When Lola Smallwood-Cuevas thinks about nearly 5 million California residents who could lose their health coverage, she sees something unfair. Those people work hard, often at jobs for big companies that don't offer affordable health insurance. Meanwhile, taxpayers like you and me end up paying for their doctor visits.
Smallwood-Cuevas, a California state senator, is pushing a bill that would publicly name the largest companies whose workers are enrolled in Medi-Cal, the state's version of Medicaid. She argues that big businesses should be transparent about whether they're shifting healthcare costs to the public.
"It's a basic principle that taxpayers deserve transparency about which large employers are shifting their health care costs onto the public," she said.
California isn't alone. Nevada has had a similar transparency law since 2017. Major companies like Walmart and Amazon regularly appear on Nevada's list of biggest Medicaid employers. Walmart disputes this, saying it includes part-time and seasonal workers in their counts and that their full-time employees earn too much to qualify for Medicaid. The company says it offers affordable medical coverage to most workers, including no-cost virtual care options.
"Health care affordability and access to quality care remain real barriers for many Americans, and Walmart continues to be committed to being part of the solution," said Walmart spokesperson Katrina Proffitt.
The push comes as the federal government prepares to enforce new work requirements for Medicaid recipients. The joint state-federal program, which spent nearly $932 billion in 2024, will soon require most nondisabled adults aged 19 to 64 to prove they're working, volunteering, or going to school at least 80 hours per month to keep coverage. Nebraska and Montana have already started enforcing this rule.
The Congressional Budget Office estimates these work requirements will push more than 5 million additional people into uninsured status by 2034.
Some states are going beyond naming companies. New Jersey's Democratic Governor Mikie Sherrill signed a bill in June that actually fines businesses. Companies with 50 to 249 workers enrolled in Medicaid pay $325 per person each year. Those with 500 or more Medicaid-enrolled workers pay $725 per person annually.
Back in California, Governor Gavin Newsom—who may run for president next year—is working with lawmakers to explore tax options that would force large businesses to contribute more toward employee healthcare. Any new taxes would fall to the next governor to decide.
Research from KFF suggests many of the people at risk actually are already working. More than half of adults on Medicaid without dependent children either already meet the 80-hour requirement or face challenges that would qualify them for an exemption.