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Why federal judge turned down work requirements for Medicaid in two states

This week saw President Trump resurface the political debate over health care, as he declared his intention to repeal the Affordable Care Act. At the same time, a federal judge blocked work requirements the administration had tried to implement on Medicaid benefits in two states. Amna Nawaz reports and talks to The Washington Post’s Catherine Rampell about health care policy and legal challenges.

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  • Judy Woodruff:

    It is safe to say that, when this week started, few expected the never-ending battles over health care to move front and center once again.

    But President Trump tried to do just that when he said repeatedly, including just today, that he wants to try again to repeal and replace the Affordable Care Act, often referred to as Obamacare, first by winning in court, and then by having Congress pass a replacement plan.

    Now, we should note there is no such plan in existence yet. In the meantime, his administration has continually tried to chip away or knock down parts of the health care law through executive action.

    But, as Amna Nawaz tells us, a pair of important court rulings this week determined the administration went too far.

  • Amna Nawaz:

    A federal judge blocked new work requirements for Medicaid recipients in two states, Kentucky and Arkansas.

    Judge James Boasberg ruled that adding those requirements could prevent people from getting health care coverage, and coverage itself, he said, is the core tenet of Medicaid. The Trump administration has so far allowed at least eight states to implement those work requirements for able-bodied residents. Several other states have also applied to do so. Arkansas was the first state to implement them.

    In his ruling, the judge cited the impact on Medicaid recipients in Arkansas, including a man named Adrian McGonigal.

    This fall, Catherine Rampell went there to talk to him and see how the program was working.

    Here's some of what she found.

  • Adrian McGonigal:

    Well, I just got out of the hospital.

  • Catherine Rampell:

    Adrian McGonigal's life is coming undone.

  • Adrian McGonigal:

    They were wanting me to stay longer, but…

  • Catherine Rampell:

    In the past few weeks, he's lost his job, his health insurance, even his feelings of self-worth.

  • Adrian McGonigal:

    Without my medication, I can't really sleep good, so…

  • Catherine Rampell:

    He's worked all his life. But now, at the age of 40, he's entirely dependent on people like his mom to get by. And he blames the U.S. Department of Health and Human Services.

  • Woman:

    Your status as far as?

  • Adrian McGonigal:

    The Arkansas Works is concerned.

  • Catherine Rampell:

    This summer, he had a decent-paying job at a chicken plant outside Bentonville. But when the Trump administration allowed the state of Arkansas to impose new work requirements on Medicaid, he, like many Medicaid recipients, got confused about how to report his hours.

  • Adrian McGonigal:

    I thought that everything was good about this. I thought it was just a one-time deal, that you report it, and then that was it.

  • Catherine Rampell:

    He was wrong. He was supposed to log those hours online every month. He became one of the 12,000 people that the state has booted from the Medicaid rolls in the last three months.

  • Adrian McGonigal:

    How do I get my insurance back on?

  • Catherine Rampell:

    He discovered this only when he went to fill prescriptions at this drug store and the pharmacist told him, sorry, your coverage has been canceled.

  • Adrian McGonigal:

    And that it was going to be like $340 for one of the medications, and like $80 for the other one.

  • Catherine Rampell:

    So, he left empty-handed. This was a big deal, because McGonigal has severe COPD, a chronic lung disease that makes it difficult to breathe.

    Without his meds, he landed in the hospital multiple times and missed a lot of work. His supervisor tried to accommodate him, but he wasn't healthy enough to perform his job. So he lost it.

    He's now part of a lawsuit against the federal government, charging that his story is a cautionary tale. His lawyers say it proves why adding work requirements to a health insurance program can backfire and actually make it harder for the poor to hold down a job.

  • Amna Nawaz:

    And since Catherine filed that story, about 18,000 Arkansans lost their Medicaid coverage; 2,000 of them have re-applied. And Arkansas Governor Asa Hutchinson says more than 70,000 have moved off Medicaid rolls.

    Governor Hutchinson wasn't available to appear on the program today. But here's some of what he said yesterday.

  • Gov. Asa Hutchinson, R-Ark.:

    I contend that Judge Boasberg is wrong. And I'm urging the Department of Justice and Secretary Azar to appeal the ruling and to seek an expedited appeal of the district court's decision.

    It is important to emphasize today that I remain fully committed to a work requirement, and we are in this for the long haul, because we believe it is the right policy for our Arkansans who want to work and need more training and more opportunity.

    I should add that President Trump and his administration remains committed as well to this work requirement.

  • Amna Nawaz:

    There was a second decision yesterday related to health care law from another federal judge. He ruled a Trump administration effort was illegal.

    The administration had allowed small businesses to pool together and offer health insurance plans that avoid some of the law's requirements. The judge called it — quote — "clearly an end-run" around the ACA.

    Let's take a look now at all of this, starting with the bigger decision on Medicaid.

    And for that, I'm joined by Catherine Rampell, who is also a columnist for The Washington Post.

    Catherine, welcome back to the "NewsHour."

    We just heard that story about Adrian McGonigal you told from last fall. Just give me a sense, how unique was his story, that set of circumstances that allowed him to fall through the cracks?

  • Catherine Rampell:

    I will say that, when we visited Arkansas, we heard from a lot of people who were confused about the requirements, how they were to be recorded, if people were going to prove that they were actually abiding by the requirements, as well as a lot of lack of awareness about whether the requirements even existed.

    So, he is by no means unique. Even though who were aware that the requirements existed also expressed concern in many cases about their ability to meet them. There were people who were working, but maybe not working enough hours, for example, or who had trouble with transportation.

  • Amna Nawaz:

    So, walk me through now the judge's decision this week that blocked Arkansas, right, from continuing that program and also blocked Kentucky from implementing the same work requirements.

    What was the core justification for blocking those, from the judge's perspective?

  • Catherine Rampell:

    This was actually the second time, to be clear, that a judge had determined that Kentucky could not implement its work requirements program, despite having gotten approval from the Trump administration to do so.

    Basically, the judge was objecting to the fact that, while the executive branch has a lot of authority to implement new rules around Medicaid or around other kinds of federal programs, they have to be in accordance with the core tenant of whatever law authorizes the existence of those types of programs.

    So, in the case of Medicaid, the core tenet of Medicaid is to — the provision of health care to the needy. This is what the judge cited in his decision. He said that by putting these kinds of restrictions on the Medicaid program, or at least to the Medicaid expansion program, that wasn't furthering, again, this core purpose of the Medicaid law.

  • Amna Nawaz:

    So we should point out people who advocate for these work requirements — you talked to some of these folks in Arkansas — we heard Governor Hutchinson there — including the president, they say it incentivizes beneficiaries to lead healthier lives.

    They say that steps like this will help to lift some of these people who may be stuck in poverty out of that life. And I'm wondering, based on what you saw, based on the people you talked to out there, did you see that happening? Was that support there?

  • Catherine Rampell:

    Well, in the case of Arkansas, for example, the state didn't allocate any additional funding for job training programs or job search programs or anything along those lines.

    This new set of requirements, of course, was intended to incentivize people to go out and find work. But the problem with that as a construct, I guess, is that most people who are enrolled in Medicaid were who are not disabled are already working — either they're working, or they're looking for work, or they have another kind of exemption, like they're a full-time caregiver, for example, that allows them to — that basically fulfills the idea that the program is intended to be furthering, in terms of incentivizing people to get to work.

    The problem, as we saw in the case with Adrian McGonigal, is that there are a lot of people who are on Medicaid for whom Medicaid enables them to work. They are getting health care, they're getting prescriptions that allow them to hold down a job.

    So there are cases where the intention of this new program is actually backfiring in a sense, that people who had been working, by having their Medicaid coverage taken away, are having more difficulty holding down a job.

  • Amna Nawaz:

    So, Catherine, take us into sort of a big-picture view. We have heard from the Trump administration they want to continue to press forward with implementing these work requirements.

    There are still several states who have applications pending. How is this going to play out, especially when you look at the larger affordable health care and the health benefits right now?

  • Catherine Rampell:

    Well, in fact, actually today, the Trump administration approved a waiver for another state, Utah, which is doing a partial expansion of Medicaid, for it to implement a similar Medicaid work requirement program.

    So there is no sign at this point the Trump administration is reversing course. It looks quite likely that these decisions will be appealed. They may ultimately make their way up to the Supreme Court. And the other states that are still getting their waivers considered have not shown any sign that they are, you know, likely to reverse course at this point.

    But you never know. It could be that these legal rulings make them revisit, but we haven't seen that at this moment.

  • Amna Nawaz:

    Surely a battle to be played out in the courts, and you will be tracking it all as well.

    Catherine Rampell with The Washington Post, thanks for being with us.

  • Catherine Rampell:

    Thank you.

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