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U.S. District Judge Blocks States' Work Requirements For Medicaid

DAVID GREENE, HOST:

Now, under the Affordable Care Act, one program that expanded was Medicaid, which provides medical care to many Americans living in poverty. The Trump administration offered an option to states to require people to work to get benefits.

Well, yesterday a federal judge dealt the administration a blow, blocking those work requirements in two states - Kentucky and Arkansas. The Kaiser Family Foundation, which we should mention provides support to NPR, tracks the impact of health care policy on patients. And we're joined by the foundation's senior vice president, Larry Levitt.

Welcome back. Thanks for coming on this morning.

LARRY LEVITT: Thanks. Good morning.

GREENE: How significant is this court decision? I mean, could this affect a lot of people, this judge saying that you can't require people to work to get Medicaid benefits?

LEVITT: I mean, this decision is very significant. I mean, this idea of requiring Medicaid beneficiaries to work in order to get benefits has been a centerpiece of the Trump administration's health care policy. So it's certainly significant politically but also very significant for people.

I mean, for example, in Arkansas, one of those states that was affected by this court decision, 18,000 people lost their Medicaid coverage - their health insurance last year because of this requirement.

GREENE: Eighteen thousand people lost because they were not working. I mean, this requirement directly...

LEVITT: Well - yeah, it wasn't quite because they were not working. I mean, the issue became the burden of reporting whether or not you were working or whether or not you qualified for an exemption because, for example, you were caring for a family member. So it was almost less the requirement to work and more the burden of actually having to demonstrate that you were working.

GREENE: When the Trump administration has brought up this issue of work requirement, I mean, I could see some people assuming that a lot of people on Medicaid aren't working. That's not really the reality if you look at the numbers. Right?

LEVITT: No. I mean, the vast majority of Medicaid beneficiaries who are not elderly or not disabled are in fact working or caring for a family member or going to school, which is one of the ways to meet this requirement, as well. I mean, it's just 6 percent of Medicaid beneficiaries who don't fall into one of these categories or are not working. So you know, this is basically a working population.

You know, the question is really almost an ideological one. You know, conservatives tend to view Medicaid as a welfare program where you have to work for your benefits. Liberals tend to view the program as an entitlement to health care.

GREENE: I just want to step back if I can. When President Trump was elected, you sounded deeply concerned about the future of the Affordable Care Act. You said the ACA as we know it would seem to be toast. This is quite a day with a lot of news on this front and the president and his administration, you know, supporting the idea of, you know, getting rid of the law entirely. Do you feel the same way as the day President Trump was elected, or has the landscape changed in ways?

LEVITT: Well, you know - and I did say that, obviously - I mean, the Republicans had campaigned heavily in 2016, as had the president, on the idea of repealing the Affordable Care Act. And they got to work doing that almost Day One. You know, remarkably, that effort ended in failure. You know, it was a very high-profile effort to repeal and replace the ACA. It didn't work. And you know, in many ways, that may have led to Democrats taking back the House in 2018.

So I'm surprised that the Affordable Care Act is still standing; I think many others are as well. The amazing thing is that almost 10 years after the Affordable Care Act passed, we're now, this week, back to that same debate with the Trump administration in court arguing that the Affordable Care Act should be overturned.

GREENE: Larry Levitt is senior vice president of the Kaiser Family Foundation.

Thanks so much for joining us.

LEVITT: Thank you. Transcript provided by NPR, Copyright NPR.