It has largely skipped the national press’s attention — perhaps because of the presidential debate that evening — but a June 27 court ruling could have far-reaching negative consequences for U.S. health care and federalism.
If higher courts uphold it, the ruling will not only make conservative changes to state Medicaid programs difficult to impossible, but it could also permanently lock states into Obamacare’s Medicaid expansion to the able-bodied.
Hoosier Waiver Nixed
The ruling, by Chief Judge James Boasberg of the federal district court in the nation’s capital, relates to a Medicaid waiver extension the Trump administration granted to Indiana. The challenge to the waiver had lain dormant for more than four years, during which time the Hoosier State paused implementing a work requirement, which the Biden administration eventually nixed outright upon taking office.
As state Medicaid programs began normalizing following public health panics during Covid, Indiana sought to resume the remaining elements of the Medicaid waiver known as the Healthy Indiana Plan, largely as the Obama administration had approved it back in 2015. Judge Boasberg had other ideas.
In striking down Washington’s extension of Healthy Indiana, Boasberg noted that the federal process of approving Medicaid waivers must maintain a nearly single-minded focus on the implications for coverage. In his view, “the relevant question” under federal law is “whether the [waiver] will increase coverage as compared to expanded Medicaid with no waivers.” Because Boasberg held that the Trump administration did not adhere to this standard in approving
