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The Health 202: Trump administration 'undeterred' by court ruling against Medicaid work requirements

with Paulina Firozi


Describing it as a "blow," Alex Azar, the nation's top health official, spoke publicly for the first time on Thursday about a federal judge's decision to block Medicaid work requirements.

Then, several hours later, twelve Democratic attorneys general filed a new lawsuit against another administration health-care policy. We'll have more on that below.

But first, Azar.  

The Health and Human Services secretary, speaking before a friendly crowd at The Heritage Foundation, was unequivocal in his support for states setting up eligibility conditions for Medicaid and vowed to press on despite the judge's ruling.  

"We suffered one blow in district court in litigation, but we are undeterred. We’re proceeding forward," Azar said, during the event's question-and-answer session. "We’re fully committed to work requirements and community participation in the Medicaid program…we will continue to litigate, we will continue to approve plans, we will continue to work with states. We are moving forward."

When a U.S. District Court judge last month struck down the administration's go-ahead to Kentucky to add work requirements to its Medicaid program, it wasn't immediately clear how the the Trump administration would proceed. Then last week the Centers for Medicare and Medicaid Services announced it would reopen comments on Kentucky's request, effectively giving it another chance for approval.

Azar's remarks at Heritage were striking, and showed just how determined the administration is to press forward on giving states flexibility to require "able-bodied" adults to work in some way to qualify for the government-funded health insurance. Since its creation in 1965, work has never been a prerequisite for Medicaid benefits. But many Republicans argue that the program's expansion under the Affordable Care Act went beyond the original intent of the law to cover the absolute poorest Americans, and gives people an incentive not to work.  

"Supporting legislation to undo those perverse incentives is a priority for this administration," Azar said. "But in the meantime, we want to rethink how Medicaid serves able-bodied, working-age adults, which is why we have encouraged states to consider work and community engagement requirements for these populations. For these enrollees, Medicaid should be not just a government insurance card, but a pathway out of poverty, to fuller purpose and better health."

Critics of the work requirement see the push as part of a public-relations campaign by conservatives to change the narrative around Medicaid from a health-care program to a welfare one. Andy Schneider, a professor of health policy at Georgetown University, wrote in a blog post this week that he believes the administration's ultimate goal is to undermine a largely popular program and gin up public support for capping federal Medicaid payments to states. Such a move would save the federal government hundreds of billions of dollars, but would also mean millions of low-income Americans losing coverage. 

It's also yet another effort to undermine the ACA, which sought to expand Medicaid to cover people who earn up to 138 percent of the poverty level (amounting to an annual income of around $16,000 for an individual). Work requirements are expected to largely target those who became eligible for Medicaid because of the ACA. 

As we mentioned above, another administration policy that also targets Obamacare requirements is facing a new court challenge. Filed last night in U.S. District Court, eleven states and the District sued the administration over a Labor Department's rule to expand health association plans. Available to small business owners and the self-employed, these plans are often cheaper and do not have to comply with the ACA's essential benefit requirements, which ensure that health plans cover such services as maternity or mental-health care. The lawsuit argues the association plan option will siphon off healthy Americans and leave only sicker people on the ACA's individual marketplaces, driving up premiums. 

"When health plans do not sufficiently cover health care or plans are no longer affordable, our residents suffer," the Democratic attorneys general wrote. 

In the nation's capital, for example, around 100,000 people receive their insurance through the individual and small group market. Under the Labor rule, more than half covered through District small businesses could be forced into plans with less consumer protections, according to actuarial  estimates provided by the city. 

Politics, of course, is an element of who is doing what.

To bring this all full circle, one of the states involved in this lawsuit is Kentucky.  Attorney General Andy Beshear is a Democrat and has supported efforts to stop the administration from dismantling the ACA. But Governor Matt Bevin, who is pushing for Medicaid work requirements, is a Republican.

For some seeking asylum, family separations were worth the risk: 'Whatever it took, we had to get to this country’ (Video: Zoeann Murphy, Jorge Ribas/The Washington Post)

AHH: The Trump administration said it has reunited 1,442 children with their parents in time to meet a court-ordered deadline to reunite migrant families it had separated at the border following its “zero tolerance” policy crackdown. And our Post colleagues Nick Miroff and Samantha Schmidt report the administration said it was on track to return all children to parents eligible for reunification.

But hundreds of children remain in government custody. There are 711 who have not yet been reunited with their parents because those adults are said to have criminal records, have already been deported, or because their cases are still under review.

Nick and Samantha report 431 parents have already been deported from the United States. “Administration officials said they would work with the court to figure out how to return the remaining children, including those whose parents have been deported,” they write. “One hundred twenty parents declined to be reunited with their children, the government said, a decision some parents make to allow their children to remain in the United States with other relatives while their immigration claims are adjudicated.”

Meanwhile on Thursday, about 100 people, many of them children, led a protest in the Hart Senate Office Building over the family separation policy. “Protest organizers said they wanted to bring children front and center so lawmakers could see the kinds of kids the president’s ‘zero tolerance’ policy has affected,” our Post colleague Marissa J. Lang reports. “Parents at the rally said they wanted to show their children what it means to stand up for others in the face of injustice.”

OOF: The United States is one of the most dangerous places in the developed world to give birth, and USA Today’s Allison Young details in this extensive investigation some of the failures occurring daily in hospitals  that fail to prevent mothers from dying during birth or suffering life-threatening complications.

Every year, about 700 mothers die and more than 50,000 women are severely injured during childbirth. “The best estimates say that half of these deaths could be prevented and half the injuries reduced or eliminated with better care,” Allison writes. “Instead, the U.S. continues to watch other countries improve as it falls behind.”

Allison’s investigation is based on records from more than 150 cases of women whose deliveries went wrong, and reporting from 75 birthing hospitals. “Many hospitals across the country conceded in interviews with USA TODAY that they were not taking safety steps such as quantifying women’s blood loss or tracking whether moms with dangerously high blood pressure got proper medication in time,” she writes. “The lack of attention happens at hospitals big and small, from tiny community delivery units to major birthing centers that tout state-of-the art technology and training. It also happens in doctors' offices when they miss or fail to act on signs of serious complications during pregnancy and after delivery.”

Here are just some of the stunning statistics included in the investigation:

  • Every day, 2 women in America die in childbirth, totaling about 700 every year
  • 60 percent of were related to dangerously high blood pressure in mothers could have been prevented
  • 90 percent of deaths related to hemorrhage or extreme blood loss could have been prevented
  • From 1990 to 2015, the number of maternal deaths per 100,000 in most developed countries dropped, but in the United States, it increased sharply, up to 26.4 per 100,000 in 2015
  • See all the key data points, in graphics, via USA Today here

OUCH: The Centers for Disease Control and Prevention said there was a 31 percent spike in the number of gun-related homicides from 2014 to 2016. Data from the agency found more specifically, the number of people shot and killed by guns was relatively stable from 2010 to 2014, hovering between 11,008 and 11,622, the Washington Examiner reports.

Then starting in 2014, the number steadily increased and was at 14,415 at 2016. The CDC reports the use of firearms was by far the most common method of homicide through all six years of data.


— Yet another pharmaceutical company is buckling under pressure from the Trump administration over drug prices. Celgene Corp. said yesterday it plans to limit future price increase on its drugs this year.

The move follows several of the company’s rivals who have in recent weeks announced delays or other limits to drug price increases under personal pressure from Trump (on Twitter, mainly). Celgene had hiked the price of two of its top-selling cancer drugs, Revlimid and Pomalyst, by 5 percent in 2018, Reuters’s Tamara Mathias and Akanksha Rana report, but conceded it would not increase any other product prices this year. And further, Celgene chief executive Mark Alles said any individual price in price hike in the future “will be limited to no more than once a year and at a level no greater than the Centers for Medicare & Medicaid Services projected increase in national health expenditures for the year,” per the report.


— Drug manufacturer Adapt Pharma offered about 16,000 high schools and colleges free samples of the overdose antidote Narcan. But an overwhelming majority of them rejected the offer. The Radnor, Pa.-based company began in 2016 offering the nasal-spray version of the overdose reversing drug to schools, but just about 7 percent, or 1,000 schools, accepted the Narcan, BuzzFeed News’s Dan Vergano reports.

Dan notes that schools in Pennsylvania, Massachusetts, New Jersey, Georgia and New Hampshire had the highest amount of Narcan recipients, accepting about 2,000 doses in total.

Some suggested the response may have been sparked by the continued stigma, perhaps especially from parents, around the use of the overdose drug. A nursing expert told Dan some think the mere availability of such an antidote would make kids think it’s okay to overdose. Another reason for the rejections could be the targeted population was not necessarily those in need of the most help. “Overdose death rates for people in their thirties and forties are more than twice as high as those in their early twenties and younger,” Dan writes.

— A troubling new report from the Kentucky Office of Drug Control Policy found there was an 11.5 percent jump in drug-related overdose deaths in the state in 2017, even as a statewide crackdown on painkillers has led to nearly 100 million fewer opioid prescriptions in the same year.

The report found there were 1,565 drug-overdose related deaths last year, a 40 percent increase over the last five years.The prevalence of the synthetic opioid fentanyl can be blamed for more than half of the deaths, and the return of methamphetamine resulted in 360 of the deaths, the Associated Press’s Adam Beam reports.  

But Kentucky has pressed forward in its effort to combat the ongoing opioid crisis. “Every year, Kentucky lawmakers have been passing more laws designed to address the opioid problem,” Adam writes. “They have increased penalties for heroin dealers. They have diverted more money to drug treatment programs. And they limited patients to a three-day supply of prescription painkillers unless a doctor gives them written permission for a larger amount.”


—  A new poll found a majority of Hispanic adults have had trouble communicating with their health-care provider because of a language or cultural barrier. The Associated Press-NORC Center for Public Affairs Research poll found further that in those situations, more than a fourth of Hispanic adults sought help from a translator or other community resource.

Less than half of respondents said they would find it easy for older Latino adults to find a nursing home or care facility with staff that could speak in their language, and less than three in 10 said such a long-term care facility would prepare any kind of food they are used to.

A 53-year-old Orlando resident Antonio Torres told the Associated Press he would “rather just live alone and poison myself by accident rather than stay in one of those homes right now." 

“When I tell them I don’t understand them, they’ll bring someone over to speak to me in Spanish and I don’t understand them, either,” Torres, who is bilingual and legally blind told the AP about visits with health-care providers. “We didn’t grow up speaking that formal Spanish, so I have no idea what they are saying.”

— And here are a few more good reads: 

Young people have the most medical debt (Axios)

FDA hit with bot-generated wave of fake comments on flavored vapor products (Washington Examiner)

Clean, Sober and $41,000 Deep in Out-of-Pocket Addiction Recovery Costs (The New York Times )


Lawmakers aim to stop use of pill machines used to boost opioid epidemic (Washington Examiner)


Texas anti-abortion group tacks to the right, dividing state Republicans (Politico )

Federal appeals court won’t reconsider rejection of Md. drug price-gouging law (Ovetta Wiggins)

50 More Women Sue U.S.C. as Accusations of Gynecologist’s Abuse Pile Up (The New York Times)


Coming Up

  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on health care costs on July 31.
  • The Senate Veterans Affairs Committee holds a hearing on pending legislation on August 1.

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