Appeals court skeptical of Trump arguments for Medicaid work requirements

A federal appeals court on Friday repeatedly pressed a Trump administration attorney on whether the Department of Health and Human Services considered how many people would lose coverage if they were subjected to Medicaid work requirements.

The administration said a previous court was wrong to block work requirements in Kentucky and Arkansas, and argued in court that work requirements will allow beneficiaries to transition to other forms of coverage, and will free up state funding from people that may not need it. 

A three-judge panel for the U.S. Circuit Court of Appeals in D.C. appeared skeptical of that position. 

{mosads}The court’s ruling will likely have consequences beyond just Arkansas and Kentucky. The Trump administration has approved work requirements in 10 states to date, and seven more are waiting that approval.

Medicaid work requirements are atop the administration’s health care agenda. Under ObamaCare, states were given the option to expand Medicaid to childless low-income adults who didn’t previously qualify for the program.

The Trump administration argues that “able-bodied” adults should work instead, and that Medicaid should be reserved for children, people who are pregnant, adults who are disabled and very-low income residents.

Opponents of work requirements say the new rules don’t do anything to improve public health and are instead designed to kick people out of the program.

According to administration attorney Alisa Klein, conserving a state’s “finite resources” by having people get coverage from an employer or from the ObamaCare marketplace fulfills the objectives of the Medicaid program.

“If you free up state Medicaid money, there’s no question” you have the option of providing additional coverage because of the savings, Klein said. 

District Judge James Boasberg previously rejected the administration’s approval of Kentucky’s program, and blocked the implementation of the Arkansas program, after he said the administration ignored the fact that work requirements would result in tens or hundreds of thousands of people losing Medicaid coverage.

The appeals panel referred back to Boasberg’s opinion numerous times. Judge Harry Edwards, who was appointed by President Carter, said Klein never addressed the central issue.

“There are adverse effects. People are going to lose coverage. You haven’t addressed that,” Edwards said. “You can’t point to other objectives. The principal objective [of Medicaid] is coverage.”

Klein said the objective is to help people get the education and job training they need to be self sufficient. She argued that people leaving the states’ Medicaid programs are not necessarily losing coverage, because they could gain other sources of coverage later on. 

“Any loss of coverage as a result of non-compliance must be weighed against the benefits Kentucky hopes to achieve,” Klein argued. 

Over 18,000 people lost their Medicaid coverage in Arkansas in the five months the requirements were in effect before they were blocked by the court. Kentucky, meanwhile, estimated 95,000 adults would lose coverage.

The Trump administration has made it a priority to approve work requirements, and plaintiff’s attorney Ian Gershengorn said that is a problem.

The objectives cited by the administration — like saving states money and helping improve quality of life — are “nowhere to be found in the Medicaid statute,” Gershengorn said. 

He said administration officials have admitted they want to transform and restructure Medicaid to make it more like a welfare program. 

“You can’t implement [work requirements] without considering the massive coverage losses,” Gershengorn said. “Coverage is the focus of the [law] and the government hasn’t wrestled with that at all.”