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Over at City Journal, I argue that we should pay more attention to the new wave of Medicaid reforms bubbling up from the states, especially the so-called work requirements. Back in January, Kentucky became the first state to announce “work requirements” as a condition for Medicaid eligibility. Well actually, it is a “community engagement” requirement which can be satisfied by working, looking for work, taking a class, going to rehab, and other productive activities. And it applies only to childless, able-bodied adults.
But still, the Kentucky program was blessed by the Trump Health and Human Services Department, so the Resistance is out in full force to halt the community engagement requirement. Within days of the Kentucky announcement, a coalition of liberal activist groups, including the dubious Southern Poverty Law Center, filed a class action lawsuit to block Bevin’s Medicaid reforms. While that lawsuit has been dragging on, Bevin has filed a counter-suit, and ten more states have sought to implement their own community engagement program.
So the battle is on, and the stakes are high. The rising cost of Medicaid is creating fiscal emergencies across the United States, eating up a quarter of state budgets nationwide, and crowding out spending on other priorities, like education and infrastructure. If states are not empowered to rein in these costs, it will strike a mortal blow to the system of cooperative federalism on which federal aid programs are based.