For almost 50 years, the National Health Law Program (NHeLP) has advocated for a society where all people have access to quality health care regardless of their ability to pay or their health status. Inequality and racism do not make for a strong or healthy republic.
Nearing its half-century mark, NHeLP is venturing into a challenging era of conservative control of all three branches of the federal government. There is no better time to add a blog to our work – a forum to explain law and policy and why health care for all is a noble movement and integral to creating a more just and gentle society.
And we start with an update of some of our current work – focusing on the extent to which the federal government and complicit states can ignore requirements of Medicaid law. But, before jumping into that discussion, you might want to take a few minutes to read this brief article by our Health Policy Director Leonardo Cuello, “ What Makes Medicaid, Medicaid: Five Reasons Why Medicaid is Essential to Low-Income People.” It explains why Medicaid is integral to our country’s health care system.
So, given its importance, can the federal government allow states to ignore requirements of this important law? The answer is yes—but only to a limited degree, as NHeLP’s Legal Director Jane Perkins explained in an April 13 press briefing. Specifically, Perkins discussed the ways the Trump administration could undermine the efficacy of the program. (Audio of the call is here.) Perkins, in particular, focused her discussion on Section 1115 of the Social Security Act that allows the Secretary of Health and Human Services (HHS) limited power to waive some requirements of Medicaid law. She noted that several states are currently seeking waivers from HHS to add so-called work requirements to Medicaid, to impose high and mandatory premiums and cost sharing on extremely poor people, and to erect new obstacles to obtaining health coverage (and, thus, health services) – “lock-outs,” drug-testing, service exclusions. No previous administration has approved such requests.
But as Perkins noted in the press call, the new leaders of HHS have signaled “an openness to allowing states more flexibility through the Section 1115 waiver process.” And, quick on the uptake, some governors are already announcing plans to add work requirements and introduce restrictions on Medicaid coverage
That said, it’s not at all clear that the administration even has the legal authority to take these actions. As Perkins concludes in an April 3 NHeLP Issue Brief, “The approval must concern an experiment. Only certain Medicaid provisions can be waived, and the waiver can only last for the extent and period necessary. Otherwise, the approval is made without statutory authorization and judicial intervention may be needed.”
So, litigation to stop states from trying “experiments” on Medicaid that flout the strictures of Medicaid law is a distinct possibility.
To learn more about the Trump administration’s efforts to harm Medicaid, see our Defending Medicaid” resource page.
And please come back to our blog, and follow our discussions on Facebook and Twitter. We can be a stronger society – but it means steering a course that does what is right – ensuring equality and liberty for all, which can only be achieved with health.
