A federal judge on Wednesday threw out Medicaid work requirements in two states. In twin rulings, Judge James E. Boasberg of the Federal District Court for the District of Columbia rejected for a second time Kentucky’s attempt to require recipients to work or volunteer as a condition of coverage and blocked a similar rule in Arkansas. Seema Verma, who is in charge of the Medicaid program, said “We will continue to defend our efforts to give states greater flexibility to help low income Americans rise out of poverty.” The ruling will be appealed.

States. They’re just as perplexed as the rest of us over the ever-rising cost of health care premiums.

Now some states — including Montana, North Carolina and Oregon — are moving to control costs of state employee health plans. Their strategy: Use Medicare reimbursement rates to recalibrate how they pay hospitals. If the gamble pays off, more private-sector employers could start doing the same thing.

“Government workers will get it first, then everyone else will see the savings and demand it,” says Glenn Melnick, a hospital finance expert and professor at the University of Southern California. “This is the camel’s nose. It will just grow and grow.”

A House panel on Wednesday sent the latest Medicaid expansion bill in the Idaho Legislature on to the House floor, but without a recommendation to pass it.

The bill — from Nampa Republican Rep. John Vander Woude — includes controversial provisions, such as a work requirement. It also requires people who are just above the poverty line to buy private health insurance plans from Idaho’s insurance exchange.

Federal regulators Friday approved Ohio’s request to require thousands of Medicaid recipients to work, attend classes or train for a job to qualify for benefits.

The federal Centers for Medicare and Medicaid Services notified state officials that they could impose work requirements on able-bodied adults up to age 50 enrolled in the tax-funded health insurance program.

Ohio is the 9th state to get permission to mandate work for certain Medicaid beneficiaries. So far, only Arkansas, Indiana and New Hampshire have implemented the requirement.

Republican-led states are stepping up their efforts with the Trump administration to pursue work requirements and other changes to Medicaid, in the face of legal challenges and Democratic opposition.

Tennessee Republicans want permission to revamp Medicaid in exchange for a fixed amount from the federal government. Utah is testing whether it can get approval for a partial Medicaid expansion with capped payments from the federal government. And Kentucky lawmakers have weighed drug-testing recipients with criminal or substance-abuse histories, among other steps.

Michigan’s new Democratic governor is attempting to reverse course on steps taken by her Republican predecessor to require childless, able-bodied beneficiaries of the Obamacare Medicaid expansion to meet work, training or community service requirements. In a February letter to the federal administrator of the program, Gov. Gretchen Whitmer called the work requirements “onerous.”

In the letter, Whitmer cited an analysis by the Manatt law firm, which predicted that Michigan’s new Medicaid work requirements would cause 61,000 to 183,000 people to lose their health coverage over the course of a year. 

Doug Badger, senior fellow at the Galen Institute, says when so few individuals who were eligible for the Medicaid expansion in Arkansas re-enrolled, they made a rational decision that they were better off without the benefits.

“If you don’t report any work activity at all, after being told that this would cause you to lose benefits, that suggests that you don’t value the benefits very highly. This is consistent with research showing that Medicaid recipients receive about 20 to 40 cents of benefits for every dollar of Medicaid spending,” Badger said.

Hospital industry lobbying against health care regulatory changes paid off Thursday when the Georgia House voted against major certificate-of-need (CON) legislation by a 94-72 margin.

House Bill 198 remained alive temporarily after the chamber approved a motion to reconsider the legislation. But by late afternoon, the lead sponsor, Rep. Matt Hatchett (R-Dublin), said the bill would not be brought back up on Thursday, which was the 2019 General Assembly session’s Crossover Day.

Democratic lawmakers in Connecticut introduced legislation Thursday that would create a public option for health-care coverage, allowing individuals and small businesses to buy insurance through the state. Under the proposal, Connecticut would create multiple plans that small businesses and their employees could buy starting in July, leveraging the state’s existing purchasing power to lower costs. And in 2021 Connecticut would begin offering a new health-insurance option that any state resident would be able to join. The public insurance would offer coverage options for small businesses and individuals who don’t qualify for subsidies through the Affordable Care Act, officials said.

After health care sharply divided Democratic and Republican candidates in last fall’s campaigns, Florida lawmakers are considering wide-ranging changes to what a GOP leader derides as the “hospital-industrial complex.”

Ideas on the table in Florida’s Republican-controlled Legislature steer clear of demands for universal health care or Medicaid expansion, advanced by federal and state Democratic contenders during the November elections.

States that expanded their Medicaid health insurance programs are hunting for ways to fund the new enrollees in 2020 as they face a final drop in federal contributions.

The federal government will still cover the bulk of the costs of care for the roughly 13 million Americans newly eligible for Medicaid under the Affordable Care Act, which allowed states to expand the program to people earning somewhat above the federal poverty level. But the gradually decreasing federal contribution — originally set at 100 percent but reduced to 90 percent starting next year — has left some states with budget holes to fill.