Kentucky: Federal judge shoots down #DanceSpiderDance* work requirement!

2019 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

 

*As I explained 3 years ago:

Basically, Republicans have gone from saying "screw the poor" to "OK, you can see a doctor but only if you dance for me first."

ca·pri·cious (kəˈpriSHəs,kəˈprēSHəs/adjective): given to sudden and unaccountable changes of mood or behavior.

"a capricious and often brutal administration"

synonyms:fickle, inconstant, changeable, variable, mercurial, volatile, unpredictable, temperamental

HUGE. This doesn’t just impact Kentucky, it also has implications for Michigan, Ohio, Arkansas, Indiana...

BREAKING: A federal just just struck down Kentucky's Medicaid requirements.
"The Secretary's approval of Kentucky HEALTH is VACATED and REMANDED to the agency; and 4) Judgment is ENTERED in favor of Plaintiffs."
More to come...

— Alice Ollstein (@AliceOllstein) June 29, 2018

— Charles Gaba (@charles_gaba) June 29, 2018

Here's the lowdown via Ms. Ollstein of Talking Points Memo:

The Trump administration’s approval of Kentucky’s strict Medicaid work requirement, set to go into effect July 1, was vacated on Friday by a federal judge in Washington D.C. and sent back to the Department of Health and Human Services for reconsideration.

In a sweeping ruling striking down the entirety of Kentucky’s Medicaid waiver, U.S. District Judge James Boasberg sided with the dozen-plus low-income Kentuckians who had challenged the new rules, and said that the Trump administration acted in an “arbitrary and capricious” manner by approving them.

“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 wrote, later adding that HHS “entirely failed to consider Kentucky’s estimate that 95,000 persons would leave its Medicaid rolls during the 5-year project.”

As a reminder, the entire point of Medicaid is...you know...to provide healthcare coverage to people. The purpose of it is not to "inspire" or "goad" people into working (especially when the vast majority of those on Medicaid via ACA expansion do either work, go to school, care for a sick relative and so forth anyway).

Though far from the final word on the matter, Friday’s ruling is a resounding defeat for the Trump administration’s health agenda, of which Medicaid work requirements has been a top priority. Following the failure of the GOP-controlled Congress to repeal the Affordable Care Act and abolish its optional expansion of Medicaid, the administration has turned to the state Medicaid waiver process, approving policies that will deny health coverage to hundreds of thousands of people.

So much winning!

It's extremely important to keep in mind that this isn't just about Kentucky--this will have significant implications for the dozen or so other states which have either imposed work requirements for Medicaid expansion already or are waiting in the wings to do so...including my own state of Michigan, where the GOP-controlled legislature and GOP governor just signed off on their own work requirement law which is, if anything, more draconian that Kentucky's.

Friday’s victory for the plaintiffs — who were represented by the National Health Law Program, the Kentucky Equal Justice Center and the Southern Poverty Law Center — will likely inspire similar lawsuits in those other states.

Kentucky’s waiver, had it been allowed to go into effect, would have denied coverage to non-disabled state residents who could not prove they were working at least 80 hours per month. It would also have charged low-income Medicaid recipients health care premiums, eliminated full coverage of dental care, vision services, and over-the-counter medications for many adults, ended retroactive Medicaid coverage, and implemented a six-month lockout period for people who failed to re-enroll in time or report a change in income.

Hmmmm...none of those things sound like providing heatlhcare for people; all of them sound an awful lot like taking away healthcare coverage for them.

Kentucky’s Republican Gov. Matt Bevin has repeatedly threatened to abolish his state’s Medicaid expansion entirely if the work requirements waiver was struck down in court. Attorneys for his administration even brought this threat into Judge Boasberg’s courtroom, arguing that any harm done to the plaintiffs was not “redressable” because they would lose their Medicaid either way, and warning the judge that his ruling could cause widespread damage in Kentucky and in other states considering expanding Medicaid.

I'm not a lawyer, but I'm pretty sure threatening judges isn't a wise idea, especially if the threat involves holding hundreds of thousands of your own constituents hostage. Just saying.

Judge Boasberg took a dim view of that line of argument, saying that Kentucky’s threat to terminate the Medicaid expansion would only happen after all legal appeals in the case are exhausted, if it happens at all.

“Kentucky tries to muddy the waters,” he wrote in his opinion. “Even if Kentucky were able to ‘unexpand’ Medicaid (far from a foregone conclusion), Plaintiffs would have, at minimum, momentary relief.”

That really is the biggest potential downside to this development, of course: Kentucky, as well as some of the other states could potentially scrap Medicaid expansion altogether if they can't impose work requirements...and other states which haven't expanded yet will be less likely to do so. This is especially true right here in Michigan, where our existing ACA expansion waiver will expire at the end of 2019 if it isn't renewed...which means that if the work requirement law which was just signed last week by outgoing GOP Governor Rick Snyder isn't signed off on by CMS, all 680,000 Michiganders currently on the program would lose coverage.

But wait, there's more!

Boasberg also wrote scathingly of the Trump administration’s claim that its Medicaid waiver decisions were not reviewable by courts.

If that were true, he said, “The Secretary could singlehandedly rewrite the Medicaid Act. Imagine, for instance, that he approved a demonstration project targeting the blind. He could then waive Section 1396a’s requirement that a state (or all states) cover blind people. The Secretary promised at oral argument that he would not do so, but what’s to stop him?”

Granted, Trump already thinks he can do whatever the hell he wants, so that's not terribly surprising.

The court’s ruling Friday comes on the heels of a new study by the Kaiser Family Foundation that found that as many as four million people would lose their coverage if similar rules were adopted nationwide. The majority of those people, Kaiser found, would be people who are working but who have difficulty navigating the system of documenting and reporting that work to the state.

Has Donald Trump ever had to prove that he "performs work" on anything at any time for anyone? Just wondering.

“Most disenrollment would be among individuals who would remain eligible but lose coverage due to new administrative burdens or red tape versus those who would lose eligibility due to not meeting new work requirements,” the study found.

Anyone remember when the GOP was the party that hated burdensome, unnecessary, inefficient red tape and paperwork?