Daily on Healthcare: Medicaid work requirements may be stopped in court

By | March 14, 2019

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Medicaid work requirements may be stopped in court: The Trump administration is in federal court this morning defending the Medicaid work requirements it approved in two states. Federal Judge James Boasberg of the U.S. District Court for the District of Columbia will hear the cases, the first of which kicked off at 10 a.m. and involves a request to the court to dismiss a challenge to work rules in Arkansas. The next case kicked off immediately after, at 11 a.m., in which the Trump administration will defend the legality of work requirements in Kentucky.

The context: Medicaid work requirements obligate able-bodied, low-income adults to work or train for work for 80 hours a month to be allowed to stay on the program. When Arkansas’s law went into effect, it caused 18,000 people to lose Medicaid within seven months, as beneficiaries either didn’t work or did not report the hours they did work. Kentucky’s program will go into effect July 1 if the court doesn’t block it.

The complaint: Plaintiffs argue they are overly burdened by the restrictions and contend they are illegal because they they do not fulfill Medicaid’s purpose of helping people get access to healthcare. “Medicaid helps people stay healthy enough to work,” Kevin De Liban, attorney at the Legal Aid of Arkansas, one of the groups representing the plaintiffs, said in a statement. “Therefore, it does not make any sense to make people jump through needless and costly hoops when they are often already working or trying to take care of family members.”

The defense: Republicans and the Trump administration ideologically disagree with Democrats about who Medicaid should cover. They contend it should cover the most vulnerable people, such as people with disabilities, children, and older adults who need specialized care. Under Obamacare, Medicaid was allowed to cover people who were low income regardless of disability status or whether they worked, and the rules Trump officials are permitting in states are an effort to chip away at that expansion. Officials have defended the work requirements as fulfilling Medicaid’s duty to help patients get healthier, citing studies that show people who are working are also likely to be in better health. They say the goal of the program should be to help move people out of poverty.

The decider: Boasberg, an appointee of former President Barack Obama, blocked a previous version of Kentucky’s Medicaid work rules from going into effect last year. He concluded that the Trump administration didn’t adequately consider whether the rules would help bring medical care to patients.

Good morning and welcome to the Washington Examiner’s Daily on Healthcare! This newsletter is written by senior healthcare reporter Kimberly Leonard (@LeonardKL) and healthcare reporter Cassidy Morrison (@CassMorrison94). You can reach us with tips, calendar items, or suggestions at dailyonhealthcare@washingtonexaminer.com. If someone forwarded you this email and you’d like to receive it regularly, you can subscribe here.


Azar grilled by House Appropriations Committee:

What he said on FDA: Health and Human Services Secretary Alex Azar committed Thursday to supporting a Food and Drug Administration commissioner to replace Scott Gottlieb who will be strong on e-cigarette regulations. In response to a question from Rep. Nita Lowey, D-N.Y., Azar said: “That is my agenda so I’m certainly not going to support putting someone in as FDA commissioner who doesn’t share my agenda on tackling this e-cigarette epidemic.”

He defended the Title X rules: The Trump administration’s rules say that medical facilities providing abortions or referrals for abortions and other family planning services cannot be housed under the same roof. Azar said the rules were in line with congressional intent and that if facilities were to close after losing access to the grants then “one concedes we have been subsidizing the abortion enterprise.”

Democrats throughout the hearing accused the administration of being inconsistent in its budget by setting ambitious health goals, but then enacting measures Democrats see as counter-productive. As an example, they pointed to the administration’s goals of ending HIV transmission and combating the opioid epidemic while also calling for cuts to Medicaid. They took issue with Republicans and Azar using the term “pro-life” to describe the administration after federal officials also separated families at the border.

“You can’t talk about voting for life and pick an choose those issues that you believe are going to promote life,” Rep. Rosa DeLauro, D-Ct., said, pointing to areas in Trump’s budget that would be cut. “These are life issues,” she added. “And some of my colleagues just like to pick and choose that suit their own ideologies. We don’t have that luxury in this body. We have to consider life issues across the board, and that extends to what we did on the border.”

Azar is facing the Senate Finance Committee now. Tune in.

Outgoing FDA Commissioner Scott Gottlieb unveils e-cigarette restrictions: The FDA plans to force stores to sell flavored e-cigarettes in parts of their facilities that are off-limits to minors, a requirement that would make it impossible for many to sell vaping products. FDA is giving e-cigarette companies until Aug. 8, 2021, to have FDA review their devices, shortening the previous deadline it set by one year.

Vapers United said in a statement that FDA’s regulations were too vague because they didn’t specify how e-cigarette products should be sold in separate parts of a store. But the American Cancer Action Network said FDA should have called for a total ban on flavored e-cigarettes.

During the 30-day comment period FDA is seeking information on whether it needs to provide more specific examples of how stores should set apart sections in its store. The rule generally means an area of the store, or the whole store, where no one under 18 would be allowed to enter. A walled-off area would qualify, but FDA is seeking input on whether any technologies could also be helpful in keeping minors away from the products.

Pallone announces investigation into ‘junk’ healthcare plans backed by Trump: House Committee on Energy and Commerce Chairman Frank Pallone, D-N.J., announced Wednesday that the panel is launching an investigation into short-term insurance plans backed by the Trump administration.

The administration has promoted the plans as alternatives to Obamacare plans, and they are not required to have the essential benefits mandated by Obamacare, such as prescription drug coverage, maternity care, or mental health treatment, and they are allowed to turn down customers with pre-existing illnesses.

State-run reinsurance programs lowered Obamacare premiums: Study: State-run reinsurance programs lowered health insurance premiums by nearly 20 percent, according to a study released Wednesday that will aid Democrats seeking added funding for a federal reinsurance pool. Reinsurance programs reimburse insurers for high claims from very sick people, helping keep down premiums across the system.

Seven states — Alaska, Maryland, Maine, New Jersey, Oregon, Minnesota, and Wisconsin — have set up their own reinsurance programs using the Affordable Care Act’s “innovation waivers.” Avalere, the firm that conducted the study, found that those states saw premium reductions ranging from 6 percent to 43.4 percent. The study also found that the reinsurance programs saved the federal government about $ 1 billion in subsidies.

ACLU sues over Kentucky ‘eugenics’ abortion bill: The American Civil Liberties Union is suing to block a Kentucky measure that would ban abortions on the basis of race, gender, or disability status — a law similar to one the Supreme Court is currently considering reviewing. “Kentucky just passed a ban on abortion based on the reason a person might need one,” the ACLU said on Twitter Wednesday shortly after the Kentucky legislature sent the bill to GOP Gov. Matt Bevin. “The only person who decides whether you need an abortion should be you. We are suing immediately.”

Supporters of the measure often refer to it as a “eugenics bill.” Doctors would lose their license if they were to flout the ban. Bevin, who has called himself the “most pro-life governor in America,” is expected to sign it into law.

Scalise presses Democrats to bypass Pelosi for vote on medical care for abortion survivors: Republican Whip Steve Scalise, R-La., alongside members of the House GOP conference and anti-abortion advocates outside the Capitol, demanded that Democrats sign onto an effort to bypass Nancy Pelosi and Democratic leadership and set up a vote on the Born-Alive Abortion Survivors Act. The bill would make it a felony for a doctor to fatally harm an infant after it survived an attempted abortion.

Minority Leader Kevin McCarthy of California faulted Democrats for objecting to GOP attempts to bring the bill up for a vote through unanimous consent. “This is not a partisan issue,” McCarthy said. “Last night on the floor, for the 17th time, we asked to bring up born-alive protection. For the 17th time, Democrats refused.”

The Rundown

STAT Leading scientists, backed by NIH, call for a global moratorium on creating ‘CRISPR babies’

The New York Times Pentagon pushes for weaker standards on chemicals contaminating drinking water

The Washington Post The parents of more than three dozen unvaccinated kids want them back in school. A judge said no.

The Oregonian Rare case of Oregon tetanus required care of 100 doctors, nurses

The Sacramento Bee Blacks, Hispanics can cut dementia risk with heart-healthy habits, UC Davis study finds


THURSDAY | March 14

House and Senate in session.

March 13-16. American Bar Association 20th Annual Emerging Issues in Healthcare Law Conference. Agenda.

March 13-14. America’s Health Insurance Plans health policy conference. Agenda.

March 14-15. Meeting of the Presidential Advisory Council on HIV/AIDS. Details.

10 a.m. Arkansas Medicaid work requirement oral arguments in the U.S. District Court for the District of Columbia. Kentucky oral arguments follow at 11 a.m.

10:15 a.m. 215 Dirksen. Health and Human Services Secretary Alex Azar to testify about the agency’s budget before the Senate Finance Committee. Details.

TUESDAY | March 19

2:30 p.m. 1775 Massachusetts Ave. NW. Brookings interview with departing Food and Drug Administration Commissioner Scott Gottlieb. Details.