October 11, 2019 has been circled on the calendar for months.
This morning, the United States Court of Appeals for the D.C. Circuit held oral arguments for the case Charles Gresham v. Alex Azar, II, commonly known as Arkansas’s Medicaid work requirement case.
The appeal was filed by the United States Department of Health and Human Services after Judge James Boasberg ruled on March 27th, 2019, that the work reporting requirement Arkansas added to its Medicaid Expansion program “cannot stand.” This ruling sparked calls from Arkansas officials urging the Department of Health and Human Services to appeal the ruling. That appeal was heard this morning before the three-judge panel of the U.S. Court of Appeals for the D.C. Circuit.
Though the D.C. Circuit consists of 18 judges, only a combination of three of those judges hear any given case. For the work requirement appeal, that panel included Judge Cornelia Pillard, Judge Harry T. Edwards, and Judge David B. Sentelle. These three judges will play an instrumental part in the future of Arkansas’s Medicaid expansion program – Arkansas Works.
As the oral arguments began, the courtroom drama was evident. The attorney for the government argued that work requirements are merely a test – a hypothesis – for how states can improve health. She tried to argue that work requirements are just a “means to an end” and a method to help states reduce the cost of Medicaid while increasing coverage.
The judges seemed unconvinced. “Is that really what they are trying to test?” Judge Pillar interjected. The attorney replied that it is meant to assist individuals to graduate to the Affordable Care Act’s marketplace or other methods of insurance besides Medicaid. Skeptically, Judge Pillar responded, “is there data in the record that supports that claim – that work requirements are intended to help to transition individuals between the Medicaid population and the marketplace?”
“People are going to lose coverage because of the pilot,” said Judge Harry Edwards, who did not seem convinced by the attorney’s reasoning. The discussion then shifted to waivers being a method for which states can increase the population and services covered by Medicaid, a direct contradiction to the impact of the work requirements. This is just a test case, the attorney for the Department of Health and Human Services stated, though the Judges urged her to focus more on the real effects, rather than a hypothetical goal that did not happen.
Even Judge David Sentelle seemed unconvinced by the logic provided by the Department of Health and Human Services, which attempted to compare the Medicaid work requirements to those in other safety-net programs like food stamps and the Temporary Assistance for Needy Families program. “Those are statutory conditions there,” he stated. “This is not comparable at all. Why did Congress add the requirements to those programs but not to Medicaid if they intended those to be there?”
Much of the discussion focused on the actions the Department of Health and Human Services took in approving the waivers to Arkansas and Kentucky, specifically the impacts that it would have on coverage. “In Arkansas’s situation, the waiver does not require a look at the impact since it was only an amendment to an already approved Waiver,” the Department of Health and Human Services attorney replied when was asked about the thousands of individuals left without health insurance coverage when the work reporting requirements were enacted between June and December 2018.
While the first take from the appeal seems promising, an official ruling from the three-judge panel is expected in the coming weeks. The stakes in this case are high, because of the 18,000 Arkansans who lost coverage, the thousands more who would likely lose coverage if the case is decided in the Department of Health and Human Services’ favor and work requirements were reinstated, and what it might mean for other states and their efforts to place similar requirements on their Medicaid recipients.
For a detailed look at the harmful impact of the work reporting requirements on Arkansas’s Medicaid population, check out our three-part series: An Early Look at the Impact, Losing Coverage, and Final Verdict.