Judge blocks Medicaid work requirements

Judge blocks Medicaid work requirements

A federal judge blocked efforts in two states to impose onerous work requirements on Medicaid  recipients on Wednesday, dealing a major blow to the Trump administration’s efforts to scale back the popular health program. The judge found that work requirements in Arkansas and Kentucky undermined the core objective of Medicaid – the provision of medical coverage to the needy. Arkansas and Kentucky were among the first to take advantage of a new federal policy that makes it easier for states to strip coverage from low-income adults – including people who met the work requirements but had difficulty reporting their work hours. Eight other states have had their requests for work requirements approved, with seven more pending. The Washington Post’s Amy Goldstein reports:

Judge James E. Boasberg of the U.S. District Court for the District of Columbia concluded that in letting Kentucky go forward with its requirements, HHS had been “arbitrary and capricious” — the same criticism he leveled once before. He wrote that he “cannot concur” that Medicaid law leaves the HHS secretary “so unconstrained, nor that the states are so armed to refashion the program Congress designed in any way they choose.” The 48-page Kentucky opinion is the more emphatic of the two rulings. The judge walks through the reasons he remains unpersuaded by even a second set of arguments by the administration as to why the program should be allowed to go forward. But the 35-page Arkansas decision has more immediate impact. It strips away the federal basis on which that state added work requirements last June that apply to more than 115,000 poor and working-class Arkansans under a part of Medicaid, known as Arkansas Works, that was expanded under the Affordable Care Act. So far, about 18,000 people have lost coverage for failing to meet the rules or failing to report to the state that they complied.

Medicaid work requirements were a contentious issue last year in Louisiana. As Jeanie Donovan (then of Louisiana Budget Project) explained then, the idea of a work requirement may sound good to some. But  the reality is that it would take away health coverage, create more red tape and make it harder for many people who want to work to find employment.


How to reduce child poverty
Child poverty and neglect is extremely expensive, costing the United States more than $1 trillion per year.  This is why – beyond simple compassion – it makes common sense for government to invest in programs that reduce the number of children living in poverty, and set them on a path to a more prosperous and productive adulthood. The New York Times’ Nicholas Kristof looks at some of the ideas – from child allowances and baby bonds to  – emerging from Democratic presidential candidates:

Baby bonds have been proposed by Senator Cory Booker and are an excellent way to reduce wealth gaps and help low-income families buy homes, afford college and start businesses. The idea is that every child would get a $1,000 savings account at birth, and then children in low-income households would get an additional $2,000 deposit in the account each year. At age 18, the person would get control over the account — which at this point could be worth almost $50,000, including interest — but it could be used only for wealth-building purposes, such as education, a down payment on a home or possibly starting a business. Such accounts have been rigorously studied since the 1990s and have been remarkably successful at helping people gain financial success, often as entrepreneurs. … A plus: Baby bonds would reduce most of the racial wealth gap in the U.S.


ACA enrollment drops in Louisiana
The number of individuals enrolled in health insurance through the Affordable Care Act marketplace in Louisiana fell to a record low in 2019, according to figures from the U.S. Centers for Medicare and Medicaid Services. Despite lower premiums, enrollment in the individual insurance exchange fell by 15 percent, from 109,855 in 2018 to 92,948 in 2019. While the drop in enrollment may be alarming at first glance, the reasons behind it are positive for Louisiana: more people are covered through their jobs and through Medicaid expansion, leading fewer to look for plans in the marketplace. The Advocate’s Sam Karlin explains:

Frank Opelka, deputy commissioner for life, health and annuity, said Medicaid expansion is a “well-known core driver of population loss from the ACA individual market.” For instance, in states like Louisiana and Virginia that expanded Medicaid more recently, Opelka said the ACA individual market populations fell more quickly than states with more stable Medicaid populations. A growing economy also appears to be having an effect on the individual exchange, which offers insurance to people who don’t receive it through work, Medicaid, Medicare or other means. As more people find work, they are usually eligible for employer-sponsored health insurance. “We have also seen evidence some of this population is moving into the small group market as the state economy improves and employer-sponsored insurance becomes more available,” Opelka said in a statement. Brian Burton, director of the Southwest Louisiana Area Health Education Center, the only federally-contracted group that helps people navigate the exchange, also pointed to Medicaid expansion and a rising economy to explain the drop in individual exchange enrollment. Blue Cross and Blue of Louisiana cited those same contributing factors to the decline in exchange membership.


Three nominated to fill vacancy on REC
Despite the ongoing stalemate, Louisiana’s Revenue Estimating Conference serves as a national model for revenue forecasting. One of the keys to that is the independent economist, who serves on the four-member panel and helps decide how much money the state has available to spend each year. Since the REC was created in the late 1980s, only one economist has served in that role – the venerable Jim Richardson of LSU. But he’s retiring, and three economists have been nominated by the Louisiana Board of Regents to fill his big shoes. The Advocate’s Mark Ballard breaks it down:

  • Stephen R. Barnes, who is director of the LSU Economics & Policy Research Group. He’s worked at LSU since December 2000 and received his doctorate from the University of Texas.
  • Gregory B. Upton Jr., analyzes economic policy issues in the energy industry at the LSU Center for Energy Studies. His Ph.D. is from LSU.
  • Gary A. Wagner analyzes regional economics as well as state and local public finance issues at ULL. His doctorate is from West Virginia University.

Commissioner of Higher Education Kim Hunter Reed and Board of Regents Chairman Marty J. Chabert, sought recommendations as well as input from both public and private universities across the state in selecting the final slate. “We have advanced a strong slate of candidates who have the expertise needed to serve in this important role,” Reed said. “I am grateful to the faculty who expressed an interest in serving and certainly grateful to Dr. Richardson for his long and stellar tenure.”

The REC has been at the center of controversy lately, as House Speaker Taylor Barras has refused to recognize an updated revenue forecast. This had led to competing budget bills, one that recognizes the updated forecast and one that does not.


Number of the Day
18,000 – Number of Arkansas residents who have already lost health care coverage for failing to report that they have complied with the state’s Medicaid work requirements. A federal judge blocked the work requirements on Wednesday. (Source: The Washington Post)