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A federal judge has blocked two states' work requirements for Medicaid, ruling that the Trump administration had been "arbitrary and capricious" in allowing the rules, which caused tens of thousands of people in Kentucky and Arkansas to lose benefits. Writing for the US District Court for the DC Circuit, Judge James E. Boasberg found that Health and Human Services Secretary Alex Azar had approved the work requirements without adequate consideration of whether they would get in the way of the program's core mission: providing healthcare for low-income people.

Boasberg had already put Kentucky's work requirements -- under the name Kentucky HEALTH and we don't care what the acronym stands for -- on hold last year for essentially the same reason. Medicaid is a program to provide healthcare, and if you add requirements that cause tens of thousands to lose healthcare, well then you're not providing it, dummies (we're paraphrasing, a bit). No, not even if you insist you're encouraging recipients to take a more active role in their own health by worrying that they'll lose their coverage by not meeting the arbitrary requirement to work 20 hours a week and then submit proof every damn month. (As we point out every damn time "work requirements come up," most Medicaid recipients ALREADY WORK). The rulings also have implications for a whole bunch of other red states that want to impose work requirements -- six others have also received permission from HHS for similar requirements.


In his ruling yesterday, Boasberg noted that Azar had essentially re-approved the very same Kentucky program, with minor revisions, and that Azar still hadn't reconciled the central purpose of the Medicaid Act -- provide healthcare to poors -- with projections that up to 95,000 Kentuckians a year would lose coverage. Nor was Boasberg impressed by the new, even more batshit argument HHS rolled out to defend the work requirements:

namely that, although Kentucky HEALTH may cause nearly 100,000 people to lose coverage, that number will be dwarfed by the approximately 450,000 people who would suffer that fate if Kentucky ends its coverage entirely of those who have joined the Medicaid rolls via the Affordable Care Act, as it has threatened to do if this project is not approved.

As for the claim that Kentucky would simply go broke and have to end its Medicaid expansion for everyone if it didn't trim those 95,000 people off the roles, Boasberg pointed out that might be a workable argument, but noted that Azar hadn't actually provided any evidence the work requirements would actually save any money. In fact, the administrative costs of adding work requirements probably outweigh any savings from reduced enrollments. Either way, Azar never actually showed his work, so no, that argument doesn't fly.

The judge also dismissed the Trump administration's claim that work requirements would lead Medicaid recipients to become "financially independent" by getting jerbs. For one thing, there's nothing in the Medicaid statute about financial independence, and for another thing, if people lose their healthcare, they're actually less likely to be financially independent, no?

Boasberg tossed out the work requirements in Arkansas for essentially the same reasons he blocked Kentucky's plan last year, and again yesterday: Once the work requirements went into effect in 2018, nearly 17,000 Arkansans lost coverage, and if people are losing coverage they'd otherwise have, well then you're defeating the purpose of Medicaid. You Idiots.

Plaintiffs' position is simple: "The purpose of Medicaid" is to enable states "to furnish health care coverage to people who cannot otherwise afford it." [...] Yet the Secretary, just as in [the 2018 Kentucky case] "failed to consider adequately" the impact of the proposed project on Medicaid coverage. [...] Indeed, he neither offered his own estimates of coverage loss nor grappled with comments in the administrative record projecting that the Amendments would lead a substantial number of Arkansas residents to be disenrolled from Medicaid. Those omissions, they urge, make his decision arbitrary and capricious.

Plaintiffs are correct. As Opening Day arrives, the Court finds its guiding principle in Yogi Berra's aphorism, "It's déjà vu all over again."

Judge Boasberg pointed out the absurdity of the Arkansas work requirements in the first page of his decision, highlighting how they actually led Medicaid recipient Adrian McGonigal -- who was working -- to actually lose both his benefits AND his job:

In mid-2018, McGonigal learned that he would be subject to new work requirements, which he would have to report online, as a condition of receiving health benefits. These were imposed by the Arkansas Works Amendments (AWA), approved by the U.S. Secretary of Health and Human Services in March 2018. Despite his lack of access to, and difficulty working with, computers, he was able to report his employment in June 2018, but he did not know he needed to continue to do so each month. As a result, when he went to pick up his prescriptions in October, the pharmacist told him that he was no longer covered, and his medicines would cost him $800. In the absence of Medicaid, he could not afford the cost of the prescriptions and so did not pick them up. His 2 health conditions then flared up, causing him to miss several days of work, and Southwest Poultry fired him for his absences. He thus lost his Medicaid coverage and his job.

In striking down the two states' work requirements, the judge prevents Kentucky and Arkansas from throwing anyone off Medicaid while HHS reconsiders their applications -- this time taking into account how the work requirements might harm people who otherwise qualify for the program.

It's almost as if Boasberg, an Obama appointee, thinks Medicaid has something to do with providing health benefits instead of shaming the poor.

[Vox / WaPo / Gresham v. Azar (Arkansas) / Stewart v. Azar (Kentucky)]

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Doktor Zoom

Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.

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