A federal judge just struck a blow to the Trump administration's cruel plot to gut Medicaid

A federal judge just struck a blow to the Trump administration's cruel plot to gut Medicaid
Office of the Vice President
The Right Wing

On Wednesday, a federal judge dealt a massive blow to one of the Trump administration's pet projects.

Washington, D.C. District Court judge James Boasberg struck down work requirements in Kentucky and Arkansas, ruling that the waivers granted by Health and Human Services Secretary Alex Azar were not valid because work requirements do not further the Medicaid Act's mission of improving public health.

The rules differ in some ways, but both broadly require certain Medicaid recipients to complete a minimum number of work or community service hours each month and provide proof to the state.

Kentucky's work requirement, known as Kentucky HEALTH, was the first to be approved by the Trump administration but was struck down last year by the same judge, and the newly revised rules were scheduled to take effect on April 1. Arkansas has already implemented its work requirement system, known as Arkansas Works, with disastrous consequences over 18,000 people in the state have lost Medicaid coverage, many of whom actually were working but couldn't figure out how to meet the state's confusing reporting requirements, especially those in rural areas who don't have easy access to the internet.

Boasberg criticized Arkansas for doing virtually nothing to help Medicaid recipients understand and comply with the new work requirement, saying "the State's outreach efforts may well be falling severely short." He further criticized Kentucky, which argued that their work requirement does further the mission of expanding health coverage because Gov. Matt Bevin intended to cancel Medicaid expansion entirely if he didn't get his way: "The Court cannot concur that ... states are so armed to refashion the program Congress designed in any way they choose."

Several other Republican-controlled states are currently seeking approval for similar work requirement programs.

Medicaid is a joint federal-state program both Congress and the states provide funding, and the states are in charge of administering the program within their borders. The Medicaid Act sets strict guidelines about how the program can be run, but the Department of Health and Human Services can approve what are called "Section 1115" waivers if a state has a custom-designed plan that would promote health and coverage beyond what traditional Medicaid does. The Trump administration is trying to flip this on its head, encouraging states to apply for waivers that will lead to fewer people being covered.

Boasberg's ruling holds that states cannot use Section 1115 waivers in this manner. "That provision of the Act does not turn the comprehensive Medicaid program into a buffet for states," he wrote.

Medicaid work requirements are a particular passion of Seema Verma, the administrator of the Centers for Medicare and Medicaid services. She has claimed that denying low-income people health coverage is actually good for them, insisting that "it is not compassionate to trap people on government programs or create greater dependency on public assistance." She has also claimed that work requirements do further the mission of Medicaid, pointing to studies that show people with jobs tend to be healthier (when in reality the correlation is probably the other way around.)

Arkansas and Kentucky were early adopters of the Affordable Care Act's Medicaid expansion, which made the program available to people up to 138 percent of the poverty line. The Affordable Care Act originally required states to expand Medicaid, but a Supreme Court ruling allowed states to decide whether they wanted to or not. Republicans in these states are now intent on chipping away at this progress, and work requirements are one way the Trump administration is encouraging them to do it.

For now, that effort has hit a roadblock.

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