HHS did not adequately
consider whether work requirements meet Medicaid’s goal of providing health
care to low-income Americans, a judge ruled.
A federal judge
blocked Kentucky’s Medicaid work requirements on Friday,
ruling that the Trump administration did not adequately consider before
approving the state’s proposal whether work requirements would violate the
program’s purpose of providing health care to the most vulnerable Americans.
The court decision is at least a
temporary blow to the ambitious plans of Republican-led states and the Trump
administration to remake the program.
The ruling came
in a lawsuit involving Kentucky, one of the first states to have
its proposal requiring certain Medicaid recipients to work (or else lose their
benefits) approved by the Trump administration. District court Judge James
Boasberg, an Obama appointee, came down in favor of the plaintiffs, led by the
National Health Law Program and Kentucky Equal Justice Center, who sought to
block the work requirements from taking effect on July 1 as planned.
The federal
government is obligated under federal law to consider whether a Medicaid
proposal advances the program’s objectives, the judge wrote, and the Trump
administration failed to meet that standard before approving Kentucky’s plan.
“The Secretary
never adequately considered whether Kentucky HEALTH would in fact help the
state furnish medical assistance to its citizens, a central objective of
Medicaid, Boasberg said in his decision. “This signal omission renders his
determination arbitrary and capricious.”
The ruling
puts the future of Medicaid work requirements in
doubt. The Trump administration has made them a priority, encouraging states to
put forward proposals that require many nondisabled, nonelderly adults to work
or look for employment. If they fail to meet these requirements, they could
lose their health insurance.
Four states — Kentucky, Indiana,
Arkansas, and New Hampshire — have had their work requirements approved by the
administration. Seven others — Arizona, Kansas,
Maine, Mississippi, Ohio, Utah, and Wisconsin — have proposals waiting for
approval by the federal government.
Friday’s court
decision is unlikely to be the end of the matter, as the ruling is expected to
be appealed. But at the very least, it should delay the implementation of work
requirements in Kentucky.
The underlying
case hinges on a pretty simple argument: Does requiring Medicaid recipients to
work to receive benefits further the program’s goals? Many advocates, who argue
that Medicaid is first and foremost a health insurance program, believe that
work requirements are contrary to Medicaid’s purpose if they cut people’s
access to health care.
The state of
Kentucky and the Trump administration obviously feel differently. They argue
that requiring work should improve Medicaid recipients’ economic station and
therefore their health — in spite of evidence that most Medicaid
recipients already work or would not be expected to work. And those who do
work could still lose their coverage because
the work requirements are not structured in a way that reflects the realities
of low-income work, like irregular or seasonal hours.
The Kaiser
Family Foundation has estimated that 1.4 million to 4
million Americans — out of about 70 million covered by Medicaid — could lose
their coverage if work requirements were imposed nationwide. The vast majority
of the coverage losses would result from enrollees failing to report their
compliance to the state, not because they were failing to fulfill the work or
job search criteria.
Kaiser Family Foundation
In his ruling,
Boasberg specifically chastised the Trump administration for failing to
consider Kentucky’s own internal estimate that as many as 95,000 people could
lose their Medicaid coverage within the first five years after Medicaid work
requirements took effect.
“At bottom, the
record shows that 95,000 people would lose Medicaid coverage, and yet the
Secretary paid no attention to that deprivation. Nor did he address how
Kentucky HEALTH would otherwise help “furnish ... medical assistance,’” the
judge wrote. “In other words, he glossed over ‘the impact of the state’s
project’ on the individuals whom Medicaid ‘was enacted to protect.’”
Kentucky has
notably raised the stakes in its lawsuit. Not only is it trying to institute
work requirements, but the state is threatening that, if the court blocks it
from putting these rules in place, it will end Medicaid expansion entirely. The
roughly 400,000 people covered by the expansion of Medicaid under Obamacare in
this state would lose their insurance.
According to
several people who were present during the oral arguments, Kentucky’s lawyer
attempted to paint a dire scene: If the judge rules against work requirements,
Medicaid expansion would quickly end. That isn’t actually true, but the desired
effect was clear. “Blackmail much?” one person who was there told me.
If you look
at the text of Kentucky Gov. Matt
Bevin’s executive order that set up this Catch-22, it’s a bit more complicated.
The order says that the Medicaid expansion must end only when three conditions
are met:
- Any part of Kentucky’s Medicaid work
requirement waiver is invalidated by a court.
- All judicial appeals have been exhausted.
- Six months have passed.
Adding to the
confusion, Bevin didn’t even really need to issue that executive order. He
could end Medicaid expansion any time he wants.
”It was just a
threat to the judge,” Joan Alker of Georgetown University’s Center for Children
and Families told me. “He could terminate the waiver and expansion with six
months’ notice.”
But the through
line here is clear: Bevin is trying to take Medicaid expansion hostage, arguing
that if Kentucky isn’t allowed to impose a work requirement, then there will be
no more expansion. By the Bevin administration’s logic, work requirements do
advance the goals of Medicaid, because without them, Kentucky is going to end
its expansion and hundreds of thousands of the state’s most vulnerable citizens
will lose their insurance.
But even if
Bevin is willing to follow through on his threat, the story isn’t likely to be
over.
”If he tries to
end coverage, there will be massive political backlash and much litigation
under various theories to slow him down,” Sara Rosenbaum, a health law
professor at George Washington University, told me. “Lots of potential legal
arguments, beginning with the fact that they would need to redetermine
eligibility under traditional rules for every single enrollee.”
The district
court’s decision is probably just the first blow in a protracted legal battle.
But it is a win for health care advocates who believe that requiring people to work
to receive Medicaid violates the program’s principles.
https://www.vox.com/policy-and-politics/2018/6/29/17517862/medicaid-work-requirements-kentucky-lawsuit-decision
No comments:
Post a Comment