- A three-judge panel seemed highly skeptical of how Medicaid work requirements in Arkansas and Kentucky actually further the objective of the health insurance program for those with low incomes.
- During oral arguments on Friday, the D.C. Circuit Court of Appeals judges questioned how the work requirements promote coverage gains. Judge Harry Edwards said the Trump administration has not explained the reasons behind the coverage losses: "You haven’t addressed it and you haven’t accounted for it."
- Critics of work requirements seemed pleased following Friday's hearing given the line of questioning by the judges.
President Donald's Trump administration has so far approved the imposition of work requirements in nine states. In exchange for maintaining health insurance coverage, Medicaid beneficiaries must work or engage in some other activity such as volunteering or training.
Critics have blasted the administration for altering the program in this way, saying it will lead to a loss of coverage.
In Arkansas, nearly 17,000 people lost coverage in the first few months due to barriers in reporting work hours, according to a report from Georgetown University Health Policy Institute.
The judges on Friday seemed to take issue with the loss of coverage, which some suggested seemed to be in conflict with the main aim of the Medicaid program.
Edwards, appointed by former President Jimmy Carter, referenced a lower court's ruling that struck down the work requirements in Arkansas, calling the decision very thoughtful and thorough. He asked the administration why its believes the lower court decision is wrong, noting the loss of coverage.
"You’re not addressing the effects of the program on coverage," Edwards said. "The effects on coverage are not hypothetical."
The administration blamed the rollout for those losses in Arkansas. The administration also seemed to argue that these work requirements would ultimately lead to members to transition into commercial coverage on Affordable Care Act exchanges a benefit to the Medicaid program as it would free up more resources for the program as a whole.
"Where is the evidence that this kind of stick is even plausibly going to cause that effect?," asked Judge Cornelia T.L. Pillard, appointed under former President Barack Obama.
Edwards seemed frustrated by the lack of answers.
"You haven't addressed coverage in anyway that judges, at least, can digest what you've said and be satisfied that this is reasoned decision making," he said. "You're talking about hypotheses that are kind of up in the sky."
"You're looking to objectives that are not in the statute and you're failing to address, as he said, the critical statutory objective — bottom line. And Judge Pillard just asked you again and you haven't been able to answer it."
The lawsuits were brought by enrollees in the two states' programs. Both Arkansas' and Kentucky's work requirements were struck down in a lower court.
As the administration continues to push for work requirements, a government report showed it's costly to implement them. It has cost taxpayers nearly $408 million to execute the program in five states.
The report raised serious questions about whether the programs were actually budget neutral given the fact that these administrative costs are not presented to federal regulators to consider before approving Medicaid work requirements. The Government Accountability Office called for more oversight of these costs.