A ruling against Kentucky’s Medicaid work requirements could affect other states

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• HARI SREENIVASAN:

  For more, I spoke recently with Sara Rosenbaum, a professor of Health Law and Policy at George Washington University Milken Institute School of Public Health.

  Sara Rosenbaum, thanks for joining us. So let's first talk about Kentucky. It was poised to be the first state in the country to add work requirements for some Medicaid recipients but just days before taking effect, a judge blocked the new rules. Why?

• SARA ROSENBUAM:

  Kentucky's proposal like the proposals in other states really boiled down to removing people from Medicaid. The state by itself projected a 15 percent drop in Medicaid beneficiaries. And what the judge said was you haven't shown us how an experiment on the poor that removes tens of thousands of people from the Medicaid program furthers the objections of the Medicaid program. So you haven't done your job under the law, you have to go back and explain why removing coverage from people furthers the objectives of Medicaid.

• HARI SREENIVASAN:

  All right, let's talk a little bit about that word experiment. Are 50 states allowed to basically have 50 different experiments on what could and could not work and in this case what could and what could not be sued to stop?

• SARA ROSENBUAM:

  Medicaid does not, except in one very particular circumstance, allow a state to impose work requirements. So, in order to conduct a work experiment — and I use the word experiment quite, quite literally here — the federal government has to turn to a different provision of law. One that actually predates Medicaid itself. And so in order to use this special authority, which has been around for 55 years now, the secretary is essentially no longer approving a state program under the Medicaid statute. He's approving it as an experiment.

• HARI SREENIVASAN:

  Now there's going to be people who look around and say look, we have historically low unemployment, what's the harm in adding work requirements to getting this incredible benefit of health care?

• SARA ROSENBUAM:

  In fact the unemployment rates as you point out are historically low. The vast majority of poor people work, look for work. The nature of of labor in a low wage market, which is where low income adults are obviously, is that it comes in cycles, you may get more hours, you may get fewer hours, you may be called in for a time or get laid off for a while, you may be a seasonal worker. And so, there's a normal fluctuating to and fro and any effort that can be made to help people who are in low wage jobs, who need skills training, who need help finding work is a wonderful thing. And the results of voluntary work programs are actually quite strong.

  What is a real head scratcher here, from a policy point of view, is why you would ever threaten people's health insurance coverage for this, When there is no evidence in fact that more than the smallest handful of low income people just don't work and don't want to work and have no reason not to work. To put at risk people's coverage simply because they can't report in their monthly hours clocked at work, when in fact there's a tiny handful of people who, you know, are that proverbial needles in the haystack is I think what makes the whole enterprise so irrational and frankly so inhumane.

• HARI SREENIVASAN:

  All right. Sara Rosenbaum, a professor of Health Law and Policy at George Washington University. Thanks so much for joining us.

• SARA ROSENBUAM:

  Thank you.