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Medicaid Work Requirement Could Face Tough Court Test

Earlier this year, Republicans and Democrats finally cut a deal on expanding health insurance to people who live in poverty or with disabilities.

But the key to cutting that deal is now at risk.

Adam Ryan doesn’t have health insurance, a fact that serves as a dark cloud over his day-to-day life in the New River Valley.  “If I get around animals and dander I can get a pretty severe asthmatic attack, and I don’t have an albuterol inhaler or a prescription for it. I know that’s what I need, so I’ve been kind of bumming those off people who do have insurance,” Ryan says.

He works at the Target in Christiansburg. But, unfortunately, he doesn’t work enough hours for him to qualify health insurance under the Medicaid expansion the General Assembly approved earlier this year. “I’ve been averaging less than 20 hours pretty much all year except for maybe a few holidays, and now its kind of picking back up because of the back-to-school season. So I’m getting over 20. But normally it’s below 20,” Ryan admits.

In order to cut a deal earlier this year, Republicans held out for a 20-hour-a-week work requirement. That means Adam Ryan would probably have to continue bumming inhalers off of his friends and clocking into work at his part time job at Target, except for this: a federal court may be offering new hope to people who don’t work 20 hours a week. That’s because those work requirements might actually be in violation of the law.

“Simply put, if you’re trying to add work requirements, there’s a federal judge in Washington D.C. who has pretty much said they’re not going to fly,” says lawyer Rich Kelsey.

At issue is a waiver Kentucky received from the agency that administers Medicaid. The waiver allows Kentucky to add work requirements as a condition to get health insurance. The judge ruled this might block access to health insurance to people who work at places like Target and want to work more than 20 hours a week but can’t. “This agency is not going to be capable of creating a written explanation that will satisfy the waiver requirements because to do so fundamentally changes the Medicaid Act," Kelsey says. "And that’s a big problem.”

A big problem for people like Lauren Toomey at Americans for Prosperity. She was one of the chief opponents of Medicaid expansion. “A lot of what was put out there when the House Republicans put forth this plan for so-called conservative expansion was using Kentucky as an example. The federal government granted them a waiver.”

So why wouldn’t it grant Virginia a waiver too? Even if they work a little differently. “The way that they did their work requirements was kind of in the reverse," Tommey argues. "Virginia wanted work requirements to expand. Kentucky got the waiver to have work requirements to roll it back. Even still, the federal government is now saying no go.”

Jon Liss at New Virginia Majority says he hopes Medicaid expansion will move forward without work requirements. “That would not be a bad thing as long as the rest of the Medicaid expansion, which was a six-year battle to get here in Virginia. But we think that for the up to 400,000 people in Virginia who now have access to healthcare, it would be great thing.”

One person who agrees with that is Adam Ryan, the guy who has to bum inhalers off friends because he doesn’t have health insurance. “You have the CEOs of these corporations having no problem getting the best healthcare in the world, probably. And they’re doing it off the backs of our work, and all workers should be entitled to that same treatment that any CEO of these companies have.”

For now, Virginia is still trying to get that waiver blocking him from getting health insurance. But state officials say Medicaid will expand in January regardless of what happens with the work requirement — if it’s eventually granted or if the courts strike it down. Either way, 400,000 people who don’t have health insurance now will have access to it next year.

This report, provided by Virginia Public Radio, was made possible with support from the Virginia Education Association.

Michael Pope is an author and journalist who lives in Old Town Alexandria.
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