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In a blatant reversal of Obamacare policy, of adding people to Medicaid, the Trump administration is allowing states to kick them off Medicaid by imposing new requirements to receive benefits

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GREG WILPERT: It’s The Real News Network. I’m Greg Wilpert, coming to you from Baltimore.

Earlier this year, the Trump administration allowed individual states to develop work requirements for those enrolled in Medicaid, the program that provides healthcare to low-income individuals and families. The effect of this would be to knock tens of thousands of poor people off the public healthcare rolls. Also, it represents a stark reversal of the policy of Obamacare, which added millions to Medicare. This week, former U.N. Secretary General Ban Ki moon denounced the United States in an interview in The Guardian, saying U.S. failure to provide healthcare for all is unethical and politically and morally wrong, calling universal healthcare a human right. He said U.S. leaders are, quote, abandoning people because they are poor.

Already three states, Arkansas, Kentucky, and Indiana, have been approved for changes to Medicaid. About 10 other states are awaiting federal waivers to change who can get Medicaid benefits by imposing mandatory work and other requirements. In Arkansas, for example, more than 4000 low-income Medicaid recipients will lose their healthcare benefits if they do not work 80 hours a month or more, are not enrolled in school, volunteer in community, or search for a job for at least 80 hours a month.

Joining us today to discuss the new Medicare rules is Leonardo Cuello. He is director of health policy at the National Health Law Program. Thanks for joining us on The Real News today.

LEONARDO CUELLO: Thanks so much for having me.

GREG WILPERT: So tell us, what progress have you and your organization made in the case against Arkansas and the Trump administration? Can you describe some of the key issues in fighting these changes in Arkansas, and in making sure that those affected will be informed?

LEONARDO CUELLO: Yeah, sure. So as you described, 40,300 people have already lost their insurance in Arkansas. Another 5,000 may lose their insurance by October 1. Another 6,000 by November 1. And then a whole wave of tens of thousands more starting January 1 become at risk. So together with Legal Aid of Arkansas, the Southern Poverty Law Center, we filed a lawsuit to try and prevent HHS, Health and Human Services, and the state from doing this. We are doing everything we can to expedite the lawsuit, to try and get these people their health insurance back as soon as possible. Some of these people are in the middle of serious healthcare treatments. We have a very strong case. And the reason we do is that these policies are not only bad as a matter of health policy. They’re also really bad on the law.

And what we really need is sort of for the public to understand the facts about what’s really going on here, regardless of how they, what they call this, or what they try and pretend it is. These proposals don’t include job training, they don’t include a new jobs data bank, they don’t include transportation to help people get to jobs. They don’t include new childcare services. They don’t do anything to actually help people work. What they do is take health insurance away from people. And they take their health insurance away from people by making them fill out forms, giving them more red tape, and basically making them go through hurdles and processes to show that they’re either working or looking for a job, or whatever the case may be. But at the end of the day there are a whole bunch of people who are actually working who are going to get tripped up by this and lose their coverage. So they’re not doing anything to help people work, and they’re actually doing something that’s going to take health insurance away from a lot of people.

GREG WILPERT: So, Kentucky is another state that is in the process of overhauling Medicaid. And Republican governor Matt Bevin in July has suspended dental and vision benefits for nearly 500,000 Medicaid recipients after a federal judge blocked his plan to massively overhaul the safety net program by imposing work requirements similar to those in Arkansas. Your group was part of a fight in Kentucky that stalled this work for benefits requirement. What is the status of the governor’s efforts there, and where do all of those people who have been stripped of dental and vision coverage stand now?

LEONARDO CUELLO: OK. Well, so the good news is that in Kentucky, after we won our case, which I’ll talk about in a second, the governor threatened to take the dental and vision and transportation services away from people but he backed off. We don’t really know why he backed off. I can tell you we did send a letter to Health and Human Services saying this doesn’t look legal to us, this doesn’t look like an appropriate action. It looks like, in fact, that it flies directly in conflict with the decision that the judge just issued. So they did not move forward with taking away the dental and vision.

But if we look at what they were trying to do in Kentucky big picture, they were trying to do that policy of taking health away, health insurance away from people if they don’t document that they’re working, or something like that. And they were doing seven other things, all equally bad, that would take health insurance away from people. The estimate, by the state’s own admission, was that 100000 people would lose coverage if they were able to do what they proposed. We sued in January, and in June a federal judge agreed with us, and the judge basically said HHS collected evidence about what the impact of this would be, and they did exactly the opposite of what the evidence showed, because the evidence showed this would be very harmful and they shouldn’t do it, and they went ahead and did it anyway. And that directly conflicts with the purpose of the Medicaid program. So Kentucky’s attempt to do this was shut down by a federal judge.

Now, what’s happening today, where we are today at least, is that Kentucky is attempting to kind of evade that federal judgment. What they did is they took this proposal, reopened it up for public comments, which is part of the normal process, and then they’re just going to turn around and reapprove it, and they’re going to say now we considered all the things that that the judge raised, and therefore we’re going to move ahead with it. But they are not actually changing any of the substantive program, right.

So it’s like if you hired somebody to fix your roof, and they said they fixed it, they wrote up a report saying what they did, and then it turned out your roof was still leaking. And you called them up and you said, you’ve got to come back, because this isn’t- this isn’t right. And all they did was write up a new report and hand you a new report saying, OK, here’s the new explanation of what we did. It doesn’t change the fact that the actual program that will result in 100,000 people losing coverage hasn’t been improved or ameliorated in any way.

GREG WILPERT: Another state that has also been approved to make changes is Indiana, where an estimated 85,000 low-income residents who receive Medicaid benefits will soon face the same new requirement of either finding a job, volunteering, getting job training, or going to school to avoid losing their health care benefits. And Dr. Jennifer Walthall, secretary of the Indiana Family and Social Services Administration said, quote, we’re building this program with a very intentional stated goal of having zero people having their benefits suspended. Would this be possible that nobody loses their coverage?

LEONARDO CUELLO: The short answer is no. The whole point of this is that people will be terminated again. It doesn’t provide any solutions. It just takes healthcare away from people, takes health insurance away from people, many of these people be vulnerable people. The really broad point here is whether we’re talking about Kentucky, whether we’re talking about Arkansas, whether we’re talking about Indiana, they all say that their program is a better one. At the end of the day what we’re arguing, what they’re arguing about is whether, you know, you prefer death by firing squad or death by electric chair. At the end of the day they are taking health insurance away from people, and exactly the details of the program don’t matter. They’re all half baked in an attempt to take health care away from people.

So Kentucky’s has problems. Arkansas’ has problems. Indiana’s has problems. And the only difference is that Arkansas’ went live in September and Indiana’s is scheduled to go live in January. So the only thing that’s better about Indiana is that the firing squad starts in January as opposed to September.

GREG WILPERT: One state that was denied a waiver is Kansas. Trump’s Medicaid chief Seema Verma indicated that the state went too far in opposing lifetime limits on Medicaid benefits. Do you see the Trump administration’s rejection of lifetime limits to Medicaid as being a form of drawing a line? And how do you view the chances of pending waivers that are being sought by Arizona, Maine, Utah, and Wisconsin, which are call for some form of time limits to benefits?

LEONARDO CUELLO: Time limits is a very, very serious problem. It cuts against the entire purpose of the Medicaid program, which is to be there when people need it. It cuts its entire design of the law, which said to states, you can get this federal money to help provide health insurance for people in your states. But one of the requirements for getting that money from the federal government is that you have to actually make health insurance available to the people who need it. And now the states want to say, we want to continue to get the money, but we want to be able to stop providing care based on an arbitrary time limit that we’ve made up. So it doesn’t match the law.

In terms of where the administration is going, at the beginning of the year they actually seemed to start slowing down their conversations about these waivers. And we thought, OK, maybe they- you know, and it happened after our lawsuit. And we thought, OK, maybe they’ve actually, they’re taking a moment to think about this and realize these are bad ideas. Unfortunately, they are ramping back up, and they are starting to reconsider a lot of the bad ideas that came up earlier. One of those ideas is those requirements that we talked to earlier around working. They were going to try and implement those in states that hadn’t even done a Medicaid expansion, meaning we’re talking about states where the only adults who are even in the program are people who have a disability, are women who are pregnant. So there really aren’t- there really isn’t a population of people who you should be subjecting to these work requirements. And it actually puts people in a terrible catch-22, because if they work, they go over the income limits, they lose their Medicaid. If they don’t work, they, you know, this work acquirement comes in and takes their health insurance away. And either way, they lose their health insurance.

At the beginning of the year, HHS seemed to realize, you know what? This may be a bad idea. And then suddenly they are now back in conversations to approve these things in states like Mississippi and Alabama. And the solution to this problem that they’ve proposed is woefully inadequate. It’s like putting a bandaid on a broken bone.

GREG WILPERT: So, opponents say that these requirements will have a tremendous negative impact on healthcare for the most vulnerable. Opponents also cite studies that show work requirements often lead to worse healthcare outcomes, because some people will lose coverage for not being able to jump through the administrative hoops; and the other studies say that these requirements seem more like an attempt to knock people out of the program rather than to get them out of poverty. What can we expect, in your opinion, on this point, and what might the future hold?

LEONARDO CUELLO: So that is absolutely right. These policies hurt people. And you know, the basic point here is they get the logic exactly backwards. It’s not the case that you force people to work to improve their health. It’s that we provide people with health insurance. We help them purchase health insurance, in some cases. And that leads to them being better able to work. Right? If your friend tells you, hey, you know, I hurt my back this weekend, you don’t say to your friend you need to immediately go out and rake some lawns so that you can feel better, right? That’s not how health works. So they have it exactly backwards.

Their efforts here are not going to result in anybody getting jobs, because they haven’t created any solutions to the problems that prevent people from getting jobs. If you have somebody in rural Arkansas who can’t find a job, what they’re suggesting is not going to actually help that person get a job. It’s just going to take health insurance away. And if that’s a person who has a chronic illness that they’re managing that they get medications for, what’s the result of this going to be? That they’re going to have a huge decline in their health, and that is actually going to be the reason that they end up being unable to work in the long term. So they have this exactly backwards.

You know, I like to say it’s like if I told you that I’m going to go try and join the NBA so that I can get taller. Right? That’s not how the causation works. It’s not the rain that causes the clouds. And so they have this exactly backwards. And the outcomes here are going to be terrible. We have 4,300 people in Arkansas who have lost their health insurance. These are low-income parents, some of them with chronic illnesses. Many of them are probably working, as it turns out. So these are just really terrible situations. People with disabilities are being swept up in this.

GREG WILPERT: OK. Well, unfortunately we’re going to have to leave it there. I was speaking to Leonardo Cuello, director of health policy at the National Health Law Program. Thanks again for having joined us today, Leonardo.

LEONARDO CUELLO: Pleasure being with you.

GREG WILPERT: And thank you for joining The Real News Network.

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Gregory Wilpert is Managing Editor at TRNN. He is a German-American sociologist who earned a Ph.D. in sociology from Brandeis University in 1994. Between 2000 and 2008 he lived in Venezuela, where he first taught sociology at the Central University of Venezuela and then worked as a freelance journalist, writing on Venezuelan politics for a wide range of publications and also founded, an English-langugage website about Venezuela. In 2007 he published the book, Changing Venezuela by Taking Power: The History and Policies of the Chavez Government (Verso Books). In 2014 he moved to Quito, Ecuador, to help launch teleSUR English. In early 2016 he began working for The Real News Network as host, researcher, and producer. Since September 2018 he has been working as Managing Editor at The Real News. Gregory's wife worked as a Venezuelan diplomat since 2008 and from January 2015 until October 2018 she was Venezuela's Ambassador to Ecuador.