Only days before a Republican plan called Kentucky HEALTH was to go into effect as a replacement for Medicaid for thousands of people, a federal judge has vacated the switch to the state-run plan that would offer less, cover fewer people and require all adults to work or go to school – and document it with paperwork regularly – in order to continue to receive benefits.
The case brought by 16 Kentucky citizens on Medicaid is being closely watched by many other states because, this past January, Kentucky was the first to seek and receive a waiver from the Department of Health and Human Services after President Trump took office – allowing the state to undo most of the Medicaid expansion that was enacted under President Obama, as part of the Affordable Care Act (ObamaCare).
It was estimated about 100,000 people, out of more than 1.4 million on Medicaid, would lose benefits within a few years. About 600,000 of those covered are children.
U.S. District Judge James E. Boasberg ruled in a 60-page opinion from his courtroom in Washington, D.C., today that the work requirements under the new plan and other aspects would “violate the 1965 federal law that created the federal-state health plan for people who are low-income or disabled.”
“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,” writes Judge Boasberg.
“This signal omission renders his determination arbitrary and capricious,” adds the judge. “The Court, consequently, will vacate the approval of Kentucky’s project and remand the matter to HHS for further review.”
While the Kentucky Health plan has been blocked, Gov. Matt Bevin, a Tea Party Republican, former Army officer, and businessman, is threatening instead to kill the entire Medicaid expansion program and take health benefits away from 500,000 people.
The only ones remaining under Bevin’s plan would be elderly, disabled, the blind and low-income families with children.
Under Obama, the Medicaid expansion that states could voluntarily elect expanded benefits to include all citizens of a state who have an income under a certain level (about 130 percent of what is considered poverty).
After Kentucky was the first to get an HHS waiver, Indiana and a number of other states have also been approved or are waiting for approval of the Trump changes which include the work requirements for recipients to get the health care assistance.
Kentucky approved the Medicaid expansion under a Democratic governor but after Bevins was elected in 2015 he began to look for ways to reverse the decision as a way to cut the budget and avoid any new taxes.
Under Bevins, the work requirements – euphemistically known as “community engagement rules” – are necessary give people “the dignity of work.”
His rules require healthy adults to work, volunteer for 20 hours a week, attend school or participate in activities such as job training to maintain their health coverage.
It also requires each person to pay monthly premiums of between $1 and $15 a month.
The Louisville Courier-Journal estimates about 200,000 people would be directly affected by work rules,
The suit challenging Bevin’s plans was brought by the National Health Law Program, the Southern Poverty Law Center and the Kentucky Equal Justice Center.
The advocates argued that federal law created Medicaid as a health plan with no work requirement and said the rules are unnecessary because most of those affected already work, often at low paying or part-time jobs that do not come with any health benefits.
If someone fails to fulfill the requirements, that person would be “locked out” for up to six months before they could reapply.
Earlier this week, the non-partisan, non-profit health policy organization, The Kaiser Family Foundation, issued a study that projected most of those who would lose Medicaid under Bevins plan, reports the Courier-Journal, “will be people who already are working or are exempt from the requirements but fail to keep up with the new rules.”
“Specifically,” adds Kaiser, “under all scenarios, 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 said.
Kaiser adds that “a loss of Medicaid coverage by people who actually meet the requirements may be an ‘unintended’ negative consequence of the new rules.”
The judge in his ruling said the HHS Secretary was too hasty in offering the waivers and failed to study the impact of the changes or estimate how many would lose benefits.
The ruling stops Kentucky Health, but also sends the whole thing back to HHS to rewrite the waiver plan, after doing additional research, so that it doesn’t violate the original intent of the Medicaid law.
What that means is that the Republican attempt to strip millions of health care is like a zombie who will be returned to Frankenstein’s operating room to get changes that Trump believes will pass muster with the judge – and it will then rise from the dead.
Critics of the work rules point out many of those who do not work are caregivers for family members or have other reasons they do not have employment, and the work rules are really just a way to penalize those the Trumpians think are lazy and living off the taxpayers.
As usual with Trump and the Republicans, it is not about what is good for the American people, but rather how the rich and big companies can avoid paying any more taxes.
At least for now, a judge has forced them to go back to the drawing board.