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Supreme Court will hear Trump administration defend controversial Medicaid work requirements

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Supreme Court will again hear if Obamacare if is unconstitutional

The Supreme Court will take a look at another challenge of the constitutionality of the Affordable Care Act, or Obamacare, in the fall.

WASHINGTON – The Trump administration’s effort to let states impose work requirements on Medicaid recipients is going to the Supreme Court.

The justices agreed Friday to hear the administration’s defense of the controversial program despite a unanimous defeat at the hands of a federal appeals court panel and the likelihood that President-elect Joe Biden will end the program.

While requiring some welfare recipients to work has been federal policy since the 1990s, forcing low-income people to work or prepare for employment in exchange for health coverage is unusual.

Only Arkansas and New Hampshire have work requirements for Medicaid, though trials have been approved for seven other states, and another 10 states have applied. An earlier program in Kentucky was discontinued.

The U.S. Court of Appeals for the District of Columbia Circuit ruled unanimously in February that requiring work does not promote Medicaid’s primary mission, which is health care. The decision was written by Judge David Sentelle, an appointee of Republican President Ronald Reagan.

In Arkansas, more than 18,000 people lost Medicaid coverage under the program during a five-month period in 2018. The appeals court concluded that it was “arbitrary and capricious” for the Department of Health and Human Services not to have considered such a potential outcome.

Opponents of the Medicaid work rule had urged the Supreme Court not to consider the administration’s appeal, particularly in the midst of the COVID-19 public health emergency.

More: How a third wave of COVID-19 engulfed the US

“During a pandemic in which 50 million Americans have filed for unemployment and nearly 12 million have lost employer-sponsored health insurance, the secretary of health and human services asks this court to revive demonstration projects that would allow states to kick people off Medicaid for failing to seek and obtain jobs that are not there,” former U.S. acting solicitor general Ian Gershengorn wrote in opposition to the request.

Jane Perkins, legal director at the National Health Law Program, said the administration “failed to account for the significant loss in health coverage that these approvals would produce. Tens of thousands of people would lose their Medicaid coverage and become uninsured.”

But current acting solicitor general Jeffrey Wall noted that under the Affordable Care Act, enacted in 2010 and upheld by the Supreme Court two years later, most states expanded Medicaid to include “large numbers of working-age, nondisabled adults.” 

The appeals court’s reasoning, Wall wrote, “threatens to impede innovations that may make states’ Medicaid programs more effective and sustainable.”

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