Medicaid

Elections matter.

True to his word, newly-inaugurated Democratic Kentucky Governor Andy Beshear has indeed eliminated the state's controversial and much-litigated Medicaid work requirement provision for the 400,000 state residents who are on the low-income healthcare program thanks to the Affordable Care Act:

Former Republican Gov. Matt Bevin’s controversial plan to impose work requirements and monthly premiums for many Kentucky Medicaid recipients is no more, Democratic Gov. Andy Beshear announced Monday.

(Monday = Last Monday; this is from a week ago)

In one of his first major moves as the 63rd governor of Kentucky, Beshear signed an executive order Monday rescinding Bevin’s Kentucky HEALTH plan, which sought to impose strict work requirements for able-bodied, working-age adults. It would have ended health coverage for an estimated 95,000 Kentuckians.

I haven't written about Utah's batcrap Medicaid expansion program in quite awhile...since last March, in fact. As a reminder, here's where things stood at the time:

Yes, that's right: Not only did they lop 50,000 people out of the loop entirely, the other 90 - 100K enrollees will also be subject to...wait for it...work requirements. Well...sort of; keep reading.

First, it looks like they'll have to apply to at least 48 employers as well. So...what, if they get hired by the first one they still have to apply with 47 more?

Note that it says "and" before the fourth item, not "or"...which means all of them will have to register online, complete a training assessment, apply to at least 48 companies and complete an online training course.

...Oh by the way, one more thing: The minimum wage in Utah is $7.25/hour.

Just days after a lawsuit was filed challenging Michigan's impending Medicaid expansion work requirements, Michigan Governor Gretchen Whitmer sent a letter to legislative Republicans urging them to stop throwing good money after bad on a policy which is pretty much doomed to failure anyway:

Gov. Gretchen Whitmer said delaying implementation of work requirements for enrollees in Michigan's Medicaid expansion program would prevent the state from potentially wasting at least $1 million.

The Democrat issued a special message to legislative leaders Tuesday, a day after saying the Republican-controlled Legislature should pause the rules taking effect in January.

Whitmer said the state has spent $28 million to implement the workforce engagement requirements and is on track to spend an additional $40 million this fiscal year — an unnecessary expense if a federal judge blocks the rules.

Coming on top of not one, not two, but three other states either scrapping or "delaying" implementation of Medicaid expansion work requirements (Arizona, Indiana and Montana), this one isn't particularly surprising given that Democrats hold the governor's seat and just flipped both the state House and Senate. Still welcome, though!

Gov. Ralph Northam has directed Virginia's Medicaid program to "pause" negotiations with the federal government on approval of a work requirement that was central to a political deal that allowed the state to expand eligibility for the program's health care benefits to hundreds of thousands of uninsured Virginians.

Northam cited the Democratic takeover of both chambers of the General Assembly in legislative elections last month. He also referred to litigation that has faced other states that have tried to link Medicaid health benefits to requirements that program participants seek work, training, education or other forms of civic engagement.

From The Hitchhiker's Guide to the Galaxy:

But the plans were on display…”
“On display? I eventually had to go down to the cellar to find them.”
“That’s the display department.”
“With a flashlight.”
“Ah, well, the lights had probably gone.”
“So had the stairs.”
“But look, you found the notice, didn’t you?”
“Yes,” said Arthur, “yes I did. It was on display in the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying ‘Beware of the Leopard.”

From a June story about Arkansas' "Designed to Fail" Medicaid work requirement disaster:

Under the Arkansas law, targeted enrollees were notified by the state via mail and informational flyers that they were required to work 80 hours a month, participate in another qualifying activity such as job training or community service, or meet criteria for an exemption such as pregnancy, a disability or parenting a child.

UPDATE: Well what do you know? Less than a day after Kliff wrote her story on the BYU-Idaho situation, they've already reversed their stance! Bravo for her!

BYU-Idaho, the school @sarahkliff reported would not allow its students to enroll in Medicaid, sent this email to students reversing its decision, per my DMs pic.twitter.com/jEuIu9K1KT

— Dylan Scott (@dylanlscott) November 26, 2019

Original story below...

I heard about this story a couple of weeks ago but didn't get around to writing about it until today. Via Twitter:

Students of the BYUs: might want to start making some noise: the Church Board of Ed just decided that they won’t accept Medicaid as a provider for their student health insurance requirement. The week IDaho expanded Medicaid too. Catch 22? DMBA doesn’t count for ACA requirement.

Michigan

As my friend, U of M Law Professor and former Deputy Assistant Attorney General Sam Bagenstos just noted, this was pretty much inevitable:

BREAKING -- Poverty rights group files suit in federal court against work requirements MI has enacted for those on expanded Medicaid program Healthy Michigan.

— Gongwer News Service (@GongwerMichigan) November 22, 2019

A lawsuit has been filed challenging Michigan's new Medicaid work requirements that take effect Jan. 1. Plaintiffs are 4 people enrolled in the Medicaid expansion program known as Healthy Michigan #MiLeg

— David Eggert (@DavidEggert00) November 22, 2019

Fellow U of M law professor Nicholas Bagley already has the legal complaint itself:

The recent elections in Virginia, Kentucky and Louisiana had two things in common: The first is that all three were huge victories for Democrats (they took control of both the state House and Senate in Virginia, flipped the Governor's seat in Kentucky and held onto it in deep red Louisiana).

The second is that all three elections were won in large part based on...Medicaid expansion.

As Greg Sargent notes in the Washington Post:

Yet Edwards won, in large part, by also stressing his implementation of the Affordable Care Act’s Medicaid expansion in the state during his first term. Indeed, Edwards’s lead pollster, Zac McCrary, told me during an interview that no single issue was more important in driving the governor’s victory.

In 2015, Republican Matt Bevin campaigned for governor on two major healthcare-related platforms:

  • Eliminate the state's perfectly-functioning, award-winning, highly-praised and beloved ACA exchange, "kynect" for no particular reason other than spite.
  • Eliminate the state's ACA Medicaid expansion program, which as of this writing provides around 480,000 low-income Kentuckians with healthcare coverage.

For some inexplicable reason, voters in Kentucky elected him regardless. Once he got into office, he did indeed make good on the first promise, shutting down the state's perfectly good ACA exchange platform and shifting KY to the federal exchange at HealthCare.Gov.

When it came to eliminating Medicaid expansion, on the other hand, he found it to be a little bit tougher than expected; actually pulling the plug on nearly half a million people's healthcare coverage proved to be a tougher nut to crack than he thought.

Various healthcare wonks, including myself, have been warning for years that imposing work requirements on Medicaid enrollees would be pointless, ineffective, wasteful, expensive and cruel.

Several studies, including this one from just the other day, have driven home this point clearly: Adding work requirements to Medicaid expansion enrollees serves no useful purpose other than to kick tens of thousands of people off of their healthcare coverage (which, of course, is the whole point from the POV of those who add the requirements).

As for the one positive-sounding goal (increasing employment) which supporters always use to try and justify them, that's a complete joke:

The first major study on the nation’s first Medicaid work requirements finds that people fell off of the Medicaid rolls but didn’t seem to find more work.

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