Biden tosses Trump rule that forced people to work to get Medicaid


The reversal aligns with Biden's promise to make health care accessible for all Americans.

President Joe Biden plans to strike down a Donald Trump-era policy on Friday that allowed states to enforce work requirements for individuals on Medicaid, the latest of a number of efforts by the new administration to protect Americans' health both during the COVID-19 pandemic and beyond.

The original policy, rolled out by the Trump administration in early 2018, invited individual states to apply to the Centers for Medicare and Medicaid Services for permission to impose work requirements on prospective and current Medicaid recipients in order to obtain or keep health coverage.

Under Trump, the work requirements were approved in 13 states. According to the Washington Post, 10 others are still in the process of applying for similar approval.

Though a number of court rulings struck down aspects of work requirements for Medicaid coverage in Arkansas, Kentucky, and New Hampshire, the Trump team claimed it remained "undeterred" by legal challenges to the policy. In early December the Supreme Court agreed to hear the case, with an outcome pending.

Seema Verma, Trump's administrator for the Centers for Medicare and Medicaid Services and arbiter of which states received permission to apply work requirements, defended the program after its implementation — but seemed unable to support her defense with facts.

At a House Energy and Commerce meeting in October 2019, Rep. Joe Kennedy III (D-MA) asked Verma, "Ma'am, can you point me to one study that says work requirements make people healthier?

Verma deflected, saying only that there were "many studies that talk about how employment has a positive impact on health outcomes."

Kennedy pushed back, asking her if she could name a study that demonstrated work requirements for Medicaid were a "good policy."

"I've spoken to many people living on the Medicaid program living in poverty, and none of those individuals want to stay where they are," Verma answered.

Studies have shown that some 600,000 to 800,000 adults on Medicaid stood to lose health care coverage if Trump's work requirements were implemented in every state that applied for the exception. In Arkansas, which actually did implement Trump's Medicaid work requirements in 2018, more than 18,000 low-income individuals lost health care in just seven months under the new policy.

According to the Kaiser Family Foundation, most individuals receiving Medicaid are either already working in low-income positions or report an inability to work.

A team of Harvard researchers also found in 2019 that in Arkansas, employment rates did not markedly improve under the policy — instead, the state experienced dramatic drops in health care enrollment. Studies have also found that Medicaid cuts are particularly dangerous to those with long-term mental health issues.

The monthly reporting requirements that the policy would necessitate are also expensive; Kentucky, for instance, had an estimated $271 million budget to track its Medicaid recipients for its work requirement.

The Trump administration's attacks on Medicaid, which began early in Trump's tenure, escalated well into the COVID-19 pandemic which has sickened 27.4 million Americans and killed 475,000, and included threats to limit funding over abortion coverage mandates in states like California, among other things. His attacks came on the heels of expert estimates that 88 to 115 million more people would be forced into poverty by the pandemic, and that chronic medical conditions and mental health struggles have gotten worse for Americans in the past year.

Biden, who has pledged to secure health care for as many Americans as possible during his time in office, has pushed to undo some of that damage.

"Come January, we're going to work quickly with Congress to dramatically ramp up health care protections, get Americans universal coverage and lower health care cost, as soon as humanly possible," the president said Nov. 10.

On his first day in office, Biden issued 10 executive orders to combat the spread of COVID-19. Additionally, he signed an executive order reopening enrollment on Obamacare exchanges.

He's also rolled out plans to expand Medicaid eligibility coverage, offer a public option to all adults, increase the amount deductible from income tax to buy insurance directly, end advertising tax breaks for drug companies, and limit price increases set by manufacturers on his drugs.

"For President Biden, this is personal," the White House said in a fact sheet describing his orders on Jan. 28. "He believes that every American has a right to the peace of mind that comes with knowing they have access to affordable, quality health care."

Published with permission of The American Independent Foundation.