Tagged Medicaid Expansion

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Has everyone recovered from their daylight saving time jet lag? Every year we get a whole host of articles about why changing the clocks is outdated, terrible and really quite bad for our health, and yet! Here were are, still grumpy and tired. But it’s almost the weekend, so let’s soldier on.

Here’s what you may have missed in your spring-forward daze.

President Donald Trump released his $4.75 trillion budget plan this week, which included a big increase in military funding and deep cuts to other domestic spending. Although the proposal will be dead on arrival in Congress, it still serves as a good road map for the administration’s priorities and Trump’s re-election campaign.

There were some health care wins, but there were also some blows, as well. At the heart of it all, critics say, are contradictions that undercut Trump’s talk about supporting certain public health causes. Take the $291 million budgeted for HIV, for example. Trump’s proposal allocates hundreds of millions toward the cause domestically, but then cuts global aid and chips away at programs like Medicaid, which HIV patients rely on.

Some of the health care highlights in the budget:

• Shaving $818 billion from projected spending on Medicare over 10 years and calling for belt-tightening within the popular program to combat “waste, fraud and abuse”;

• Cutting nearly $1.5 trillion from projected spending on Medicaid and transforming the program into a block grant system (a controversial idea that has received a lot of criticism in the past, even from Republican governors);

• Slashing spending on the National Institutes of Health, a longtime favorite of lawmakers of both parties, by $4.5 billion, with the National Cancer Institute absorbing the largest chunk of that cut;

• Increasing funding for pediatric cancer research by $50 million;

• Cutting HHS funding to $87.1 billion, which would be 12 percent less than in the spending plan Congress adopted for this fiscal year;

• Charging the e-cigarette industry $100 million a year in user fees that would go toward the FDA and its oversight efforts;

• And raising funding for VA medical care by nearly 10 percent.

Another interesting tidbit comes out of Politico’s reporting: HHS would be directed to steer $20 million toward a small children’s health program sought by one of Trump’s golfing buddies, Jack Nicklaus.

The New York Times: Trump Proposes a Record $4.75 Trillion Budget

The Washington Post: Springing Forward to Daylight Saving Time Is Obsolete, Confusing and Unhealthy, Critics Say

The Washington Post: Trump Pledges Support for Health Programs but His Budget Takes ‘Legs Out From Underneath the System’

Politico: Trump’s Budget Would Steer $20M to Jack Nicklaus-Backed Hospital Project

Democrats were less than pleased with the suggested budget. Lawmakers warned HHS Secretary Alex Azar — who bore the brunt of their ire at a hearing on Tuesday — that if Medicaid were transformed into a block grant system the change would face “a firestorm” of opposition.

The New York Times: Congress Warns Against Medicaid Cuts: ‘You Just Wait for the Firestorm’

Meanwhile, the “Mediscare” game went another round with Democrats saying that the “unbelievable” cuts fulfill long-standing Republican ambitions “to make Medicare wither on the vine.” If the accusations sound familiar to ones you’ve heard in the past, you’re not mistaken. They just might have been coming from Republicans. The Washington Post Fact Checker untangles it all to show that everyone is guilty of playing this particular scare game.

The Washington Post Fact Checker: Democrats Engage in ‘Mediscare’ Spin on the Trump Budget


Following FDA Commissioner Scott Gottlieb’s surprise resignation announcement, Dr. Ned Sharpless has been named as the acting chief of the agency. Sharpless’ current work as the director of the National Cancer Institute has focused on the relationship between aging and cancer, and the development of new treatments for melanoma, lung cancer and breast cancer.

The appointment was a bit of a curveball for some agency watchers. Some Republicans had been chafing at the way Gottlieb embraced his pro-regulation side as commissioner and were hoping for a sea change. But Sharpless is a Democrat who has spoken out before about how his worries over the e-cigarette industry keep him up at night, so the direction of the agency may not be changing soon. (HHS Secretary Alex Azar has said this is a temporary appointment and the search for a permanent commissioner is underway, but there are also hints that Sharpless could step into the role.)

Colleagues were quick to praise the cancer doctor and research veteran for his breadth of experience and his “approachable, objective” demeanor.

Stat: How Ned Sharpless, Biotech Veteran, Vaulted to the Top of the FDA

No one can accuse Gottlieb of getting whatever the professional version of “senioritis” is, despite the fact that he’ll be departing in a few weeks. The FDA has issued a proposal that would sequester flavored e-cigarettes to areas off-limits to anyone under age 18. The stores can still sell tobacco, mint and menthol e-cigarettes, which the FDA says are more popular among adults than minors.

The New York Times: F.D.A. Moves to Restrict Flavored E-Cigarette Sales to Teenagers


Beto O’Rourke is the latest Democrat to throw his hat in the ring for 2020, but can the moderate Texan overcome his baggage when it comes to his past opposition to the Affordable Care Act? In terms of his current stance, he has said that he supports universal health care, but has, like other moderates in the race, taken pains not to name “Medicare-for-all” in particular.

The Wall Street Journal: Beto O’Rourke’s Past GOP Ties Could Complicate Primary Run


The Connecticut Supreme Court has now cleared the way for Sandy Hook families to sue gunmakers over wrongful marketing. In the lawsuit, the families pointed out ads with slogans like “Consider your man card reissued,” which they say is specifically targeted for troubled young men like Adam Lanza. The ruling is fairly narrow and limited to marketing — the justices dismissed other aspects of the lawsuits — but could have far-reaching ramifications because it strips away some of the blanket immunity offered to gun manufacturers by Congress.

The New York Times: Sandy Hook Massacre: Remington and Other Gun Companies Lose Major Ruling Over Liability


Lawyers are starting to warn their clients who have filed disability claims with the government to clean up their social media because Uncle Sam might start snooping for fraud. “You don’t want anything on there that shows you out playing Frisbee,” one said. Advocates for people with disabilities say using social media sites in such a way would be irresponsible, as it’s impossible to gauge just from the pictures people post if they need disability aid.

The New York Times: On Disability and on Facebook? Uncle Sam Wants to Watch What You Post


In the miscellaneous file for the week:

• Calls for a worldwide moratorium on gene-editing human embryos expose the ethical divide over the research, which has been thrust into the spotlight following a Chinese scientist’s shocking and unexpected revelation that he successfully accomplished the feat.

Reuters: Experts Call for Halt to Gene Editing That Results in ‘Designer Babies’

• An entrenched culture of sexism at VA facilities has led female veterans to forgo needed care in order to avoid harassment. “It’s like a construction site,” said Rep. John Carter (R-Texas).

The New York Times: Treated Like a ‘Piece Of Meat’: Female Veterans Endure Harassment at the V.A.

• Court filings detail Johnson & Johnson’s role in the opioid epidemic, including accusations that the company operated like a drug “kingpin … profiting at every stage.’’

Bloomberg: US Opioid Drug Epidemic: J&J Called ‘Kingpin’ by Oklahoma

• The cost of this Oregon child not getting vaccinations? $800,000 in medical bills and 57 days in the hospital. The terrifying ordeal shows how quickly a small cut can spiral into a devastating emergency.

The New York Times: An Unvaccinated Boy Got Tetanus. His Oregon Hospital Stay: 57 Days and $800,000.

• Medical ethicists were given a lot to think about this week: In this case, it’s examining the tough decisions that come from deciding to extract sperm from a deceased loved one. While some support the choice if it’s a spouse, what happens if it’s the parents who are making the call?

Stat: Efforts to Save the Sperm of the Dead Bring Heartache and Tough Questions

• Is there a chilling effect on disease research when social media activists engage in thought-policing? Scientists say yes, and that, ultimately, the patients are the ones getting hurt.

Reuters: Special Report: Online Activists Are Silencing Us, Scientists Say


Doctors say our oversanitized culture does no favors to our immune system. (I have been pounding this drum for years, so I had to include this story.) The next time you drop some food on the floor, apparently the right move is to embrace the three-second rule and eat it. Have a great weekend!

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Has everyone recovered from their daylight saving time jet lag? Every year we get a whole host of articles about why changing the clocks is outdated, terrible and really quite bad for our health, and yet! Here were are, still grumpy and tired. But it’s almost the weekend, so let’s soldier on.

Here’s what you may have missed in your spring-forward daze.

President Donald Trump released his $4.75 trillion budget plan this week, which included a big increase in military funding and deep cuts to other domestic spending. Although the proposal will be dead on arrival in Congress, it still serves as a good road map for the administration’s priorities and Trump’s re-election campaign.

There were some health care wins, but there were also some blows, as well. At the heart of it all, critics say, are contradictions that undercut Trump’s talk about supporting certain public health causes. Take the $291 million budgeted for HIV, for example. Trump’s proposal allocates hundreds of millions toward the cause domestically, but then cuts global aid and chips away at programs like Medicaid, which HIV patients rely on.

Some of the health care highlights in the budget:

• Shaving $818 billion from projected spending on Medicare over 10 years and calling for belt-tightening within the popular program to combat “waste, fraud and abuse”;

• Cutting nearly $1.5 trillion from projected spending on Medicaid and transforming the program into a block grant system (a controversial idea that has received a lot of criticism in the past, even from Republican governors);

• Slashing spending on the National Institutes of Health, a longtime favorite of lawmakers of both parties, by $4.5 billion, with the National Cancer Institute absorbing the largest chunk of that cut;

• Increasing funding for pediatric cancer research by $50 million;

• Cutting HHS funding to $87.1 billion, which would be 12 percent less than in the spending plan Congress adopted for this fiscal year;

• Charging the e-cigarette industry $100 million a year in user fees that would go toward the FDA and its oversight efforts;

• And raising funding for VA medical care by nearly 10 percent.

Another interesting tidbit comes out of Politico’s reporting: HHS would be directed to steer $20 million toward a small children’s health program sought by one of Trump’s golfing buddies, Jack Nicklaus.

The New York Times: Trump Proposes a Record $4.75 Trillion Budget

The Washington Post: Springing Forward to Daylight Saving Time Is Obsolete, Confusing and Unhealthy, Critics Say

The Washington Post: Trump Pledges Support for Health Programs but His Budget Takes ‘Legs Out From Underneath the System’

Politico: Trump’s Budget Would Steer $20M to Jack Nicklaus-Backed Hospital Project

Democrats were less than pleased with the suggested budget. Lawmakers warned HHS Secretary Alex Azar — who bore the brunt of their ire at a hearing on Tuesday — that if Medicaid were transformed into a block grant system the change would face “a firestorm” of opposition.

The New York Times: Congress Warns Against Medicaid Cuts: ‘You Just Wait for the Firestorm’

Meanwhile, the “Mediscare” game went another round with Democrats saying that the “unbelievable” cuts fulfill long-standing Republican ambitions “to make Medicare wither on the vine.” If the accusations sound familiar to ones you’ve heard in the past, you’re not mistaken. They just might have been coming from Republicans. The Washington Post Fact Checker untangles it all to show that everyone is guilty of playing this particular scare game.

The Washington Post Fact Checker: Democrats Engage in ‘Mediscare’ Spin on the Trump Budget


Following FDA Commissioner Scott Gottlieb’s surprise resignation announcement, Dr. Ned Sharpless has been named as the acting chief of the agency. Sharpless’ current work as the director of the National Cancer Institute has focused on the relationship between aging and cancer, and the development of new treatments for melanoma, lung cancer and breast cancer.

The appointment was a bit of a curveball for some agency watchers. Some Republicans had been chafing at the way Gottlieb embraced his pro-regulation side as commissioner and were hoping for a sea change. But Sharpless is a Democrat who has spoken out before about how his worries over the e-cigarette industry keep him up at night, so the direction of the agency may not be changing soon. (HHS Secretary Alex Azar has said this is a temporary appointment and the search for a permanent commissioner is underway, but there are also hints that Sharpless could step into the role.)

Colleagues were quick to praise the cancer doctor and research veteran for his breadth of experience and his “approachable, objective” demeanor.

Stat: How Ned Sharpless, Biotech Veteran, Vaulted to the Top of the FDA

No one can accuse Gottlieb of getting whatever the professional version of “senioritis” is, despite the fact that he’ll be departing in a few weeks. The FDA has issued a proposal that would sequester flavored e-cigarettes to areas off-limits to anyone under age 18. The stores can still sell tobacco, mint and menthol e-cigarettes, which the FDA says are more popular among adults than minors.

The New York Times: F.D.A. Moves to Restrict Flavored E-Cigarette Sales to Teenagers


Beto O’Rourke is the latest Democrat to throw his hat in the ring for 2020, but can the moderate Texan overcome his baggage when it comes to his past opposition to the Affordable Care Act? In terms of his current stance, he has said that he supports universal health care, but has, like other moderates in the race, taken pains not to name “Medicare-for-all” in particular.

The Wall Street Journal: Beto O’Rourke’s Past GOP Ties Could Complicate Primary Run


The Connecticut Supreme Court has now cleared the way for Sandy Hook families to sue gunmakers over wrongful marketing. In the lawsuit, the families pointed out ads with slogans like “Consider your man card reissued,” which they say is specifically targeted for troubled young men like Adam Lanza. The ruling is fairly narrow and limited to marketing — the justices dismissed other aspects of the lawsuits — but could have far-reaching ramifications because it strips away some of the blanket immunity offered to gun manufacturers by Congress.

The New York Times: Sandy Hook Massacre: Remington and Other Gun Companies Lose Major Ruling Over Liability


Lawyers are starting to warn their clients who have filed disability claims with the government to clean up their social media because Uncle Sam might start snooping for fraud. “You don’t want anything on there that shows you out playing Frisbee,” one said. Advocates for people with disabilities say using social media sites in such a way would be irresponsible, as it’s impossible to gauge just from the pictures people post if they need disability aid.

The New York Times: On Disability and on Facebook? Uncle Sam Wants to Watch What You Post


In the miscellaneous file for the week:

• Calls for a worldwide moratorium on gene-editing human embryos expose the ethical divide over the research, which has been thrust into the spotlight following a Chinese scientist’s shocking and unexpected revelation that he successfully accomplished the feat.

Reuters: Experts Call for Halt to Gene Editing That Results in ‘Designer Babies’

• An entrenched culture of sexism at VA facilities has led female veterans to forgo needed care in order to avoid harassment. “It’s like a construction site,” said Rep. John Carter (R-Texas).

The New York Times: Treated Like a ‘Piece Of Meat’: Female Veterans Endure Harassment at the V.A.

• Court filings detail Johnson & Johnson’s role in the opioid epidemic, including accusations that the company operated like a drug “kingpin … profiting at every stage.’’

Bloomberg: US Opioid Drug Epidemic: J&J Called ‘Kingpin’ by Oklahoma

• The cost of this Oregon child not getting vaccinations? $800,000 in medical bills and 57 days in the hospital. The terrifying ordeal shows how quickly a small cut can spiral into a devastating emergency.

The New York Times: An Unvaccinated Boy Got Tetanus. His Oregon Hospital Stay: 57 Days and $800,000.

• Medical ethicists were given a lot to think about this week: In this case, it’s examining the tough decisions that come from deciding to extract sperm from a deceased loved one. While some support the choice if it’s a spouse, what happens if it’s the parents who are making the call?

Stat: Efforts to Save the Sperm of the Dead Bring Heartache and Tough Questions

• Is there a chilling effect on disease research when social media activists engage in thought-policing? Scientists say yes, and that, ultimately, the patients are the ones getting hurt.

Reuters: Special Report: Online Activists Are Silencing Us, Scientists Say


Doctors say our oversanitized culture does no favors to our immune system. (I have been pounding this drum for years, so I had to include this story.) The next time you drop some food on the floor, apparently the right move is to embrace the three-second rule and eat it. Have a great weekend!

Podcast: KHN’s ‘What The Health?’ The Karma Of Cutting Medicare

Like those of his recent predecessors, President Donald Trump’s proposed budget for the fiscal year that starts in October will not be adopted by Congress. Still, a presidential budget plan is an important indicator of the administration’s priorities.

The Trump administration’s priority for health is for the federal government to spend less. In some cases much less, as evidenced by its proposed funding for the National Institutes of Health and Centers for Disease Control and Prevention.

Also this week, a federal district judge in Washington, D.C., heard arguments in a case challenging work requirements for some Medicaid enrollees in Arkansas and Kentucky. This is the same judge who struck down an earlier version of Kentucky’s proposal.

Meanwhile, Food and Drug Administration chief Scott Gottlieb is stepping down, but this week he issued more rules intended to prevent minors from purchasing flavored e-cigarette products.

This week’s panelists are Julie Rovner of Kaiser Health News, Stephanie Armour of The Wall Street Journal, Alice Ollstein of Politico and Rebecca Adams of CQ Roll Call.

Among the takeaways from this week’s podcast:

  • Trump’s budget may turn the tables on the Republican Party. It calls for more than $500 billion in reductions to Medicare, much of that in payments to providers. That is similar to what Democrats proposed to help fund the Affordable Care Act — a tactic that Republicans used to whip up widespread opposition to the law and gain control of the House of Representatives. Count on Democrats to return the favor in coming campaigns.
  • Some Republicans, including Rep. Tom Cole of Oklahoma, a key Republican on the House Appropriations Committee, signaled concerns about budget cuts recommended by the administration, especially for NIH.
  • On Medicaid, the budget suggests that states be allowed to administer many parts of the program as they see fit. But opponents are likely to ask courts to stop any efforts to weaken federal requirements for coverage.
  • House Democrats have begun an investigation of the marketing and benefits of short-term insurance plans to see if they are denying promised coverage to consumers. The lawmakers are concerned that what they call “junk plans” are confusing consumers who would be better off with policies from the ACA’s marketplace. But any efforts to rein in the plans — which have the blessing of the Trump administration — could run into opposition from Republicans.
  • A federal appeals court this week ruled that Ohio may exclude Planned Parenthood from participating in several small federal health programs that provide money to the state to distribute. The case does not involve either Medicaid or the federal family planning program, but the participation of four judges appointed by Trump could signal a judicial trend.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: Buzz Feed News’ “Military Doctors Told Them It Was Just ‘Female Problems.’ Weeks Later, They Were In The Hospital,” by Ema O’Connor and Vera Bergengruen.

AND

The New York Times’ “Treated Like a ‘Piece of Meat’: Female Veterans Endure Harassment at the V.A.,” by Jennifer Steinhauer.

Rebecca Adams: Kaiser Health News’ “’Medicare-For-All Gets Buzzy In Unexpected Locales,” by Shefali Luthra.

Stephanie Armour: Kaiser Health News’ “Understanding Loneliness In Older Adults – And Tailoring A Solution,” by Judith Graham.

Alice Ollstein: HuffPost’s “These Citizen Activists Fought Hard to Expand Health Care. Then Their Lawmakers Rebuked Them,” by Jeffrey Young.

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Podcast: KHN’s ‘What The Health?’ The Karma Of Cutting Medicare

Like those of his recent predecessors, President Donald Trump’s proposed budget for the fiscal year that starts in October will not be adopted by Congress. Still, a presidential budget plan is an important indicator of the administration’s priorities.

The Trump administration’s priority for health is for the federal government to spend less. In some cases much less, as evidenced by its proposed funding for the National Institutes of Health and Centers for Disease Control and Prevention.

Also this week, a federal district judge in Washington, D.C., heard arguments in a case challenging work requirements for some Medicaid enrollees in Arkansas and Kentucky. This is the same judge who struck down an earlier version of Kentucky’s proposal.

Meanwhile, Food and Drug Administration chief Scott Gottlieb is stepping down, but this week he issued more rules intended to prevent minors from purchasing flavored e-cigarette products.

This week’s panelists are Julie Rovner of Kaiser Health News, Stephanie Armour of The Wall Street Journal, Alice Ollstein of Politico and Rebecca Adams of CQ Roll Call.

Among the takeaways from this week’s podcast:

  • Trump’s budget may turn the tables on the Republican Party. It calls for more than $500 billion in reductions to Medicare, much of that in payments to providers. That is similar to what Democrats proposed to help fund the Affordable Care Act — a tactic that Republicans used to whip up widespread opposition to the law and gain control of the House of Representatives. Count on Democrats to return the favor in coming campaigns.
  • Some Republicans, including Rep. Tom Cole of Oklahoma, a key Republican on the House Appropriations Committee, signaled concerns about budget cuts recommended by the administration, especially for NIH.
  • On Medicaid, the budget suggests that states be allowed to administer many parts of the program as they see fit. But opponents are likely to ask courts to stop any efforts to weaken federal requirements for coverage.
  • House Democrats have begun an investigation of the marketing and benefits of short-term insurance plans to see if they are denying promised coverage to consumers. The lawmakers are concerned that what they call “junk plans” are confusing consumers who would be better off with policies from the ACA’s marketplace. But any efforts to rein in the plans — which have the blessing of the Trump administration — could run into opposition from Republicans.
  • A federal appeals court this week ruled that Ohio may exclude Planned Parenthood from participating in several small federal health programs that provide money to the state to distribute. The case does not involve either Medicaid or the federal family planning program, but the participation of four judges appointed by Trump could signal a judicial trend.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: Buzz Feed News’ “Military Doctors Told Them It Was Just ‘Female Problems.’ Weeks Later, They Were In The Hospital,” by Ema O’Connor and Vera Bergengruen.

AND

The New York Times’ “Treated Like a ‘Piece of Meat’: Female Veterans Endure Harassment at the V.A.,” by Jennifer Steinhauer.

Rebecca Adams: Kaiser Health News’ “’Medicare-For-All Gets Buzzy In Unexpected Locales,” by Shefali Luthra.

Stephanie Armour: Kaiser Health News’ “Understanding Loneliness In Older Adults – And Tailoring A Solution,” by Judith Graham.

Alice Ollstein: HuffPost’s “These Citizen Activists Fought Hard to Expand Health Care. Then Their Lawmakers Rebuked Them,” by Jeffrey Young.

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Judge Vows To Rule On Medicaid Work Requirements By End Of March

The federal judge who shot down a Medicaid work requirement plan last June remained deeply skeptical Thursday of the Trump administration’s renewed strategy to force enrollees to work.

U.S. District Judge James Boasberg, who last year blocked Kentucky’s work requirement, heard testimony on a revised federal approval. He also had a hearing on Arkansas’ Medicaid work requirement — which took effect last July and has led to 18,000 Medicaid enrollees losing coverage.

After the court hearings in Washington, Boasberg said he would rule on both states’ programs by April 1, which is when the next round of Arkansas enrollees could be kicked off the program. Kentucky plans to implement its work requirement this summer.

A ruling against a work requirement would have vast repercussions in more than a dozen other states that have been approved for new work requirements in Medicaid, the federal-state health program, or are seeking them from the Trump administration.

Throughout the two-hour-long hearings, Boasberg questioned Justice Department lawyer James Burnham on whether the work requirement plans approved by the Trump administration were helping to achieve Medicaid’s goal of promoting health coverage.

When Burnham argued that work requirements would give people incentives to find work and improve their lives, Boasberg interjected: “That is not the purpose of Medicaid.”

On Capitol Hill, Democrats grilled Health and Human Services Secretary Alex Azar about the work requirements. Azar testified this week before three separate committees, two in the House and one in the Senate, on the administration’s budget request for the department.

Addressing the Senate Finance Committee on Thursday, Azar disputed the idea that everyone who lost Medicaid in Arkansas was now uninsured. “Only 1,000 of those 18,000 people appealed” their loss of Medicaid, he said. “Only 1,452 of those 18,000 even reapplied for Medicaid when open enrollment came again.”

Azar said that “seems a fairly strong indication” that the rest of those cut from the program “got a job and insurance elsewhere.”

Top health officials for the Trump administration have said getting people on Medicaid into jobs will make them healthier — which they call a key goal of the program.

States can implement work requirements since Congress has given the HHS secretary permission to approve their experiments with the Medicaid program, the administration asserts.

But advocates for the poor say an experiment that leaves thousands of people without coverage runs counter to Medicaid’s aim to improve access to health care.

In his ruling last year, Boasberg, who was appointed by President Barack Obama, said Azar’s approval of Kentucky’s plan failed to consider whether the strategy would “help the state furnish medical assistance to its citizens, a central objective of Medicaid.” He said promoting health generally or helping someone get a job was not the point of the state-federal program created in 1965.

Kentucky last year became the first state to win federal approval for its proposal requiring that certain Medicaid recipients work, go to school or fulfill community service. After Boasberg’s ruling last June, the state filed a new waiver application seeking to meet the judge’s requirements, and the Trump administration approved it.

Federal officials have approved work requirement proposals in seven states — Arizona, Arkansas, Indiana, Kentucky, Michigan, New Hampshire and Wisconsin. In each of those states, the requirements would apply only to people who gained Medicaid coverage under the expansion promoted by the Affordable Care Act. Ten other states — Alabama, Kansas, Mississippi, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Utah and Virginia — also have requested approval. Some of those states have not expanded Medicaid and are seeking to add work requirements to their regular programs.

Kentucky Gov. Matt Bevin, a Republican, has threatened to scrap the Medicaid expansion unless his state is allowed to proceed with the new rules, a move that would cause the more than 400,000 new enrollees to lose their coverage. He said the work requirement will help move some adults off the program so the state has enough money to help others on the program.

Boasberg questioned whether the state has proven its case to the federal government that it needs work requirements to keep its Medicaid program financially sustainable. “At the end of the day, isn’t the centerpiece of your case the fiscal sustainability argument?” Boasberg asked the Trump administration’s lawyer.

Burnham argued neither Kentucky nor Arkansas was kicking people off their programs and causing them to lose benefits. He said people were just choosing to not comply with the state’s new reporting requirements to show they were working, doing volunteer work or meeting one of the states’ exceptions.

Ian Gershengorn, a lawyer representing the National Health Law Program and other plaintiffs trying to overturn the work requirements, said Kentucky’s financial sustainability argument “seems absurd” because the federal government this year is paying 94 percent of the costs for the Medicaid expansion population.

He said HHS should not be approving Kentucky’s waiver based on the governor threatening to kill the entire Medicaid expansion if he doesn’t get work requirement authority.

Gershengorn said Azar cannot argue in approving Kentucky’s waiver that he has no idea how many people would lose coverage since the Arkansas experience already shows thousands lost Medicaid coverage.

The Kaiser Family Foundation has estimated that 1.4 million to 4 million Americans could lose their coverage if work requirements were imposed nationwide. Most of the coverage losses would result from enrollees failing to report their compliance to the state, not because they were failing to fulfill the work or job search criteria. (Kaiser Health News is an editorially independent program of the foundation.)

The Justice Department attorney tried to show the difference between the first Kentucky approval in January 2018 and the second one made last November was that the HHS secretary analyzed what effect the experiment would have on health coverage. He said keeping the Kentucky program would ensure the expansion stayed in place as well as give adult enrollees access to vision and dental coverage.

But Gershengorn argued the difference between the two approvals is that the state and the federal government now know the implications work requirements can have on enrollees.

“There is massive harm,” Gershengorn said. “It is not speculative.”

KHN chief Washington correspondent Julie Rovner contributed to this report.