Alice Ollstein

Alice Ollstein is a reporter at Talking Points Memo, covering national politics. She graduated from Oberlin College in 2010 and has been reporting in DC ever since, covering the Supreme Court, Congress and national elections for TV, radio, print, and online outlets. Her work has aired on Free Speech Radio News, All Things Considered, Channel News Asia, and Telesur, and her writing has been published by The Atlantic, La Opinión, and The Hill Rag. She was elected in 2016 as an at-large board member of the DC Chapter of the Society of Professional Journalists. Alice grew up in Santa Monica, California and began working for local newspapers in her early teens.

Articles by Alice

On Friday, Michigan Gov. Rick Snyder (R) signed a strict Medicaid work requirement passed by the state’s GOP-controlled legislature. Under the new law, Michigan will join the dozen states who are actively seeking or have already received a waiver from the Trump administration to implement the new rules — which are expected to drop hundreds of thousands of people from the Medicaid rolls.

Michigan’s bill was significantly rewritten after the first version came under fire for having a significant racially disparate impact. Under the original proposal, people living in counties with unemployment rates above 8.5 percent would have been exempt from the work requirement. Those counties were overwhelmingly white, rural, and Republican. Low-income residents of color in Detroit and Flint, where the joblessness and poverty are extremely high, would not have received an exemption, because the wealthier suburbs surrounding those cities pulled the overall county unemployment rate below the threshold.

The blowback to that plan prompted Michigan lawmakers to make revisions, including the elimination of any exemptions for people in places where it is difficult to find a job.

“They can avoid the disparate impact by leveling up or leveling down, and they chose to level down,” Nicholas Bagley, a law professor at the University of Michigan who specializes in health policy, told TPM. “They could have chosen to extend the same solicitude they had for people in rural areas with high unemployment to people in cities with high unemployment, but did not do so. I think it speaks to how punitive this law will be for many people. You’re telling people to find work where there is no work to be had.” 

The revised law requires adult Medicaid enrollees who do not have a disability to work at least 20 hours per week in order to maintain their insurance. If they cannot find a job, they can complete community service to fulfill the requirement, but only for three months each year.

More than half a million people in Michigan would be subject to the new requirements, and as many as 54,000 people could lose their coverage as a result.

And if the Trump administration were to deny Michigan’s request for a waiver to implement the work requirement, or if a court were to strike them down as illegal under the Medicaid statute, the state is threatening to roll back their Medicaid expansion.

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With House Republicans’ immigration bills likely to go down in flames Thursday afternoon, many vulnerable GOP lawmakers are fearing the political ramifications of their inaction in the face of public outrage over the mass separation of migrant children and families.

But Rep. Pete King (R-NY) is not too concerned.

“Americans care more about Americans,” he told TPM a few hours before the vote.

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After weeks of insisting that only Congress could change the administration’s policy of separating migrant children and their parents, President Trump signed an executive order on Wednesday afternoon that would allow the government to detain families together as they await their immigration hearings. The administration will not, however, cease its policy of bringing criminal charges against immigrants who commit the civil violation of crossing the border unauthorized.

“We are keeping a very powerful border. And it continues to be a zero tolerance,” Trump said. “We have zero tolerance for people that enter our country illegally.”

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Senate Republicans calling for an end to the Trump administration’s policy of separating immigrant parents from their children are pushing legislation that would roll back due process, anti-trafficking and human rights protections — something the administration has long sought to accomplish — allowing for faster deportations of asylum-seekers and the indefinite detention of minors.

House Republicans, meanwhile, are pushing bills that would do all that, slash legal immigration and allocate tens of billions of dollars for a wall on the U.S.-Mexico border.

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The Trump administration released its final rule on Tuesday for Association Health Plans — cheap, skimpy plans that don’t have to comply with many Obamacare protections and regulations. The plans, which cover far fewer services than ACA plans, are expected to lure millions of people out of the individual market, driving up premiums for the older and sicker people who remain.

But the biggest stories this week are coming from federal courts across the country that are grappling with the future of Medicaid and the Affordable Care Act.

Though the Trump administration has thrown its weight behind a lawsuit from 20 GOP states seeking to kill what is left of the ACA, the arguments at the heart of the case are getting panned by legal experts — even those who backed previous lawsuits against the ACA. While the merits of the case may be dubious, its impact could be enormous. Among other effects, it would allow insurers to reject people with pre-existing conditions or charge them higher premiums, throw the premium subsidy system into chaos, tank the ACA’s online marketplace, and weaken protections for people with employer-sponsored insurance. A new study from the Urban Institute estimates that 17 million more people would be uninsured next year if the case succeeds.

In another major case impacting the ACA that flew under the radar last week, a three-judge panel at an federal appellate court said the Trump administration does not have to pay insurers the billions of dollars they say they’re owed as part of the ACA’s risk corridors. The companies say the payments to insurers with a disproportionate number of sick customers could have helped prevent the skyrocketing premiums we’re seeing today. At least one of the insurers has asked the full court to re-hear the case.

Meanwhile, a ruling is expected by the end of June in a lawsuit challenging Kentucky’s Medicaid work requirements, premiums, lockout periods, and benefits cuts. At the oral arguments in D.C. on Friday, TPM heard lawyers from Kentucky and the Trump administration attempt to convince the judge that striking down these rules — which are expected to boot nearly 100,000 people from the Medicaid rolls — will bring devastation both to Kentucky and much of the country. Kentucky has threatened to gut its Medicaid expansion entirely, leaving about 500,000 people uninsured, if the state waiver loses in court. The Trump administration also argued that an adverse ruling would deter all of the red and purple states currently considering expanding Medicaid to abandon their efforts. Attorneys for the challengers told TPM that those claims are “not legally relevant” and “dubious as a policy matter,” and the judge seemed skeptical as well.

Finally, the battle over Maine’s Medicaid expansion is living to fight another day. Gov. Paul LePage (R) is appealing a state court ruling ordering him to move forward with implementing the expansion his constituents voted for last November. LePage’s refusal to extend insurance to 70,000 more Mainers will likely drag out until he is term-limited out of office this fall.

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The first legal challenge to the Trump administration’s crusade for Medicaid work requirements came before a federal judge in Washington on Friday, where attorneys representing 16 low-income Kentuckians argued they would be unlawfully stripped of Medicaid coverage should the court allow the state’s waiver to take effect in July. The groups challenging the policy said the work requirements violate Congress’ original intent for the Medicaid program and instead are a mere cover for cutting tens of thousands of people from the rolls.

In response, attorneys representing the Trump administration and Kentucky Gov. Matt Bevin (R) warned U.S. District Judge James Boasberg of dire consequences should he rule against their new Medicaid rules.

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A federal judge in Washington expressed concern Friday morning about giving a Russian company charged with conspiring to influence the 2016 presidential election via a social media troll campaign access to sensitive information about American citizens.

U.S. District Court Judge Dabney Friedrich ordered the company’s attorney and special counsel Robert Mueller’s team to craft an agreement within 10 days that will govern what data the defendants can see and what should be withheld out of fear it could be passed into the hands of hostile foreign agents, namely Russia intelligence.

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Attorneys for Kentucky Gov. Matt Bevin (R) will tell a federal court this Friday that that the governor plans to take his ball and go home if he can’t get his way on Medicaid work requirements, premiums, and other restrictions. Bevin, who campaigned on ending the Medicaid expansion but backed down from that threat once elected, is now arguing that he will scrap the state’s Medicaid expansion if the controversial new rules are struck down by federal courts.

Kentucky was the first state in the nation to win permission from the Trump administration to impose the new Medicaid rules, which are expected to throw nearly 100,000 Kentuckians off the program. With at least a dozen other states looking to adopt their own Medicaid work requirements, the outcome of the case could determine the future of the program not only in Kentucky but across the country.

Kentucky and the Trump administration are jointly fighting a lawsuit from a dozen-plus Kentucky residents who fear the work requirements and other hurdles will strip them of their Medicaid coverage. The plaintiffs are arguing, among other points, that the new rules do not further Congress’ original intent for Medicaid — to provide affordable health care to low-income people.

Kentucky’s waiver will allow the state to deny coverage to any non-disabled adult who cannot prove they are working at least 20 hours per week. The state also will be able to charge low-income Medicaid recipients health care premiums, eliminate full coverage of dental care, vision services, and over-the-counter medications for many adults, end retroactive Medicaid coverage, and implement a six-month lockout period for people who fail to re-enroll in time or report a change in income.

In the state’s legal filings, Kentucky responds that the challengers don’t have legal standing because they can’t prove they will be harmed by the new rules, which are set to go into effect in July. The state additionally says the lawsuit should be thrown out because Bevin’s promise to scrap the Medicaid expansion entirely if he loses in court means that the challengers’ claims are not “redressable” — essentially, they’re screwed and will lose their Medicaid coverage no matter which way the court comes down.

“Governor Bevin has made it unmistakably clear that Kentucky will withdraw from expanded Medicaid if this case ultimately succeeds in invaliding Kentucky HEALTH,” the state’s reply brief states. “In fact, he has given that conclusion the force of law.”

That “force of law” is an executive order Bevin signed in January that would trigger the termination of Kentucky’s Medicaid expansion within six months if the work requirements waiver is blocked by courts and all appeals are exhausted, meaning that about half a million people would lose their health coverage.

“No matter how much Plaintiffs want expanded Medicaid and no matter how hard they work to keep it, that ultimate decision is not up to them,” the state’s legal brief asserts bluntly. “That decision is Kentucky’s to make.”

In their own legal briefs leading up to Friday’s oral arguments, the Kentuckians challenging the waiver push back with three main counterpoints. First, they say Bevin may not be able to completely kill the expansion even if he wants to.

“It’s not like he can just snap his fingers and the expansion is done,” said Leonardo Cuello, the director of health policy at the National Health Law Program, one of the organizations representing the plaintiffs in court. “In fact, there are serious questions as to whether he can legally undo the expansion.”

Cuello told TPM that their attorneys also plan to implore the judge not to endorse Bevin’s hostage-taking tactic, arguing that doing so would be “rewarding bad threats.”

“If you were to allow Kentucky to get away with this argument, you’d be saying that anytime someone can come up with a threat worse than the harm the plaintiff is identifying, they can strip away someone’s standing,” he explained. “That sends the message that any government official could avoid lawsuits by saying, ‘If you grant this challenge, we’ll do this other thing that’s even worse.'”

Finally, the plaintiffs counter Kentucky with a somewhat wonky argument based on a past federal case involving housing subsidies. They say that even if the court takes Bevin’s “Medicaid waiver or nothing” threat into account, that should not prevent the court from protecting the plaintiffs from a clearly imminent danger.

“All we need to show is that the waiver is a clear step on the path to injury, and that removing it is necessary to removing the threat of injury,” Cuello said. “Our plaintiff’s claims are redressable, because striking down the waiver would be removing an absolute barrier to them, even if it doesn’t prevent other barriers down the line.”

The arguments over Kentucky’s waiver come as many other states move to implement their own restrictive Medicaid rules. Some, including Michigan, have included a provision similar to Kentucky’s, where any outside threat to the work requirements would trigger the abolition of the entire Medicaid expansion.

Cuello told TPM that those states should think twice before crafting such a set-up, calling it “an irresponsible game of chicken.”

“It’s out of your control whether the Department of Health and Human Services approves the waiver and whether courts strike it down,” he said. “It’d be like saying you’ll terminate the Medicaid expansion if the stock market in Japan dips below a certain threshold.”

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