Illustration courtesy Kaiser Health News

Kentucky advocates for affordable and easily accessible health care continue to celebrate a judge’s decision to reject the state’s planned Medicaid overhaul but are staying alert for more threats to the insurance of low-income Kentuckians.

On Wednesday, U.S. District Judge James Boasberg sided with more than a dozen Kentucky Medicaid recipients who challenged the Trump administration’s approval of the state’s plan to require some “able-bodied” adults to work 80 hours a month and to adhere to some other requirements, such as paying monthly premiums. He also rejected a similar plan based in Arkansas.

But, for Kentuckians, uncertainty remains because of the possibility of an appeal, the looming threat that Gov. Matt Bevin could decide to end Medicaid expansion in Kentucky as highlighted in the lawsuit, and efforts by the Trump administration to dismantle the Affordable Care Act entirely.

Boasberg’s decision was “certainly a milestone, but it’s not the finish line,” said Jason Dunn, a policy analyst for Kentucky Voices for Health. “We know we have to stay vigilant. We know there’s going to be threats to this coverage that will continue as long as we have certain leaders in place, and we’re going to be on the lookout for those and be prepared for those when they arise.”

Meanwhile, an Oldham County farmer, Bree Pearsall, who is a married mother of two young children, said the judge’s decision is confirmation that someone’s looking out for Medicaid recipients like her. The family has had Medicaid since 2015 and Pearsall said the stability of that coverage is vital to both them and their business, Rootbound Farm.

“We will always need an alternative for affordable and accessible health care because we are self-employed and we are entrepreneurs,” she said. “… We are also low income and for many small family farms like ours … the profit margins are thin. … We also know that farming is one of the most dangerous professions in Kentucky and nationally, and so we cannot do this work without access to health care coverage.”

On a media call with Dunn and several other consumer advocates, Pearsall also questioned the Bevin administration’s motives for trying to implement Kentucky HEALTH.

Both the state and the federal government have said the waiver would benefit beneficiaries in various ways, such as helping them achieve financial assistance through community engagement, reduce dependency on public assistance, incentivize healthy behaviors and allow the state to stretch its finite resources.

But Pearsall said “the governor’s proposed changes in Medicaid were not based in good health policy. They were based in his desire to punish and shame folks for being low-income by putting barriers in place to make it harder to access care.”

Adam Meier

Adam Meier, secretary of the Kentucky Cabinet for Health and Family Services, has called the judge’s decision to vacate the approval and send it back to the U.S. Department of Health and Human Services “illogical” and a mere setback to the Kentucky HEALTH timetable. “We believe that we have an excellent record for appeal and are currently considering next steps.”

The lawsuit, which followed a similar successful legal challenge last year, was brought by more than a dozen Kentucky Medicaid recipients, who argued that Kentucky HEALTH would harm Kentuckians across the state — from custodians and cashiers to musicians and retired workers — and that the Trump administration still hadn’t adequately addressed concerns about the 95,000 people would lose coverage because of the plan. The plaintiffs were represented by the Kentucky Equal Justice Center, Southern Poverty Law Center and the National Health Law Program.

“Wednesday’s ruling was a tremendous victory of the 16 courageous plaintiffs who challenged a harmful waiver and also comes with a welcome relief for more than 1.2 million low-income, hard-working Kentuckians and their families who rely on Medicaid for health insurance,” said Emily Beauregard, executive director of Kentucky Voices for Health.

Her organization was among those that rallied the public to sound off when the U.S. Centers for Medicare and Medicaid Services opened a new comment period on the Kentucky HEALTH plan last summer. “After reading Judge Boasberg’s 48-page ruling, I can tell you that our voices were heard and the impact of these comments is evident throughout,” Beauregard said during the media call.

Ben Carter, a lawyer for KEJC, said the judge’s opinion did not focus on whether work requirements and other barriers are bad policies. Instead, he honed in on whether the federal approval was the result of reasoned decision-making by U.S. Health & Human Services Secretary Alex Azar.

The judge found the decision to be arbitrary and capricious. He also frowned upon a threat made last year by Bevin to end Medicaid if a court were to strike down Kentucky HEALTH.

“Threatening to end Medicaid expansion if you don’t get your way in court does not yield the kind of reasoned decision-making that the court is looking for in order to be able to approve an agency’s decision,” Carter said.

The judge also was keenly aware of the fact that thousands of people could lose coverage as a result of Kentucky HEALTH, even beyond the 95,000, and took issue with a lack of explanation about how those individuals would suddenly be able to get other insurance, Carter said.

Proposed changes to the Medicaid program have “to be viewed in the light of whether those changes advance the objective of furnishing medical assistance and other services to vulnerable populations,” Carter said.  “… The court comes back again and again to this objective of furnishing medical assistance.”

Boasberg has scheduled a status hearing on the case for April 10 in Washington, D.C.