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Health Care Primer: Medicaid And ACA Wars Continue, Lawsuits Be Damned

August 21, 2018 10:54 a.m.

Three low-income Arkansans currently enrolled in Medicaid sued the Trump administration last week over its approval of strict work requirements for enrollees in the state, rules they say threaten to kick them and thousands of others off their coverage. The legal arguments in the case are very similar to the one that successfully struck down Kentucky’s Medicaid work requirement in June, essentially saying that Trump’s HHS violated both the Medicaid statute and the Constitution in approving the rules without taking into account the harm they could cause. In Arkansas, the only state so far to actually implement a work requirement, that harm is imminent. Thousands of people could lose their insurance this summer after failing to navigate the new online-only system for filing their work hours.

But these lawsuits are not stopping or slowing down the Trump administration’s crusade for Medicaid restrictions. Politico reports that HHS is on the brink of approving work requirements in at least three more states — Arizona, Wisconsin and Maine — and is prepared to allow Wisconsin, for the first time, to ask Medicaid beneficiaries if they use drugs or are in recovery. Gov. Scott Walker (R) originally wanted to go further, and asked HHS for permission to implement mandatory tests for any Medicaid applicant who flagged a history of drug use and deny coverage to those who refused the test or refused to enter treatment if they tested positive. Legal experts told TPM this would be blatantly unconstitutional.

Yet the Trump administration is also taking some steps to shore up the ACA.

HHS approved New Jersey’s plan to implement a statewide individual mandate and reinsurance program to help stabilize the ACA market and bring down insurance premiums — steps intended to repair the damage done by Congress’ repeal of the national individual mandate and the Trump administration’s repeated blows to the ACA. HHS also announced a grant of $8.6 million to help states strengthen their ACA markets.

Meanwhile, health care is set to play a major role in this November’s midterm elections. Across the country, vulnerable red and purple state Democrats are campaigning on protecting people with preexisting conditions, and are attacking their Republican challengers for supporting a lawsuit that would gut the ACA’s coverage guarantee.

Sens. Heidi Heitkamp (D-ND), Joe Manchin (D-WV), Claire McCaskill (D-MO), Bill Nelson (D-FL) and Joe Donnelly (D-IN) are all running aggressively on health care, and polling indicates it’s a winning issue for them.

And just a month before the midterms, the lawsuit by GOP attorneys general — including Manchin and McCaskill’s challengers for the Senate — that seeks to strike down the ACA will be up before a federal court in Texas. Casting aside the oath to uphold and defend the federal laws on the books, the Trump administration is siding with the GOP states in the case, and will argue for gutting the ACA’s protections for preexisting conditions on Sept. 5. To do so so close to the election is not a great look, and Democrats will certainly make hay of it.

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