President Biden’s Thursday executive order on healthcare is set to unravel a Trump-era legal fight over Medicaid.
“There’s nothing new that we’re doing here, other than restoring the Affordable Care Act and restoring Medicaid to the way it was before Trump became president,” Biden said before he signed the order, charging Trump with making the two “more inaccessible, more expensive, and more difficult for people to qualify.”
The order, which the Biden administration touted as an effort to “reverse attacks” on President Barack Obama’s signature achievement, instructs the Health and Human Services Department to open a special coronavirus-era enrollment period for people to sign up for coverage under the Affordable Care Act. But it also compels other federal agencies to reexamine Trump-era policies regarding both the ACA and Medicaid, with the end goal of it being easier for more people to enroll.
The directive, along with an order reinstating federal funding for international abortions, signals a reverse of course on a legal battle Trump waged on Medicaid throughout his term. The fight came to a head in December when the Supreme Court accepted a case deciding whether states can impose work requirements on Medicaid eligibility.
Under the Trump administration, the practice was encouraged, and Arkansas launched a system where, to maintain eligibility for Medicaid, state residents would have to participate in jobs programs. The program, called “Arkansas Works,” inspired about a dozen other states to set up similar programs before it faced legal challenges, arguing that the requirements ran contrary to the point of Medicaid.
The U.S. Court of Appeals for the District of Columbia Circuit in February last year ruled unanimously against Arkansas, as well as then-HHS Secretary Alex Azar, finding the Trump rules allowing the program to begin did not take into account the fact that Arkansas Works could bar people from health coverage.
“Failure to consider whether the project will result in coverage loss is arbitrary and capricious,” wrote Judge David Sentelle in the court’s opinion, adding that, as a result of the program, more than 18,000 Medicaid recipients lost their coverage.
Both Azar and Arkansas Solicitor General Nicholas Bronni appealed to the Supreme Court in July. When the court accepted the case, Arkansas Gov. Asa Hutchinson praised the move, saying that the ability for states to impose Medicaid work requirements was one of “national significance.”
“It has always been our goal to provide healthcare to an expanded population of Arkansans while also providing tools for them to achieve economic stability and independence,” Hutchinson said in a statement.
But, given that the court accepted the case after Trump lost the presidential election, many legal scholars pointed out that a change in position from the incoming Biden administration could render the case moot.
“Like the border wall and ‘remain in Mexico’ cases, the timing of SCOTUS’s decision to take up these cases (which wouldn’t be argued until March) means that there’s a very good chance the Biden administration will moot them before they can be decided,” said Stephen Vladeck, a law professor at the University of Texas, after the case was accepted.
Biden’s orders expanding Medicaid and ACA also come as the Supreme Court weighs a Trump administration attempt to dismantle Obamacare entirely. In that case, the Trump administration argued that Obamacare was unconstitutional because it no longer carries tax penalties for those without insurance. The Republican-led Congress in 2017 had stripped penalties, without which, many on the Right argued, the law could not stand up.
The court is expected to decide that case this spring, and most observers, both conservative and liberal, agree that the court will not strike down Obamacare.
