The Trump-tainted U.S. Supreme Court has agreed to consider the right-wing window dressing of the work requirement for Medicaid-expansion recipients arising from the poverty-punishing province of Arkansas.
Ideally, the matter will come to nothing.
You might expect a 6-3 Republican majority on the Supreme Court to reverse the liberal Washington, D.C., circuit court of appeals, which ruled as expected in 2019 that a work requirement violated the clearly stated narrow statutory principle of Medicaid, which is to extend health insurance to the needy.
Federal law has one system for attending to a poor person's health. It has another for trying to get a poor person employed. Those systems do not overlap.
The law understands that you don't lead a man to work by forcing him to stay sick.
And that federal statute is not going to be changed at least as long as the Democrats--or other merciful persons--control the U.S. House of Representatives.
You might then expect the Biden administration to do away with the Trump-era Health and Human Services Department policy of granting waivers from normal Medicaid rules to permit states to do test programs requiring work or work-pursuit in order for residents to stay on Medicaid.
In that case, if we're lucky, we would end up having merely fed right-wing hunger for meanness. We also would have kept several lawyers busy.
Arkansas, ignominiously, was the first state to put a work requirement into effect, though it wasn't the first to get a waiver.
Our program never really was a work requirement. It was a reporting requirement by which able-bodied recipients were supposed to find computers and navigate a website to click that either they were working or trying to find work.
The real point was Gov. Asa Hutchinson's extracting the essential legislative votes from Republicans to continue Medicaid expansion in Arkansas, vital to the state budget and rural hospitals.
Hutchinson rebranded the Beebe-
era private-option form of Medicaid expansion the Arkansas Works program. He then won the Trump administration waiver, which was easy.
Thus, he kept a promise to right-wing legislators that those lazy poor people would have to get off the couch and work for their treatment for diabetes or whatever ailed them.
But when thousands upon thousands of recipients failed to meet the computer reporting requirement, the Hutchinson administration tried feverishly to find those people and get them clicked in.
In other words, and to its credit, the Hutchinson administration wanted the political benefit of a work requirement but not the reality of uninsured poor people.
Hutchinson basically admitted as much when he responded to criticism in a debate by saying a lot more than 18,000 residents would be without Medicaid if he hadn't been able to sell legislators on expansion by including the work-
reporting requirement.
Federal health-care groups studying the short-lived Arkansas program--in effect only a few months before the federal courts ended it--have concluded that it accomplished nothing other than kicking people off health insurance. There was no job-discernible unemployment increase as a result of it. Of course.
But Bill Barr's Justice Department, ever doing Trump's political bidding (until last week), sought to appeal the adverse Arkansas ruling, along with a similar circumstance from New Hampshire. Last week, the U.S. Supreme Court said, yes, we're accepting for our consideration those consolidated matters, presumably to decide in 2021.
As it happens, the authorizing waiver for Arkansas expires at the end of 2021. That means two things.
One is that the state Legislature will need to approve a new application for a reauthorizing waiver to continue the program even if the Supreme Court reinstates it.
The other is that we'll have a more compassionate presidential administration coming in next year that quite possibly could adopt a new policy abandoning such waivers.
By the way, the Trump administration's argument for exceeding the federal statute and presuming to tie Medicaid receipt to work is that another law authorizes a system of waivers to pursue innovations.
And, while Hutchinson has seemed to admit his purposes were merely political, he did talk the good right-wing talk after the federal court threw out the Arkansas work program. He lamented that the courts were turning Medicaid into just another "entitlement" program.
It's federal law that does that. And "entitlement" shouldn't be such a dirty word when it comes to health care.
Let's say you come upon a man having had some sort of medical episode rendering him unconscious. Do you simply step around him? Do you tell him you'll call 911 only if he'll get up and look for a job? Or do you call straightway for emergency medical dispatch?
I bet you'd do the latter, which means you just made health care a right.
P.S.--Of course the Supreme Court could make all this moot by killing the Affordable Care Act entirely.
--–––––v–––––--
John Brummett, whose column appears regularly in the Arkansas Democrat-Gazette, is a member of the Arkansas Writers' Hall of Fame. Email him at [email protected]. Read his @johnbrummett Twitter feed.