The major administrative policy goal of the Trump Administration’s HHS was to erect significant barriers to accessing and using Medicaid by erecting work and paperwork requirement barriers via a series of waiver solicitations. Many states applied for work requirements. Only Arkansas implemented work requirements before litigation stopped the measures as not being conducive to the fundamental purpose of Medicaid — paying for health care. Research led by Dr. Ben Sommers (now part of the Biden Administration’s HHS) found that the Arkansas work requirements did not lead to any changes in employment and led to the disenrollent of 18,000 eligible adults.
Beneficiaries sued the states and they won big at both the trial court and the court of appeals level. The states appealed the decision to the Supreme Court. The Court will be hearing the case at the end of March.
The Biden Administration has decided to try to render the Supreme Court case moot and pocket the appeals court as a win and precedent. They announced late last week that the work requirements were no longer to be approved (NY Times):
In separate actions Friday, officials notified states with approved work requirements that the administration planned to withdraw the approvals, and it rescinded a Trump-era online guidance document inviting states to pursue new work requirement plans.
There will be lawyers!
Under regular procedure, a state or the federal government can fairly readily get out of a waiver and return to the pre-waiver status-quo. The process involves a single hearing and a short waiting period. HOWEVER, the outgoing CMS Administrator, Seema Verma, sent a letter to the waiver states offering to extend the withdrawal period to nine months in return for no consideration from the states. There will be lawyers.
We know that work requirements increase administrative burden and opportunities for otherwise eligible people to fall through paperwork cracks.
We know that work requirements don’t lead to increased work.
We know there will be lawyers and lots of them, but this is a move towards increasing access and coverage of care.
rikyrah
Yess ???
They were bogus
RepubAnon
Work requirements during a time of high unemployment due to a pandemic-hit economy. With Republicans, it’s vileness all the way down.
ArchTeryx
The cruelty is the point.
stinger
It’s been a while since I’ve thanked you for posting here — so thank you, David!
Also, what rikyrah, RepubAnon, and ArchTeryx said.
Alex
Michigan’s Medicaid expansion has a kill switch if the work requirement is not implemented. The better part of a million people are on expansion Medicaid now…
Barbara
This is such good news. The original decision held that work requirements were inconsistent with the purpose of the federal statute, and it would be good if Congress could shut the door on that issue once and for all by making clear that they aren’t. I don’t have a lot of faith in the judicial outcome here.
When people support the concept of work requirements, they rarely understand what they mean in practice. For one thing, it means that people have to prove their eligibility over and over making it more likely that their benefits will be disrupted even if they meet the requirements. So the state expends money to make it harder for eligible people to get what they are entitled to. And states are rarely motivated to do this well. The Arkansas system was practically designed to make it hard to use, to kick people out of the program.
“We want to make it as clear as possible that we hate poor people even if we have to waste state tax money doing so.”
Mudbrush
Yes, thank you David, you always teach me something!
jonas
@Barbara:
Well put. For Republicans, there is no limit to wasting public dollars if the goal is to somehow humiliate or make life harder for poor or brown people (if you can do both simultaneously, it’s just gravy).
West of the Cascades
I’d always wondered if “Verma” was the plural of “vermin.”
Ohio Mom
What everyone else said, with this additional observation: requiring that someone get and keep a job before allowing them health care is classic horse before the cart.
Someone with untreated health conditions is likely to be too tired, too weak, too uncomfortable, too distracted to get a job, maintain good attendance and perform well.
Treat whatever is making them sick and then they will be in condition for the workforce.
I’m reminded of the school lunch program. We don’t feed hungry children for free (or very reduced cost) out of the goodness of our hearts (that we are a nation with little goodness in our hearts is well-established).
We feed them because the World War II draft boards had to turn away too many recruits with bowed legs from childhood rickets and other conditions caused by the poor nutrition of the Great Depression.
The bottom line is, we feed our school children because we want cannon fodder.
Jim Bales
Perhaps Biden can declare an emergency and suspend the requirement for nine months on the emergency basis, while simultaneously notifying states of the permanent change.
One imagines that they can declare the permanent change according to the traditional method, and they are covered by the emergency declaration if the courts rule against them.
And there will be more lawyers!
and there will be more lawyers!
Best,
Jim
Ken
Is there any other profession that can so easily guarantee itself future work?
My father claimed for years that the road-repair crews would mix wood scrap into the concrete they poured, so that the freeze-thaw cycle would create next year’s potholes to fix.
Mike in NC
I finished Mary Trump’s book on her very screwed-up family yesterday. The Donald was an absolute clone of his angry scumbag father. Fred Trump had no pursuits other than chasing the almighty dollar, but he did enjoy hurting and humiliating people. The Fat Orange Bastard elevated that to an art form of sorts.
joel hanes
One of the worst of the Trumpies: completely dedicated to taking health insurance benefits from as many indigent and disabled Americans as she could possibly manage in the time she had.
joel hanes
@West of the Cascades:
wondered if “Verma” was the plural of “vermin.”
I believe the Latin root denotes “worm” — perhaps her next incarnation of the popular conception of karma is accurate.
See also: “vermicious”
joel hanes
@Ken:
Is there any other profession that can so easily guarantee itself future work?
Gardeners
The Fat White Duchess
@Ohio Mom: Exactly so, and if the Rethuglican provisionns had a purpose other than cruelty the politicians might see that. They wouldn’t even have to develop a heart, just a brain. (OK, and courage, I guess.)
Thanks for laying it out so clearly
th
The Fat White Duchess
@Mike in NC: My take on the book is that *45 is an imperfect clone. His father, while equally reprehensible, was a competent businessman.
Lobo
“We know that [Fill in the blank] requirements increase administrative burden and opportunities for otherwise eligible people to fall through paperwork cracks.”
Universal benefits versus means tested benefits. Too many people get benefits or too few. The above sums up the argument for any benefit.
We saw it play out with the Covid checks. What is the point of policy?
Barbara
@joel hanes: She was the Director of Indiana’s state Medicaid agency under Mike Pence. She is a complete ideologue, but she is much smarter than Pence and was much better at bureaucratic infighting than the average Trump appointee. I think she saw being head of CMS as a stepping stone to becoming Secretary of HHS after a couple of years, but Alex Azar refused to quit. The gossip is that he hated her too much to give her the opportunity. It’s probably a stroke of good fortune for Verma that the pandemic response is not hanging over her head.
Just Chuck
@Alex: That kill switch is a requirement under a different name, and thus invalid. There Will Be Lawyers, of course.
Just Chuck
@joel hanes: Vermicious Knids!
laura
After a lifetime of working in public schools, and then the state unemployment insurance agency, my mother was covered by Medi-Cal for costs related to her residential care as she slowly sank further into alzheimers dementia and for that, our family is eternally grateful as we could not provide her the level of care or living conditions she needed despite of love for her.
At no time, not even once, did any employer seek her out or offer her any remunerative opportunities for work. It was as if she no longer was able to provide the level of customer service that a call center or retail establishment expected. Her inability to wait tables or work as a line cook, hostess or dish washer prevented her from being employed in the hospitality industry. State and local governments failed to reach out and offer a position – not even as a crossing guard or playground attendant. In her late 70’s it just seemed that the workaday world had no real use for her any more. Had she attempted to seek work in order to stay on the Medi-Cal program, the job application process was beyond her ken.
This is what I think about when the subject of work requirements comes up. It’s absolute cruelty and that is the point again and again and again with these Republican shite-bags.
Kent
I’d rather see a work requirement for agricultural subsidies. That would be more fair.
Want some federal welfare for that corporate family farm in North Dakota? Fine. Better give up your Palm Beach condo and high tail your ass back to North Dakota in December to put in and document your 20 hour/week on the farm. Otherwise no check from the taxpayers.
Doesn’t that seem like the Republican way?
Dan B
@laura: There is something about GOP mentality that would rather see one hundred people lose benefits than one person game the system. It’s as though they know wealthy people who gamed the system. They project that the majority of poor people are taking advantage of their “betters” because the majority* of their well to do friends are gaming one or more parts of the system.
*Vast majority? Every last one?
Just Chuck
@Dan B:
I don’t think they even care about the people gaming the system, that’s just an excuse. It wouldn’t matter if the system was bulletproof, they just want people to suffer.
stinger
@The Fat White Duchess: Probably the prescient Fred Trump didn’t name his son after himself in case he turned out to be a loser.
PhoenixRising
At least lawyers can say Seema Verma once did something that was good for someone.
Ronno2018
Thanks for the this post and all your other ones. Always educational even if sometimes I do not understand them!
Geminid
@Kent: I sometimes listen to a “family farm” show. The host does organic dairy up in Massachusetts, and features small and some medium scale producers, farmers markets, etc. Very anti-Big Ag. Last year he had someone from a watchdog group present analysis of the zip codes of people receiving the bulk of the $20+ billions of commodity payments triggered by trump’s stupid trade war. The people were living in gated golf communities, and big cities like San Francisco (Central Valley farm heirs, I guess). Many big payees were LLCs controlling multi-thousand acre farms. People who never see a tractor, much less drive one. Clearly an area that needs reform.