Efforts by the Trump administration and Republican-governed states to weed out Medicaid beneficiaries via work requirements hit a major legal hurdle today as a D.C. district court judge struck down waivers granted to Arkansas and Kentucky for this purpose. Judge James Boasberg (an Obama appointee) was insistent in holding that the statutory purpose of the Medicaid program is to provide health coverage to the poor, and making it conditional on work requirements or other ancillary social goals was unacceptable and an abuse of agency discretion, as the Washington Post reported:
The twinned opinions, in a pair of states that have been national leaders in the move towards Medicaid work requirements, cast doubt on the Trump administration’s approvals of efforts to re-envision the public insurance program. The opinions undo the permission the U.S. Health and Human Services Department had given those two states, telling the agency it must reconsider their applications with an eye towards the effect on poor people who depend on the coverage.
Arkansas was the state that had already implemented a work requirement, and had already kicked 18,000 people off Medicaid between September and December of last year for noncompliance (or actually, for the most part, failure to promptly report compliance). This is the second time Boasberg has blocked Kentucky’s work-requirement waiver, which has not yet been implemented.
Both states’ initiatives were part of a broader conservative effort to subvert the expansion of the Medicaid population via the Affordable Care Act’s optional provisions allowing coverage of low-income people (mostly childless individuals) who otherwise had no meaningful access to health insurance. There are states, though, like Alabama, that seek to impose Medicaid work requirements without an expansion. Politically, of course, work requirements are relatively popular, and tend to put progressives in the difficult position of defending a failure to work by allegedly able-bodied beneficiaries, even though studies have shown that nearly all of them work, are in school, or are taking care of family members.
Six other states have had work-requirement waivers approved by the administration and seven states have applications pending.
Boasberg’s decision will certainly be routed to the D.C. Court of Appeals, and if affirmed, to the U.S. Supreme Court. It’s a particularly urgent priority for Kentucky’s conservative Republican governor Matt Bevin, who’s up for reelection this year.
More generally, today’s decision is a blow to conservative social engineering, and to a Trump administration that continues to make a noisy fight against expansion of health coverage.