Millions of nondisabled working-age adults have enrolled in Medicaid since the Affordable Care Act expanded eligibility in 2014.
Medicaid is health insurance for low-income people.
The nonpartisan Congressional Budget Office estimated that in 2024, average monthly Medicaid enrollment included 34 million nonelderly, nondisabled adults – 15 million made eligible by Obamacare.
Two smaller estimates used U.S. Census survey data.
The White House Council of Economic Advisers said there were 27 million nondisabled working-age (age 19-64) Medicaid recipients in 2024.
That’s similar to the 26 million for 2023 estimated by the nonpartisan health policy organization KFF. That figure includes people who are disabled.
KFF said 44% worked full time and 20% part time, many for small companies, and aren’t eligible for health insurance.
Medicaid costs nearly $900 billion annually, two-thirds from the federal government, one-third from the states.
Forty states, excluding Wisconsin, adopted the Obamacare Medicaid expansion. Congress is considering President Donald Trump’s proposal adding work requirements for Medicaid.
This fact brief is responsive to conversations such as this one.
Gaurav Sharda attends the ACT Expo in April. He is putting people at the heart of technology decisions for Beacon Mobility companies. Cover design by Kimber Horne. Photo by Vincent Rios Design.
Meet the 2025 Innovator of the Year, Gaurav Sharda! As the chief technology officer of Beacon Mobility, Sharda is approaching innovation with a people-focused and technology based mindset to create positive outcomes for the industry. Read more about Sharda’s story as well as contracting focused features on the future of AI, safety in alternative transportation, NCST resolutions, and guidance for non-yellow school bus transportation.
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A Florida man’s 16-year journey to collect a million-dollar court judgment against a school district following a life-altering school bus crash finally succeeded. Elsewhere, others aren’t as lucky.
When he was 16 years old, Marcus Button was in a car crash with a school bus, leaving him with life-altering traumatic brain injury, loss of vision, and a 16-year journey to collect a court-ordered, million-dollar judgment for damages.
On Sept. 22, 2006, Button was riding to school in the passenger seat of his friend’s Dodge Neon when a school bus took a left turn through an intersection and into the car’s path, leaving Button’s friend with little time to brake. Button struck the windshield.
“Not a week goes by that I don’t think about this case,” said Button’s attorney, J. Steele Olmstead of Tampa, Florida. “He was a hardworking young man who mowed lawns at the trailer park where he lived. He was going to grow up, learn a trade, have a wife and kids, but now he’s just a shell.”
Olmstead said Button planned to enter his family’s drywall business, but his crash-induced disabilities closed that future.
The Button family sued the Pasco County School Board of Land O’ Lakes, Florida, the following year. At trial, Button’s own expert left ambiguous the issue of whether Button had been wearing a seatbelt, prompting the jury to find him 15 percent at fault and his friend 20 percent at fault, placing the remainder of the responsibility on the school district’s shoulders.
In 2009, the jury awarded Button $1.38 million and his parents $289,396. Despite the court judgment, the school district paid out just $163,000 until this year. State law caps government liability at $200,000 for individuals and $300,000 per incident.
While government immunity shields public entities from most lawsuits, and depending on the state, can provide strict liability caps, Florida has an unusual workaround: The claims bill process.
The system dates to the 1830s, when the builder of the state’s second capital building was stiffed on his bill, prompting the territorial legislature to step in with the power of the purse to award his costs.
“The Florida Legislature has a history of trying to right wrongs when the courts can’t,” said Lance Block, who has practiced personal injury law in Florida for more than four decades.
Last year, Block helped reach a $1.2 million settlement with the Pasco County School Board that included the entity’s support on Button’s claims bill. This pact helped push the unopposed passage of Button’s claims bill this year, after the legislature had rejected at least four similar efforts. Both the House and Senate unanimously approved the measure in April.
“People do get justice from time to time, when and if they were in another state where they would be capped, there would be no other recourse,” said Block who has carried about 50 claims bills to the legislature.
Had Button’s crash occurred in another state, it is unlikely he would have found success in overriding the government immunity cap.
After Ashley Zauflik lost her leg in crash with a school bus, a Bucks County Court in Pennsylvania granted her a $14 million judgment in 2011, of which she received the $500,000 allowed under state law. The state supreme court reviewed Zauflik’s case in 2014, and a divided panel ruled the immunity cap did not violate her civil rights.
In other cases, special circumstances even heighten a public entity’s immunity. In a 2021 suit against the Charlotte-Mecklenburg Schools Board of Education claiming a school bus had hit a parked car while delivering meals during the pandemic, the North Carolina Court of Appeals ruled Gov. Roy Cooper’s declaration of a state of emergency outright barred lawsuits against the government for property damage.
Liability caps on individual cases do not protect school districts from repeated lawsuits, prompting some to outsource the risk entirely by contracting out transportation. Transportation contractors are not entitled to government immunity and take the full risk of liability head on.
Although immunity statutes serve to protect public coffers from being drained by lawsuits, the system is not without critics who don’t think the government should be let off the hook.
The system also becomes more complicated when it comes to obtaining insurance and filing claims. Government insurance policies are as varied the U.S. topography, with some insurers covering government entities up to their liability cap and others declining to kick on until after the government has paid out the liability cap.
Some states don’t require government entities to obtain insurance at all, and others choose to self-insure through risk-management offices or use publicly funded insurance programs.
In 1992, Block in Florida represented the family of Megan Tucky, a 7-year-old child with a disability who was strangled by her restraint while riding a school bus home. In the middle of the trial, the parties settled the case for $700,000, which did not need a claims bill to be paid out, since the school district’s insurance policy covered the cost.
In Button’s case, Block said the bus that hit him was covered under a Loyd’s of London policy that declined to cover people injured in vehicles outside of the insured bus, a policy he called grossly inadequate for a school district, throwing his client’s fate into the state claims bill lottery.
“Marcus was 16 years old,” Block said. “This totally changed his life, so he’s definitely deserving of this compensation, and I wish it was for more, but this is all we were able to do.”
Unemployment benefits application (photo by Getty Images)
This report has been updated.
In a unanimous decision, the U.S. Supreme Court ruled Thursday that a Catholic Charities organization in Wisconsin doesn’t have to take part in the Wisconsin unemployment insurance (UI) system.
The ruling rejected a Wisconsin Supreme Court opinion that said the agency’s purpose was essentially secular and didn’t qualify for a religious exemption in state unemployment law.
Advocates who supported Catholic Charities cheered the ruling as a blow for religious liberty and against attempts to define whether or not an organization’s motives are sufficiently rooted in faith.
“We have maintained throughout the process and in an amicus brief that Catholic Charities is in fact a religious institution and is eligible for the unemployment insurance tax exemption offered by the state law,” said David Earleywine, associate director for education and religious liberty at the Wisconsin Catholic Conference.
Organizations that represent workers, however, have raised questions about the decision’s broader implications for employees of other institutions connected to churches, including the large networks of Catholic hospitals across the U.S.
“It is crucial that employees, especially low-wage workers, have the protections of unemployment insurance, regardless of the identity of their employer,” said Larry Dupuis, director of litigation and advocacy at Legal Action of Wisconsin. The law firm joined with groups including the Economic Policy Institute, the Century Foundation and the National Employment Law Project on a friend of the court brief supporting the Wisconsin Supreme Court ruling.
“Unemployment payments help the laid off worker, and the economy as a whole, during a downturn by supporting consumer demand,” Dupuis said.
Thursday’s ruling overturns a 4-3 Wisconsin Supreme Court decisionissued in March 2024 that declared the work of Catholic Charities Bureau Inc. of the Superior Diocese of the Catholic Church doesn’t get a pass from Wisconsin’s UI law on religious grounds.
The Wisconsin ruling, written by Justice Anne Walsh Bradley, declared that the Catholic Charities work is “secular in nature” and that the agency and its subsidiary organizations that took part in the case “are not operated primarily for religious purposes” as defined in the UI law’s religious exemption.
Official Portrait of Justice Sonia Sotomayor, Collection of the Supreme Court of the United States, Steve Petteway
Justice Sonia Sotomayor wrote Thursday for the U.S. Supreme Court that the Wisconsin high court majority’s arguments amounted to giving preference to one religious denomination over another.
The Wisconsin ruling held that the agencies’ work was not religious in nature because they didn’t attempt to preach the Catholic faith to participants and did not serve only Catholics.
“Petitioners’ Catholic faith, however, bars them from satisfying those criteria,” Sotomayor wrote. The ruling quoted from the dissent by Justice Rebecca Bradley in the Wisconsin decision.
“Wisconsin’s exemption,” Sotomayor wrote, “as interpreted by its Supreme Court, thus grants a denominational preference by explicitly differentiating between religions based on theological practices. Indeed, petitioners’ eligibility for the exemption ultimately turns on inherently religious choices (namely, whether to proselytize or serve only co-religionists).”
Earleywine said the decision reflected the position of Catholic Charities and its supporters.
“For Catholic Charities in particular, serving the poor is part of our Catholic mission — that is something that we are called to do,” he said.
Sotomayor’s ruling noted that the church offers its own unemployment compensation program for laid-off workers and dismissed the suggestion that the organizations were “more likely to leave their employees without unemployment benefits.”
Earleywine underscored the ruling’s reference to the Catholic unemployment compensation program as “essentially equivalent” to the state UI program.
The employment lawyers’ amicus brief disputed that comparison, however, and also noted that there’s no guarantee other religious employers made exempt would have any kind of substitute benefits program. The brief also argued that in the event an individual diocesesan employer can’t afford to pay benefits for a laid-off employee, the overall program has renounced any obligation to pick up the tab.
Earleywine said the ruling enables Catholic Charities organizations to sign up with the church system, which is available to employees of Catholic dioceses, including church parishes and schools. Other Catholic-related organizations without a diocesan connection — such as Catholic hospital systems or universities — are not eligible under current rules.
Justice Clarence Thomas, while joining in the unanimous opinion, wrote a separate concurrence stating that because the Wisconsin ruling did not defer to the Bishop of Superior’s assertion that Catholic Charities and its affiliates are “an arm of the Diocese, the Wisconsin Supreme Court violated the church autonomy doctrine.”
While Thursday’s ruling was emphatic, it also appeared to suggest how Wisconsin’s UI religious exemption might be rewritten to produce a different outcome.
The Wisconsin UI law exempts all churches, church conventions or church associations “without differentiating between employees actually involved in religious works” and those who are not, Sotomayor wrote.
Dupuis of Legal Action Wisconsin pointed to another concurrence, by Justice Ketanji Brown Jackson, who wrote that state UI laws could cover nonprofit employees of religiously associated organizations by focusing on the work involved rather than its underlying motivations to determine who is and who is not exempt.
“As Justice Jackson’s concurrence shows, this ruling still gives states the ability to limit the scope of the religious exemption so large employers that provide services that are not inherently religious, like hospitals, must still cover their employees,” Dupuis said.
When the federal law was revised in 1970 to include nonprofit employees in state UI programs, Congress exempted certain church-affiliated employees. The goal, Jackson wrote, was to avoid the state getting involved in a dispute “over the sufficiency of a fired employee’s prayers or the accuracy of their scriptural teaching.”
The intent of Congress was to exempt “a narrow category of church-affiliated entities” that could produce such an entanglement “precisely because their work involves preparing individuals for religious life,” Jackson wrote.
She concluded: “It is perfectly consistent with the opinion the Court hands down today for States to align their [federally-based] religious-purposes exemptions with Congress’s true focus.”
Tesla’s repair quote for a minor Model Y incident could leave drivers with a hefty bill.
Insurance claims may raise premiums, making out-of-pocket repairs a better option.
DIY repairs or independent shops may offer cheaper alternatives to Tesla’s pricing.
We can all agree that this Tesla Model Y has certainly seen better days. After the driver hit a bright yellow bollard in a parking lot, the passenger-side rear door has been dented and scratched. The plastic fender? Completely ripped off. Oh, and there are some scratches on the rear quarter panel too.
But in the grand scheme of things, it’s not catastrophic damage, just a bit of a rough day for the car. So, naturally, Tesla quoted a repair bill of $11,671, which has understandably left the owner with a few more scratches, this time, on his head.
It’s no secret that car repairs have gotten a lot more expensive in 2025 compared to a decade ago, even more so when it comes to EVs. This helps explain why insurance companies are quick to total cars over what seems like minimal damage. Still, the quoted price for this repair is nothing short of insane.
Roughly half of the quoted repair is for labor, totaling $5,486 for a claimed 60.7 hours of labor, working out to be $91 an hour. Now, if you’re the owner of this Model Y, you’re probably doing the math in your head and thinking that it doesn’t look like this car needs 60 hours of labor. But the service center begs to differ.
sgrinavi/Reddit
When presented with a repair bill like this, many car owners would simply let their insurer pay for the repairs, and get on with their lives. However, doing so could cost in the long run. Writing on Reddit, the owner of the car says that if he makes an at-fault claim with his insurance, his premium will increase by $1,000 per year for the next five years. And on top of that, they’ll lose their good driver discount. Oh, and don’t forget that $1,000 deductible they’d need to cough up.
In an ideal world for the owner, the insurer would decide Tesla repair costs are too high and decide to total the car. But, that doesn’t appear likely. As such, the best option is likely for the owner to go to an independent repair shop who can replace the door, fender, and perhaps the quarter panel, likely for far less than Tesla would charge the insurer.
Or, for all the DIYers out there, there’s always the option of fixing it themselves. Used Model Y rear doors can be found for just a few hundred dollars, and a new fender shouldn’t break the bank either. Maybe it’s time to roll up your sleeves.
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