and I sold grilled cheeses late into the night in our college town to raise funds for essential medical equipment often deemed a “luxury.” Many university groups used these grilled cheese fundraisers for functions or travel. We were the only group fundraising for someone’s right to healthcare. That care made a difference. I saw improvement in the patient’s mobility and independence, ultimately allowing him to reenter the job market. However, under the BBB work requirements, many will lose Medicaid before ever getting the chance to heal, meaning I’ll have to sell a lot more grilled cheeses to fill the gap that our government has widened. The BBB is advertised as a way to encourage self-sufficiency, with Republicans assuring that it will improve support for people with disabilities. In practice, it punishes people who fall through the cracks of how our government defines disability. The bill’s description of who counts as disabled or medically frail leaves room for subjectivity and access issues. These individuals are often capable of work under the right conditions, but the bureaucratic rigidity of disability classifications makes this lived experience invisible to policymakers.  Work requirements frame health as an individual responsibility: if you can’t work, you must not be trying hard enough, overlooking many factors that shape health. Physical barriers and stigma prevent many people with disabilities from securing job placements. It also ignores that people with disabilities experience these social barriers at a higher rate, suffering more from the relentless cycle of poverty and social exclusion when compared to non-disabled peers. The BBB institutionalizes the belief that those who can’t work deserve less care, turning bias into law.  We already know how this ends. When Arkansas imposed Medicaid work requirements in 2018, over 18,000 people lost coverage within four months without a significant increase in employment. Reports show that 64% Medicaid recipients already work at least part-time, often in low-wage jobs without benefits. For those unemployed, disability, caregiving, the job market, or school attendance were cited as barriers. The remaining group lost coverage due to bureaucratic hurdles or policy confusion. Despite claims that work requirements save money, they actually lead to higher rates of non-coverage, medical debt, and national healthcare costs. Some supporters argue that work requirements ease system strain and shorten wait times. However, stripping people of care until they collapse does not reduce costs. It shifts people to emergency rooms, prisons, and morgues. The BBB would increase disparities for many with disabilities who fall outside the mold of what policymakers believe disability looks like.  Instead of using work requirements as artificial disability allyship, policies should take an upstream approach to address factors preventing many Americans, disabled and non-disabled alike, from working. Health status, age, and educational level all predict employment. How can you work when your employer refuses accommodations? How can you secure a non-laboring job when you cannot afford the education required in the application? And if you believe the ADA would prevent this discrimination, I envy your naïveté.  I also urge fellow disability advocates to consider: what if you are next? You may qualify for assistance today, but what if tomorrow the government decides that your disability is not “burdensome enough” for coverage? Then you’ll join the line at the free clinic, made longer by the BBB, where services rely on a student flipping grilled cheeses.  The deeper issue is how the government defines “disabled enough.” It rarely captures reality, and the system demands proof of incapacity from people too sick to keep proving it. Health should never depend on a bureaucrat’s definition of “able to work.” The BBB doesn’t promote independence; it punishes vulnerability. It will deepen inequity by erasing agency, institutionalizing stigma, and redefining healthcare as something to be earned. If I must, I’ll keep making grilled cheeses. But we deserve a country where a fundraiser doesn’t determine survival. Elizabeth Caldwell is a master’s degree candidate at the Yale School of Public Health.   ...read more read less