Adam Koresh: Fighting for Students to Keep Their Coverage

Adam Koresh, a student at the University of Northern Iowa in Cedar Falls, comes from the small rural town of Elkader in northeast Iowa with an estimated population of only 1,200.

Like many Iowans, Adam relies on Medicaid for health care coverage while pursuing his degree to become a teacher. But now, the future of that coverage is uncertain.

Earlier this year, the Iowa Legislature passed a law requiring Medicaid recipients to work at least 100 hours per month or meet certain exemptions. Governor Kim Reynolds signed the law, and the state has since applied to the federal government for permission to implement it. The state submitted a waiver request to the Centers for Medicare & Medicaid Services (CMS), proposing these new work requirements under its Medicaid Wellness Plan.

For Adam, these changes could have direct consequences.

In the state’s application to CMS, Iowa does not clearly define what qualifies someone as a student. The application says that people can be exempt from the work requirement if they are enrolled in an “educational or job skills program,” but offers no specific guidelines. There is also no system yet in place to determine what paperwork or proof is needed. It may eventually involve transcripts or enrollment documents, but for now, the details are missing. What this means in practice is that people like Adam—who likely meet the exemption—could still fall through the cracks if they struggle to navigate the system or miss a paperwork deadline. This has already happened in other states, like Arkansas that tried to implement similar requirements.

Adam is proud to be a working, contributing member of his community, having worked since he was just 14 years old. Currently, to complete his field experience to become a teacher, Adam reports to school by 7:30 a.m. four days a week. At the same time, he works in the university’s food court until as late as 11:00 p.m. many nights. The long days began to take a toll, so he cut back his hours at work to focus on school.

Under the new requirements, this choice could mean losing his health care. With no clear pathway for students to navigate the system, the uncertainty is enough to create fear.

Even while he still has Medicaid, Adam is hesitant to use his coverage, highlighting how lawmakers often promote false images of Medicaid recipients as lazy or fraudulent. “The shame that Republicans push out is a big factor into why I wouldn’t feel comfortable using it more,” he said. Adam has only used his Medicaid coverage once—to get a prescription so he could buy glasses, which he paid for himself. He said the shame surrounding Medicaid has made him feel like a burden, even to his own family, despite the fact that he works and contributes. “People talk about you like you’re a burden on the taxpayer when I know I’m not,” Adam said.

Passionate about maintaining his coverage and supporting his community, Adam contacted his representative, Jason Gearhart, to discuss how the bill would affect him. Adam called Gearhart’s office, sent emails, and eventually had a phone conversation with him. During that call, Adam explained that he would begin student teaching next year. He had been advised not to work during that time because the commitment required him to take on a full-time teaching schedule. Gearhart told Adam he had no intention of taking away his health care and encouraged him to reach out if he ever had problems. However, Gearhart also said, “I went to college too and I did it with kids while I was married, so I don’t see any problems with you having to work a little bit in order to earn that health care.”

Adam found that response frustrating. “It’s obviously a lot different when you went to school,” he said. “You went to college years ago. What do you know about what it’s like now—paying rent and all this stuff?” He pointed out that the cost of living today is far higher than it was decades ago and that comparing his situation to someone who went to college in the 1990s felt unrealistic.

Gearhart directed Adam to Senator Mike Klimesh, who was leading the bill in the Iowa Senate. Adam called the senator’s office multiple times and left messages, sent many emails, but never received a response. Eventually, Adam watched the bill move through the Senate in a livestream, passing with little debate as several proposed amendments were quickly dismissed.

Adam’s concerns with the bill went beyond just the work requirements. He also criticized the process for getting an exemption. Under the new law, individuals would have to apply directly to Iowa’s director of health and human services for a good cause exemption. Adam saw this as forcing people to beg for care.

When he learned that Representative Ashley Hinson planned a town hall in Elkader, Adam prepared to speak. He hoped to share his story and explain how the work reporting requirements would harm students like him. He also hoped other lawmakers might attend. While Gearhart did not show up, Senator Klimesh did. After the town hall, Adam approached him directly and asked why he had ignored his messages. Klimesh said that lawmakers had considered students during debate, but student protections were not included in the final bill. He added that he might look into the issue again in the future if problems emerged. Adam told him that by then it could be too late. “You’re just taking away people’s health care and telling them, ‘We’ll fix it next time if we deem it’s a problem.’”

Adam also questioned why the exemption process forced students to plead with state officials. He said, “It’s going to force adults like me to beg the Iowa director of health and human services for health care.” Klimesh eventually conceded that Adam had a point, replying, “I guess I want you to beg.”

Despite the obstacles, Adam continues to advocate for students and low-income Iowans who rely on Medicaid. He wishes lawmakers would consider the real cost of living in today’s world, particularly for students trying to get an education to be productive members of society. “There has to be a way to protect the people in college that need this health care the most…people are just going to suffer silently and I don’t want to see anybody have to suffer.”

Adams story highlights the lack of thoughtfulness going into the legislation lawmakers are trying to rush through. Beyond the clear data which shows that work reporting requirements don’t increase employment and only lead to people losing coverage—the human impact is often ignored.

Adam is not asking for special treatment. He is asking to be seen. As Iowa’s Medicaid waiver sits with CMS, the vague definitions and incomplete implementation plan leave too much room for error, especially for people like Adam.

Without clear guidance, meaningful outreach, and a system designed to help people retain coverage, students, low-wage workers, and people juggling multiple responsibilities will continue to be pushed out of care they qualify for.

“I’m doing everything I can,” Adam said. “I’m working, I’m going to school, I’m preparing to be a teacher. I just want to keep my health care while I do it.”