The latest filings in the legal dispute over Medicaid work requirements again highlighted the catastrophic implementation of the program in Arkansas.
In a brief filed yesterday in the D.C. Circuit Court of Appeals, the Trump administration argued that the Arkansas program’s troubles were rooted in poor design rather than the concept itself, and that the resulting disaster — as tens of thousands of poor Arkansans lost their health insurance — was valuable as an experiment.
Attorney General Leslie Rutledge, in a separate brief, argued that the Trump administration, in approving waiver of Medicaid rules to allow the program to proceed, was reasonable in “predicting that there would not be substantial coverage losses.” That prediction, of course, was spectacularly (and predictably) wrong. But hey, it’s an experiment! Just some plucky bureaucrats in lab coats on a voyage of discovery. Neither brief gave much of any mention to the subject of this experiment: Human beings who had their health insurance snatched away.
Last March, U.S. District Judge James E. Boasberg halted Governor Hutchinson’s so-called “work requirements” program, which demanded that certain Medicaid beneficiaries fill out paperwork on a monthly basis or lost their health insurance. The Trump administration is appealing Boasberg’s decision, along with the state of Arkansas as an intervening party.
Boasberg found that federal officials failed to engage with the risk of significant coverage losses if the program was allowed. That’s precisely what happened: More than 18,000 Arkansans were stripped of their health insurance.
In yesterday’s brief, attorneys for the Department of Justice, on behalf of the Trump administration, continued the argument the administration has made previously, blaming the state’s specific policies and implementation for the massive coverage losses.
The Trump administration affirmed the plaintiffs’ contention that the state’s glitchy and confusing online-only reporting system for the requirements was “difficult, and for some impossible, due to a lack of internet access, trouble using computers, and problems working with the online portal.” This represents another humiliating rebuke of the Hutchinson administration, which vehemently defended the online-only reporting requirement before eventually caving and adding a telephone reporting option late last year.
While Hutchinson himself insisted to the end that the bureaucratic trainwreck he implemented was not responsible for the coverage losses, the Trump administration now argues otherwise, pointing to the fact that a tiny fraction of the relevant population (even among those who were in fact working) actually managed to navigate the system and report their activities. “That very low reporting rate suggested a problem with the reporting system rather than with the underlying requirements,” the feds argued.
The Trump administration offered no evidence that the program in Arkansas will not face similar troubles if it gears up again. There was no evident uptick in compliance with the reporting requirement after the telephone hotline was introduced, the only policy change the state made. If the Trump administration is arguing that the state’s rollout made it too difficult for beneficiaries to comply with the reporting requirement, Arkansas still has a long way to go.
Be that as it may. Here’s the twist. The feds argue that the failures of the Hutchinson administration are a feature, not a bug. Taking away health insurance from poor people is just testing out a hypothesis. Working out the kinks. No harm, no foul. “The experience with the rollout of the Arkansas project underscores the value of testing experiments at the local level — where changes can be made quickly — before policies are established nationwide,” Trump administration attorneys wrote.
Just to review: An abundance of public comments warned that the reporting requirements Arkansas was proposing would lead to massive losses of coverage, and that the online-only component would make a bad problem worse. The Trump and Hutchinson administrations ignored these warnings and claimed that everything would be fine. As coverage losses mounted over the year and it became clear that thousands of beneficiaries were unaware of the requirements or unable to navigate the poorly designed reporting system, Hutchinson dismissed critics and claimed beneficiaries losing coverage “simply don’t want to be part of the workforce.” You might say that the “experiment” was a failure.
Now the Trump administration admits that the state’s implementation was a disaster (and falsely implies that changes were “made quickly”), but claims that the disaster is simply a valuable data point. Arkansas will learn from the mistakes that it previously refused to acknowledge. And the failed experiment in Arkansas will help the Trump administration more effectively roll out work requirements across the nation. It will work this time. Trust them.
Rutledge takes us yet further through the looking glass. She argues that the Arkansas program was based on a “commonsense proposition” that Medicaid work requirements would lead to an increase in workforce participation rather than a massive loss of coverage. I might call this a faith-based proposition, since Arkansas just conducted this very experiment and precisely the opposite happened. But it is hard to shake Rutledge’s faith. Indeed, she argues that “the [Health and Human Services] Secretary relied on the record before him to reasonably predict that any coverage loss would be small” and “ultimately predicted that there would not be substantial coverage losses.” Oops. Rutledge’s brief does not mention that the Secretary was catastrophically wrong, and wrong in precisely the ways that health care experts predicted in public comments to the waiver approved by the Trump administration.
Let me offer a “commonsense proposition”: Given how utterly wrong the Trump administration’s prediction was last time around, perhaps a little skepticism is warranted now that the Trump administration is making a new prediction, again without evidence, that the kinks have been worked out and everything will go just fine.
But not to worry. If tens of thousands more people lose their health insurance, it’s all part of the experiment.
There is no evidence that the Arkansas program accomplished its purported aim of encouraging beneficiaries to work and thereby improve their health. There is incontrovertible evidence that the program led to more than 18,000 people losing their health insurance. Every aspect of the program’s design appeared from the beginning to encourage exactly this outcome. The state created a maze of red tape and a clunky system almost guaranteed to cull the rolls, invested no additional funding into outreach or work support services, and showed scant interest in evaluating how effective the program would be at encouraging work or what the consequences might be for access to care for low-income citizens. As the plaintiffs argued, it was a “ham-handed attempt at cutting costs by restricting access and cutting services.”
The decision to initially approve the Arkansas waiver was itself based upon zero evidence other than an affinity for right-wing talking points. Oversight was nonexistent. The incompetent program design by the state was clear and the Trump administration rubber stamped it anyway. Its “prediction” about what would happen was a farce. The hypothesis was wrong. The Trump administration nevertheless is fighting tooth and nail to return the program to Arkansas and take it nationwide, as soon as possible.
Insofar as the program in Arkansas was a grand experiment, the Trump administration is determined to ignore the results.