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By Phil McCausland
At age 40, Adrian McGonigal occupies the best position of his career serving Southwest Poultry expeditions in Pea Ridge, Arkansas – a city of about 5,700 people. He was suffering from many serious illnesses, but thanks to the state's decision to expand Medicaid, he was able to see a doctor and get the medications he needed to continue working.
But then, Arkansas imposed on Medicaid working conditions, which forced him to log on to report hours of work done to the state government. McGonigal – who had limited access to a computer and had trouble using them – had not realized he would have to report hours every month. So when he went to get his prescription in October, he was told that his drugs would cost $ 800.
He had not completed the work order and therefore lost his insurance. Because he could not afford to buy his medication, his health deteriorated, he missed several days of work due to illness and Southwest Poultry had returned.
This anecdote is behind the 35-page notice that overturned the Arkansas Labor Requirements Act this week, thwarting the one that led to the loss of 18,000 Arkans' health insurance during last months. About 2,000 people were able to re-register after losing their coverage.
The state government has promoted the law as a means of strengthening the self-sufficiency of the poorest population of the state, targeting in particular those who have health insurance for the expansion of Affordable Care Act of Medicaid.
But a handful of Arkans said that losing their health insurance cost them their ability to work. They sued Alex Azar, Secretary of Health and Human Services, after the Trump administration granted Arkansas a waiver to apply the job requirements to the federal health insurance program. .
Kevin from Lebanon, a lawyer with Legal Aid of Arkansas who worked on the case, said the 10 plaintiffs were relieved "more than anything" by the recent decision. "But what's missing in the discussion is how much stress, anxiety, fear and worry you worry about whether you're going to have the drugs that will allow you to keep your work and to live fully. "
The decisions highlight a debate over the fundamental goal of the health care program and come as Donald Trump revitalized the battle for health care at Capitol Hill this week. Administration officials insist that Medicaid is a welfare program and can therefore provide states with waivers to modify the program and add work requirements.
Critics argue, however, that the founding principle of Medicaid is to provide low-income people with access to health coverage – a concept reinstated with the extension of Medicaid under the Affordable Care Act, known as ACA or Obamacare.
Critics seem to have won this argument this week when Judge James Boasberg of the US District of Columbia said the Arkansas demands were "arbitrary and capricious because they had not been addressed – though substantial comments have been made to him. addressed – if and how the project would involve Medicaid's "central" goal: to provide medical coverage to the needy. "
The judge, appointed by Obama, also blocked a parallel waiver in Kentucky, the second decision of its kind in this case. A third lawsuit in New Hampshire is also underway with Boasberg, and the lawyers hope to obtain a comparable judgment.
"There is a similar lack of consideration of the impact on coverage in New Hampshire," said Sarah Somers, senior counsel with the National Health Law Program, a group working on all three cases.
But on Friday, two days after the decisions were ruled against the waivers provided by the Trump administration, Azar approved a similar waiver for Utah, showing that the ruling had not shaken the Trump administration's determination to limit the program and appearing to invite further litigation.
And the table is set for this to happen.
Five other states – Wisconsin, Maine, Michigan, Arizona and Ohio – have also received waivers from the secretary to implement the job requirements and six more are waiting to be ruled out. Approval: Alabama, Mississippi, Oklahoma, South Dakota, Tennessee and Virginia.
The Trump Administration and Health Services Department and Seema Verma, the Administrator of the Centers for Medicare and Medicaid Services (CMS), a long-time advocate for the Obamacare and Medicaid limitation, have approved the working conditions.
"We will continue to advocate our efforts to give states more flexibility to help low-income Americans get out of poverty," Verma said in a statement in response to the Kentucky and Arkansas decision. "We believe, like many previous administrations, that states are the laboratories of democracy and we will vigorously support their innovative, state-led efforts to develop and test reforms that advance the goals of the Medicaid program. "
CMS has not responded to a request for additional comment.
Experts and critics hope, however, that this will force the Trump administration and state governments to be more transparent about the potential impact of these policies and to cope with the realities of a government. low-income job market that does not always produce 80 hours. required work each month to meet the requirement.
"We will have to discuss more in public who will be dropped, what will happen to them and what will justify it," said Andy Schneider, researcher at Georgetown University and Medicaid expert who worked for CMS during the Obama Administration.
The aftermath of things for Arkansas and Kansas remains unclear, but this could have major and immediate consequences for thousands of people. More than 16,000 Arkans who used Medicaid before the required work has still not responded to this request, even after the decision.
However, as a result of the judgment, thousands of people will not lose their insurance on April 1, when the next group of people would be excluded from the program. However, they will continue to lose coverage if the program is reinstated, and this time it will also include those aged 18 to 29. Previously, the law applied only those aged 30 to 49 years.
Meanwhile, despite disagreement with the state's intentions, Arkansas Governor Asa Hutchinson, a Republican, on Thursday urged the Trump government to appeal the ruling so the state could go before with his plans.
"We do not know yet what the federal government will choose to do with Arkansas and Kentucky," said Somers.
Many say that the secondary route and the most likely route would be an appeal to the Circuit Court of the District Court and then the Supreme Court.
"There is certainly a reason to think that they could do it," added Somers.
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