Judge Sentelle Smacks Down the Trump Administration

The D.C. Circuit makes short work of the Medicaid work rules.

|The Volokh Conspiracy |

Today the D.C. Circuit held that the Secretary of Health and Human Services acted in an arbitrary and capricious manner in approving work rules for Medicaid recipients. In both form and substance, this was a smackdown. As to form: The opinion is very short—the entirety of the reasoning occupies 10 pages, which is about as brisk as these things get. As to substance, the court clearly doesn't see this as a close question. It begins its analysis by stating that "The district court is indisputably correct that the principal objective of Medicaid is providing health care coverage." This is important, because, as the court notes, HHS justified the work rules as assisting health outcomes, "but that alternative objective lacks textual support. Indeed, the statute makes no mention of that objective." Thus the court states:

In short, we agree with the district court that the alternative objectives of better health outcomes and beneficiary independence are not consistent with Medicaid. The text of the statute includes one primary purpose, which is providing health care coverage without any restriction geared to healthy outcomes, financial independence or transition to commercial coverage.

Then, in just three even brisker pages, the court holds that HHS failed arbitrary and capricious review because it had only a few conclusory sentences in response to concerns about the work rule reducing health care coverage. The court concludes: "While we have held that it is not arbitrary or capricious to prioritize one statutorily identified objective over another, it is an entirely different matter to prioritize non-statutory objectives to the exclusion of the statutory purpose."

I guess this was the best that HHS could do, but clearly the D.C. Circuit found it totally wanting. I would love to see the back-and-forth among the HHS and DOJ lawyers on this. Maybe some higher-ups in the Administration thought that they could persuade conservative judges. If so, it is worth noting that the opinion was written by Judge Sentelle, who is definitely conservative. It is always a bit depressing to see courts line up strictly along party lines, and a bit refreshing when they don't.

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  1. Eh, wake me when it makes it to a higher court.

    1. You really expect the Supreme Court to grant cert on this?

      1. Maybe, maybe not. But I have noticed the administration fares rather better at the Supreme court than in the lower courts, which has led me to become somewhat blase about their being “smacked down” below that level.

        1. I have noticed the administration fares rather better at the Supreme court than in the lower courts,

          That says more about the Supreme Court than about the strength of the administration’s positions.

          1. What it says is, the lower you go in the court system, the easier it is to engage in forum shopping. and the late judge Reinhardt’s attitude towards the Supreme Court, “They can’t catch them all.” is pretty common.

            1. I see.

              And what is the flaw in the reasoning, other than that you don’t like the outcome. It may surprise you to know that “This is what Bellmore says” is not a good legal argument.

              Does the fact that David Sentelle wrote the opinion influence your thinking about “forum shopping” at all? Besides, there is no better example of a biased “forum” than the Trumpist Supreme Court

            2. I don’t know the particulars, but since it is an APA challenge to a federal program my suspicion is that it had to be brought in the US District Court for DC.

              1. Yes. And it was unanimous by all three judges.
                This is very poorly written. 🙁

      2. Probably not = SCOTUS Cert.

        Q: Can the HHS request a hearing en banc?

      3. I’m not really sure I would trust the Court on this anyway considering how they f’d up the census question issue.

    2. Because The Trump Administration Can Do No Wrong?

      For someone who claims not to like government you sure do bow down to His Trumpness.

    3. Tellingly absent any engagement with the merits.
      Disobeying then ACA to own the libs.

  2. Really. The court wrote that?

    And I quote “alternative objectives of better health outcomes…are not consistent with Medicaid”

    That is…amazing.

    1. You could get better health outcomes by simply not covering people who are are sick. The people they DID cover would have much better health outcomes.
      Not consistent with Medicaid.

      1. According tothis study having Medicaid coverage makes no difference to health outcomes:

        “This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services…”

        But I would bet, a randomized study of those with Medicaid coverage that also started working as a result of work requirements would have measurable improvements in health outcomes in 2:years.

        1. Your link is broken.

          1. Given that he quotes a block of text from the study, it’s really not that hard to find.

        2. They say your link is broken, but your violence is on par. Tell us more about your feelings, and how you will impose them.

        3. Kazinski, depends on how the study is designed. Measure healthcare outcomes for everyone first, and then go back and compare the two groups—the ones who started work vs. the others—and all you get is a truism.

          The able bodied can work and the others can’t. Of course the workers will show better health than the others. Even if you measure each participant individually, before and after, isn’t it more likely that the health of someone who started out unable to work would decline over 2 years? Don’t sicker people tend to get worse more than healthy ones do?

          Tell us how you plan the study.

          1. You wouldn’t expect a massive difference. If people have real problems they run to the hospital either way. It would take years to suss out long-term benefits, primarily from some regular prescriptions for heart disease and whatnot.

        4. You’ve misread the conclusion. The study was not on health outcomes generally (although the portion you’ve quoted suggests otherwise). Rather, the study was on “prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions.”

          I would note that the part of the conclusion you left off says:

          “…raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.”

          You’d also want to consider some of the other findings from the study, before assigning confidence to the study’s conclusion which are not supported by the study itself.

          If you are interested in reading the study from a fixed link, try here.

    2. Kind of funny though. I guess a well reasoned opinion is not necessarily consistent with the D.C. Circuit.

    3. You left out a crucial part;

      the alternative objectives of better health outcomes and beneficiary independence are not consistent with Medicaid.

      I think what he is saying is that you can’t make Medicaid a tool to encourage beneficiary independence, because that might detract from the goal of better health outcomes.

      1. It’s a welfare program. Of course the gov’t can employ measures to encourage the transition of able bodied people out of welfare.

        1. It’s a program to provide medical care.

          You can “of course” all you want. That doesn’t make you right.

          1. No, what makes me right is the legal reality that it is a welfare program and the reforms were properly aimed at transitioning able bodied people out of that program to conserve state resources for the truly needy. And I would add, of course, just to irritate you.

            1. Agreed, Congress should pass those very reforms. But until they do so our hired law enforcement staff (the President and rest of the executive) can’t substitute their their opinion of what our other hired help (the legislators) should do.

              1. Thank you for saying this in that way. This is exactly true. If the law is bad you work to change it you do not unilaterally claim the law says something that it does not.

                1. We had enough of that in the previous eight years. I believe Trump has as much respect for the Constitution as the Anointed One.

              2. Robert, the only one improperly imposing an opinion is the judge. The secretary acted within his statutory discretion. In other words the statute clearly afforded the secretary with authority to approve the states’ experimental programs. The judge put a ridiculously limiting construction on one provision related to funding to block the secretary’s proper exercise of statutory discretion. I note also that this construction appears to have been put forth by the execrable southern poverty law center.

          2. It’s a program to provide medical insurance. Not care.

            That’s a critical difference. And it can provide insurance all it wants. But if the rates are too low, and no one will take your insurance, well you still have insurance.

          3. Show me where it says Medicaid is just a free giveaway, no strings attached, with no intention to assist with transitioning people to self-sufficiency.

            1. That was crazy, even for you. YOU show where its is intended to transition toward self-sufficiency. YOU show where it was EVER intended to do more than provide medical care for the indigent.

              It COULD be done a lot better, as it was BEFORE Medicaid … but that’s different than your ignorance of the law and its intent,

              1. Sorry, but if you’re going to make an absolutely absurd assertion that Medicaid and other welfare programs were not devised with the intention of people not becoming dependent upon them, the burden of proof cannot be shifted away from you. This is a commonly understood intent of welfare and has been demonstrated through nearly a century of politicians of every political stripe explaining why they want to expand and protect such programs.

                1. Sorry, but if you’re going to make an absolutely absurd assertion that Medicaid and other welfare programs were not devised with the intention of people not becoming dependent upon them

                  NOT WHAT I SAID, YOU CRAZED PSYCHO

                  them, the burden of proof cannot be shifted away from you

                  Fucking LOSER,
                  YOU MADE THE CLAIM. I CALL YOU OUT TO PROVE IT,

                  ***YOU FAIL ****
                  ALMIGHTY GOD, WHO SCREECHES THAT YOUR BULLSHIT IS DEVINE …. AND MUST BE ACCEPTED …. BECAUSE YOU SCREECHED IT!

                  YOUR DUMBFUCKERY EVEN EXTENDS TO SAYING CRAZY-ASS CONSERVATIVES …. LIKE YOU ,,, WANT TO EXPAND AND PROTECT MEDICAID! (snort)

                  This is a commonly understood intent of welfare and has been demonstrated through nearly a century of <B<politicians of every political stripe explaining why they want to expand and protect such programs.

                  BWAAAAAAAAAAAAAAAA HAAAAAAAAAAAAAAA HAAAAAAAAAAAAAA

                  BE A MAN … NOT A WHINING PUSSY … PUT UP OR SHUT UP
                  <BLOCKQUOTE YOU show where its is intended to transition toward self-sufficiency. YOU show where it was EVER intended to do more than provide medical care for the indigent.You also SUCK at …. bluffing! 🙂

        2. There are no “welfare” programs. Hear are specific programs for specific beneficiaries. You may not like them but that’s how it works. In addition, this motion that there is some significant group of “able-bodied” people sitting around collecting Medicaid benefits is just false.

          1. Really? I thought Medicaid was sort of the single-payer of the American South. Southern politicians can oppose single payer for everyone else, because they have the system wired for southern constituents. Their constituents pay nothing, go to the hospital for everything, and the federal government pays. If single payer actually passed, their constituents would end up having to pay a little bit to get it, so the the politicians oppose that. Never mind that most southern health care sucks, nobody ever sends a bill. That, anyway, is what my Arkansas relatives tell me. I’m just relying on hearsay.

            But one point there needs more attention than it usually gets. Throughout the nation, the quality of healthcare available has little or nothing to do with what insurance you have. In the Northeast, the poorest folks on medicare can get better healthcare than those living in most of the rest of the country, no matter what private insurance plans they may have. What determines the quality of healthcare your insurance buys is largely the quality of healthcare available in your area. Even a gold-plated insurance plan in Arkansas is not going to turn healthcare bought there into as good a product as Medicare routinely delivers in Boston.

            1. Have you been hanging out with Kirkland lately?

            2. You do realize how many African-Americans live in the South, right?

              Why are you such a racist, Stephen?

              1. Red Rocks, I do realize that a lot more African Americans used to live in the South than live there now. Fun fact: among the states which fought in the Civil War, only two of them had substantial black populations at that time, and have still-larger proportions of black residents today. All the others either had minimal black populations then, or have seen their previously considerable black populations shrink. The states which saw their large black populations shrink? Every state in the confederacy. The states which saw small black populations increase? Northern states, like Illinois, New York, and Michigan. The two states I mentioned? Maryland and Delaware. Both border states, and slave states, which did not join the confederacy. After first living in Virginia, I grew up in Maryland, during the Jim Crow era, but while the black population was still on the increase. I had plenty of confusing experience involving race and racism. I turned out pretty anti-racist. I haven’t been reticent about that in my comments here.

                1. Technically incorrect. Missouri has also seen its African American population % increase since 1860, and had a substantial African American populationin 1860.

                  There was a northward migration of African Americans, yes. But every single state of the Old Confederacy except Texas has a higher % of African Americans than Michigan and Illinois today.

                  1. Here is an interesting stat: Every region of the U.S. saw a net positive (intrastate) migration of “Native non-whites” from 1890 to 1940 except for the South. For example, in 1940, 13.6 percent of native non-white born in the South were living in a different region. Only 0.6 percent of native non-whites born elsewhere moved to the South. The raw numbers are: 1,548,611 native non-white born in the South moved to a different region, while only 63,558 native non-whites who were born elsewhere moved to the South in 1940.

                    For native whites, roughly 3.2 million born in the South were living elsewhere while roughly 2.2 million born elsewhere were living in the South. Pretty obviously, something about the South was uniquely inhospitable to non-whites. But we all knew that, right?

                    (https://www2.census.gov/prod2/statcomp/documents/HistoricalStatisticsoftheUnitedStates1789-1945.pdf)

          2. There are no welfare programs Pacific? I guess there’s no such thing as welfare reform either. Did you and AOC go to the same school? Did you share notes?

        3. Of course the gov’t can employ measures to encourage the transition of able bodied people out of welfare.

          Of course the government can do lots of things. But only if statutorily authorized to do them.

          1. The secretary had the statutory discretion to approve the temporary measures proposed by the states. The judge adopted an unnecessarily limiting construction of a provision related to funding to block the reforms. A position apparently put forward by the execrable southern poverty law center.

            1. The secretary had the statutory discretion to approve the temporary measures proposed by the states

              PROVE IT

              LIKE I PROVED YOU A LYING SACK OF SHIT HERE
              https://reason.com/2020/02/14/judge-sentelle-smacks-down-the-trump-administration/#comment-8131098

              And here …

              1. still citing to your own comments in the same blog? Circular idiocy is still idiocy.

              2. Like I said, I had already proven you full of shit.
                TWICE. So, for adults, we don’t keep repeating the same proof, we link to it.

                Actually, I just proved you full of shit AGAIN!
                (I think that’s 23 times on this page)

      2. They are two separate objectives, that do not need to be together. From the district court decision, as below the break (technically, the secretary writes it as 3 objectives of the Medicaid act)

        The judge is actually saying “better health outcomes are not an objective of the Medicaid act”. The objective is health insurance coverage, NOT better health outcomes. Thus actions that improve health outcomes, but do not increase health insurance coverage, are incompatible with Medicaid.

        ——————

        “In his approval letter, the Secretary explained that he considered the following objectives of the Medicaid Act: (1) “whether the demonstration as amended was likely to assist in improving health outcomes”; (2) “whether it would address behavioral and social factors that influence health outcomes”; and (3) “whether it would incentivize beneficiaries to engage in their own health care and achieve better health outcomes.” “

        1. The judge is actually saying “better health outcomes are not an objective of the Medicaid act”. The objective is health insurance coverage, NOT better health outcomes. Thus actions that improve health outcomes, but do not increase health insurance coverage, are incompatible with Medicaid.

          Then overturn the law as a fraud. How can a law to give medical coverage because no coverage is and people are dying not be about providing better medical coverage and results?

          Is Social Security not about stopping old people with no money from starving or eating cat food? Yes! But it’s not about providing them with a better or longer life.

          I’m gonna need a whole lotta bags of popcorn in the coming years.

          The lawsuit tigers this is awakening for the future is terrifying.

    4. Because the “better health outcomes” is a sham rationale. The Trump administration could care less about health outcomes.

      1. Sigh,

        There are actually good reasons to limit Medicaid enrollment. The biggest one is this: Medicaid doesn’t actually cover the cost of services for doctors.

        When doctors take on Medicaid patients, it basically acts as charity on the doctor’s part. Doctors manage to break even with private insurance and cash payments, so they don’t go out of business. But it means they can only take on so many Medicaid patients.

        When you increase the pool of those who have Medicaid, its those who really need it, the most vunerable, the children, the pregnant, the elderly, etc who suffer the most. Because they begin to be crowded out by the larger numbers of poor but healthy adults now competing for what are limited services. More people have medical insurance, but the level of actual care can drop…especially for those who need it most.

        1. If you want more, here’s a link out of California, where the state is being sued for discrimination…because of its Medicaid rates. They may have health “insurance” but if no one really takes it, or the rate of care with it is so poor, then are you really accomplishing your goals?

          https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2017/09/22/are-medicaids-payment-rates-so-low-theyre-discriminatory

          1. It will all get better when we go to Medicaid for all, which is really what Sanders, et al, is proposing.

            1. Sadly there are some models showing that national health levels will drastically improve with Medicaid for all, for just the reasons described above. The people who are the least healthy will simply die off, raising the average health of the ones who remain. It’ll take a few decades to full stabilize, as today’s moderately treated chronic conditions become the next decades terminal conditions, but some parts will occur very quickly, similar to what we saw with the Oregon Medicaid Experiment.

              1. England and Canada respectfully disagree.

              2. It’s not about that. It’s about not crushing innovation, which saves many more lives year over year.

                Whatever solution you want for the uninsured cannot be on the back of that, of you’re functionally mass murdering. We are not at a static level of medical science such that you can seize it all and start handing it out.

          2. Armchair, there seems to be little to your argument. What the data in your link suggest—if they suggest anything—is that if the reimbursement rate a state imposes is too low, then that will not work. California pays the third-lowest rate among the states, in a state economy which is among the nation’s most expensive. Other states which pay at the national average, or slightly above it, do not seem to be generating protests. California may have set the rate too low. That does not do much to support this generalization by you: “Medicaid doesn’t actually cover the cost of services for doctors.”

            1. BULLSHIT

              COMMON KNOWLEDGE that Medicaid pays 25-30% less than even Medicare. This is especially bad in the inner-city ghettos, where there are too few privately insured to overcharge and recover their losses … so NO DOCTORS at all in the larger ghettos. (Also why Planned Parenthood gets most of its revenue from Medicaid)

              Even worse for you, before Obamacare’s Medicaid expansion, 1/4 of all our uninsured, 20 million Americans, were eligible for Medicaid and CHIP (children) but NEVER ENROLLED.

              Medicaid was the first bullshit that health care should be a right, NOT charity. But private charity provided 100% coverage . Pe-Obamacare Medicaid eligibles had a HIGHER uninsured rate than non-eligbles … .more Medicaid eligibles died UNINSURED than non-eligibles (percentage)

              Obamacare BURIED this reality. In most states, any uninsured who come to the ER are automatically enrolled in Medicaid — which (a) bribed the hospitals and (b) makes the expanded coverage a FRAUD — STILL NO FUCKING DOCTORS! (fewer, actually)

              “Medicaid doesn’t actually cover the cost of services for doctors.”BULLSHIT
              Medicare pays MORE and STILL FAILS to cover costs.

              The MAYO CLINIC has been refusing Medicare (for primary care) since 2010, citing losses of $840 million. They cannot report a loss unless they write the checks, SO WHERE DID THEY GET $840 MILLION FROM? Hint: Their ONLY possible source is to OVERCHARGE INSURANCE COMPANIES, Do the math.

              Medicaid losses are HIGHER … MUCH higher, since
              a) It pays less
              b) Mayo was praised by Obama as one of the “most efficient providers.”

              Separate issue: Medicare is SUBSIDIZED by over 400 BILLION from
              a) Insurance companies (prox $150 B)
              b) LOOTING OVER 20% OF THE ENTIRE PERSONAL INCOME TAX (over $300B per year) (how Bush’s GOP “paid for” Medicare Prescriptions.)
              c) The ENTIRE Medicare Trust Fund is LESS than $300 billion, would have been bankrupt years ago … and would COLLAPSE TOMORROW WITHOUT ALL THE HIDDEN SUBSIDIES.

              Anything else? 🙂

        2. Ah yes.

          If there’s anything the Trump Administration cares about it’s the poor and helpless.

          Give me a break.

          1. This is an unhelpful comment.

            Immediately applying negative motives to the political opposition, regardless of the statement or actions helps no one.

            “The Trump Administration” cares about people just fine, they just think about things differently. Having a difference of opinion is fine, it’s the cornerstone of a firm democracy. But when differences of opinion aren’t considered “fine,” but instead prompt immediate condemnation based on inference of motives… IE, “they’re evil”… this encourages all sorts of stupidity. Driving cars into groups of Trump supporters, physical violence on teenagers who just happen to be wearing a Trump hat, or in the extreme situation, lone gunmen seeking to kill as many GOPs as they can.

            1. BULLSHIT — DO YOU LIVE IN A CAVE?
              TRUMP HAS BEEN SLASHING THE SAFETY NET FOR THREE YEARS. DID YOU FAILT TO READ HIS LATEST BUDGET PROPOSAL? OR ARE YOU LYING … AGAIN?

              TRUMP WANTS TO SLASH MEDICAID FOR THE POOR … BUT PROMISES TO NEVER TOUCH MIDDLE-CLASS SOCIAL SECURITY AND MEDICARE.

              HE WANTS TO REPEAL OBAMACARE … BUT THE GOP HAS NEVER HAD A VIABLE REPLACMENT.

              *PLUS, THE SONUVABITCH LIED THROUGH HIS TEETH … THE MOST SHAMEFUL ACT BY A PRESIDENT EVER …. DENYING THAT HIS NEO-NAZI AND WHITE NATIONALIST SUPPORTERS INITIATED THE MASS VIOLENCE IN CHARLOTTESVILLE.

              *****BELIEVING YOUR OWN TRIBE … WITH NO EVIDENCE, BLIND FAITH … MAKES YOU A MINDLESS PUPPET, DANCING ON A STRING, MANIPULATED BY THE POLITICAL ELITES …. NO BETTER THAN BERNIE’S BROS.

        3. “Medicaid doesn’t actually cover the cost of services for doctors. ”

          It comes closer than nothing, which is what most Medicaid patients otherwise have.

          1. That was more stupid than the other two.

            Pay attention.

            When they have nothing … THERE ARE NO DOCTORS to be paid, overpaid or underpaid.

  3. So, Medicaid isn’t a welfare program? The goal of helping adults transition to financial independence to further the financial sustainability of medicaid is not a proper objective? Looks like Judge Sentelle deserves a smack down himself.

    1. “The goal of helping adults transition to financial independence to further the financial sustainability of medicaid is not a proper objective?”

      The goal(s) of the program were set when Congress wrote the statute that created the program. Goals that weren’t written into the statute may be awesome, or they may stink on ice, but they aren’t goals of the program.

      1. Spare me your ignorant lecture. I’m not arguing that clear statutory provisions can be ignored. The point is that it is no way inconsistent with the medicaid statute to promote programs to further the transition of able bodied people out of that welfare program to conserve finite state resources for the truly needy. The court improperly overruled the Secretary’s exercise of statutory discretion to approve a temporary, experimental measure designed to address the damages done to the system by the over expansion of medicaid under Obama.

        1. Wasn’t Medicaid expanded by the states? In fact, didn’t several states challenge the ACA on that and win such that they didn’t have to expand it? Sounds to me like this is a state problem, not a federal one.

          1. It’s both a state and federal problem notwithstanding that the states may have chosen to participate in the ACA adult-eligible expansion.

            1. Yes but not all states chose to do so. Seems weird to me to blame the feds when it was really up to each state. Either way it should be abolished but that seems like a pipe dream at this point.

              1. YOU are why progressives have been KICKING OUR ASS for decades …. in the court of public opinion … but you’re so deep in a tribal cave, you don’t even know it.

                EDUCATE YOURSELF.
                Americans have ALWAYS paid health care for the indigent, freely and willingly … with 100% treatment … before government. It’s called a free market and charity.

                Do the math.

                If Progs are the ONLY ones CLAIMING to provide what Americans have ALWAYS wanted … and ALWAYS been willing to pay for … who wins and who loses?

                (Indigent health care traces to the British Guilds in the 1500s, Pre-government US, it was mostly ethic and fraternal lodges, funding mostly religious hospitals. There were NO for-profit health insurers until FDR created them as a tax-free employee benefit. The lodges could not switch to employer-based groups, NONE of this is know to today’s brainwashed Republicans, who mostly just hate Obamacare, and are also too dumb to know the ORIGINAL Obamacare was BIPARTISAN, with a PRIVATE, NON-PROFIT alternative to a public option, that would have killed single-payer FOREVER … FUCKSTICK MCCONNELL TURNED IT DOWN, BECAUSE HIS MAIN GOAL WAS TO DENY OBAMA A SECOND TERM (which he ALSO fucked up!, and WHY today’s GOP base is kept so totally ignorant)

        2. The outcome metrics used to justify the change are not related to the intent of the program.
          Maybe they’re good social metrics in general, but a generalized policy analysis is not what the ACA requires.

        3. All Obama’s fault.

          We get it.

          1. Not to put to fine a point on it, but if we’re talking about harms resulting from the ACA, then yeah, it’s Obama’s fault. And, an aside, I would add that Obama may very well be the worst democrat president ever to serve, and that’s up against some pretty stiff competition.

            1. MKE’s ignorance is ASTOUNDING … but all too common among today’s brainwashed party loyalists (both siders)

              Some questions for him, and his tribe.
              1) Do you know Obama won the 2008 nomination, and the election, as a MODERATE on healthcare, Or did your masters keep that from you?

              2) Do you know he kicked the crap out of Hillary and John Edwards, in opposing a mandate — WITH A BETTER ARGUMENT THAN ANYONE ON THE RIGHT! “If a mandate would work, we could end homelessness by mandating everyone to buy a house.” KAPOW!

              3) Do you know he ran against universal coverage EXPLICITLY, saying we could not afford it until AFTER we reduce costs.” ALSO better than anyone on the right!

              4) Do you know ORIGINAL Obamacare DID include MAJOR cost savings in care … AND would have killed single-payer FOREVER. A private alternative to “the public option” — designed to get GOP support … and to IGNORE his own far left. (Like Kennedy did with his tax cuts, copied identically by Reagan, opposed by the AFL-CIO and the far-left in Congress — JFK didn’t need their votes)

              5) Do you know his alternative would be cheaper than ANY government plan on earth … a nonprofit HMO CO-OP, patterned on Seattle’s Group Health Co-op, — MEMBER CONTROLLED, doctors salaried employees of their patients, run their own hospitals, own their own pharmacy (pick up scripts on your way out of the clinic, refills at any pharmacy). AND HAS A COMPETITOR!

              6) Do you know Obama’s private alternative was endorsed on the far-left Daily Kos … as a private alternative to the public option … AND as socialized medicine. TODAY’S right-wingers CANNOT believe a private, member-controlled, non-profit can be socialized medicine …. but they also babble about democratic socialism being like Soviet Gulags.

              7) Do you know MCCONNELL TURNED IT DOWN … KEEPING SINGLE-PAYER ALIVE … EMPOWERING THE FAR-LEFT, WHO FORCED THE VERY WORST PARTS OF OBAMACARE, AFTER MCCONNELL FUCKED UP.

              8) Do you know WHY Mitch FUCKED US ALL? Did you CHEER when he said his primary goal was to deny Obama a second term … so he shot himself in the ass on that ALSO!

              9) Do you know Trump is the WORST FISCAL PRESIDENT EVER … added more new 8-year debt in three years than Obama added AFTER 8 years!!

              10) Do you know Grump campaigned on paying off the ENTIRE debt …. in 8 years? …. FAIL

              11) Do you know Obama inherited the third worst economy since WWII …, but Trump inherited the longest recovery EVER for an incoming President …. FROM OBAMA? … FAIL!

              12) Do you know GDP **DECLINED** last year … that Trump’s first three years had SLOWER economic growth than Obama’s final three .,.. and created FEWER jobs …. (on top of that debt travesty)

              AND TRUMP PROPOISES ANOTHER UNPAID TAX CUT, TO EXPLODE THE DEBT EVEN MORE

              13) Is this the REPUBLICAN New Deal? 🙂

              —–
              For PROOF that Obama campaigned as a moderate, Gary Johnson’s 2012 ad has video clips of it all debates/ads/speeches. On YouTube search for “Barack Obama Was Against Healthcare Mandate Before He Was For It”

              For the private alternative to a public option (I added some detail, having been a member for 17 years)
              https://www.nytimes.com/2009/07/07/health/policy/07coop.html
              —-

              Any questions?

              (No typical bullshit about me being a liberal, I’m a libertarian since it began, opposing BOTH parties, as we do, defending BOTH truth and liberty from liars and thugs for over 50 years)

              1. If you like your plan, TheLibertyTruthTeller, you can keep your plan. Or, my favorite, a women who wants her mother to receive needed care, learns instead that, “sometimes you…you just might need a pill.”

                1. NON-RESPONSIVE, COWARDLY EVASION, SHAMEFUL

                  (SNEER)
                  HOW CRAZY IS MKE? HOW EASILY BRAINWASHED??
                  DO A GOOGLE SEARCH FOR THAT PHRASE … ABOUT NEEDING A PILL ….. DO IT! … THE PHRASE DOES NOT EXIST! IT’S LKE THE CRAZY BULLSHIT ABOOUT DEATH PANELS ,,, THAT THE GOOBERS BLINDLY SWALLOWED.

                  HERE’S WHAT OABAMA REALLY SAID — WITH A RIGHT-WING LIE AS THE DESCROIPTION — AS FUCKING CRAZY AS MKE’S BULLSHIT
                  https://www.youtube.com/watch?time_continue=1&v=U-dQfb8WQvo&feature=emb_logo

                  I PROVIDE SOURCES … PUPPETS BABBLE (BOTH LEFT AND RIGHT), DANCING ON STRINGS [ULLED BY THE POLITICAL ELITES

                  WAS “KEEP YOUR PLAN” STATED BEFORE OR AFTER MITCH FUCKED ALL AMERICANS … FOR PARTISAN GAIN??

                  ****PLUS, ONLY TWO NATIONALLY KNOWN POLITICIANS HAVE EVER STATED PUBLICLY WHY OUR HEALTH CARE IS THE WORLD’S MOST COSTLY.

                  WHO ARE THEY, MKE???? 🙂
                  IN ORDER:
                  1) REPUBLICAN Mitch Daniels, former Indiana guv, WAS FIRST, pointing out that we are the only nation that will spend $250,000 or more, for six months of life. (We’ve known since Hillarycare that half our entire healthcare costs are spent in the last two years of life)

                  See part 2 (required for MORE proof link)

                  1. Are you kidding me? This cold SOB tells a woman her mother really doesn’t need a pace maker, her life just isn’t worth the expense, just take a pill. And you think you’ve refuted something or rehabilitated that disgrace?

                    1. Are you kidding me?

                      I AM PROVING YOU A .. PATHETIC … LYING … SACK OF SHIT .;.. WITH A LINK TO ABSOLUYE PROOF.

                      This cold SOB tells a woman her mother really doesn’t need a pace maker, her life just isn’t worth the expense, just take a pill. And you think you’ve refuted something or rehabilitated that disgrace?

                      YOU SICK FUCK
                      ANYONE CAN SEE HOW SICK A FUCK YOU ARE IN THE LINK I PROVIDED

                      ****THIS LINK GOES TO THE EXACT PART OF THE VIDEO THAT PROVES YOU A SICK FUCK … YET AGAIN.
                      https://www.youtube.com/watch?time_continue=59&v=U-dQfb8WQvo

                      Keep lying. Anyone who CARES will see how INSANE you are … if they haven’t already seen proof elsewhere on this page,

                      (VOMIT)

                    2. I know in your broken mind you may now think you’re proving something but soon the intoxicants will wear off and sanity will resume (well maybe).

                2. PART 2

                  2) DEMOCRAT Barack Obama described how his own grandmother was given a costly hip transplant, WHEN SHE WAS TERMINAL CANCER … AND DIED A FEW WEEKS LATER … SAYING THAT WAS A PROBLEM (WITH COSTS)

                  https://www.washingtonexaminer.com/to-aarp-obama-praises-grandmother-he-once-said-may-not-have-deserved-hip-replacement-surgery

                  *YOUR TURN GOOBER

                  FIRST CHECK THE VIDEO ON WHAT ALL OBAMA REALLY SAID, YOU SLIMY SCUMBAG.

                  SECOND. WHAT WOULD YOU DO TO PROPERLY AND FAIRLY DEAL WITH SUCH COSTLY END-OF-LIFE PROBEMS … AND BE SPECIFIC, NO MORE SNARKY BULLSHIT.
                  NOBODY KNOWS WHAT OBAMA WOULD HAVE PROPOSED.
                  *I* KNOW ONE WAY … LET;S HEAR YOUR SOLUTION ,., NO MORE WHINING LIKE A PUSSY

                  ****AND NO MORE COWARDLY DIVERSIONS FROM YOU.

                  **** AND NO MORE FUCKING PSYCHO LIES.
                  ****SHAME ON YOU.

                  (I AGAIN respond in the demeanor of MKE)

                  STILL just a libertarian … speaking truth to power (the crazed bullshit of manipulated puppets, both left and right)

                  Left – Right = Zero
                  RESEARCH, BRAINS AND INDEPENDENT THINKING ALWAYS TRUMPS TRIBAL BABBLING.

                  (You are WAY above your class, Troll)

                  1. Wow. Speaking of pills, did you forget yours today?

                    1. Wow. Speaking of pills, did you forget yours today?

                      WOW.
                      PROVED YOU A PATHETIC … LYING …. SACK OF SHIT …. HERE
                      https://reason.com/2020/02/14/judge-sentelle-smacks-down-the-trump-administration/#comment-8131352

                      I JUST MADE IT EVEN EASIER FOR ANYONE TO SEE HOW PATHETIC YOU ARE … IN 20 SECONDS …. NOW I LINK TO THE EXACT POINT IN THE VIDEO WHERE OBMA ANSWERS HER QUESTION …. YOU SICK FUCK,.

                      YOU ALSO FAILED THE CHALLENGE … WHINY PUSSY

                      SECOND. WHAT WOULD YOU DO TO PROPERLY AND FAIRLY DEAL WITH SUCH COSTLY END-OF-LIFE PROBEMS … AND BE SPECIFIC, NO MORE SNARKY BULLSHIT
                      .
                      NOBODY KNOWS WHAT OBAMA WOULD HAVE PROPOSED.
                      *I* KNOW ONE WAY … LET’S HEAR YOUR SOLUTION ,., NO MORE WHINING LIKE A PUSSY

                      YES … WHINING

                      “Complaining about a problem, without posing a solution, is whining.”
                      -Theodore Roosevelt

                      “Any fool can criticize, condemn and complain, and most fools do.”
                      –Benjamin Franklin

                      “Wise men speak because they have something to say. Fools speak because they have to say something”
                      Plato

                      “Mass movements do not need a god, but they do need a devil. Hatred unifies the True Believers.”
                      -Eric Hoffer, “The True Believers” (1951)

                      “Throughout human history, the worst moral atrocities have been committed by those manipulated to BELIEVE they are defending some “greater good” — the Collective, the State, the Master Race, the Party or a God. Zealots and fanatics. The militant self-righteous.”
                      -Me (1994)

                      Have you NO shame? NONE AT ALL?

                    2. Plato sure has you nailed with that quote.

            2. I would add that Obama may very well be the worst democrat president ever to serve, and that’s up against some pretty stiff competition.

              Sure, MKE. Because things were in great shape when he took office, and he turned it into shit. Is that what you think?

              1. What “things” are we talking about? The IRS, The US consulate in Benghazi? Health care? Immigration? The energy industry? The rule of law?

                1. ANOTHER COWARDLY DIVERSION … AND MORE CRAZED TRIBAL BULLSHIT

                  ONE MORE TIME — WILL YOU HEAR ME NOW?
                  OBAMA INHERITED THE THIRD ECONOMY SINCE WWII … AND HANDED TRUMP THE LONGEST RECCOVERY EVER FOR AN INCOMING PRESIDENT.

                  TRUMP WAS ELECTED TO PA

                  1. TRUMP WAS ELECTED TO PAY OFF THE FEDERAL DEBT … ENTIRELY … IN 8 YEARS … INSTEAD HE HAS ALREADY ADDED AS MUCH NEW 8-YEAR DEBT IN THREE YEARS (CBO 2024 FORECAST) THAN OBAMA ADDED AFTER EIGHT YEARS. FAIL-FAIL-FAIL-FAIL

                    *** AND FDR-STYLE TRUMP PROPOSES TO EXPLODE THE DEBT EVEN MORE … WITH ANOTHER UNPAID TAX CUT

                    ****TRUMP .. WHO ENRICHES HIMSELF AT TAXPAYER
                    EXPENSE

                    ****TRUMP .. WHO CAMPAIGNED ON A 60% TAX CUT FOR HIMSELF (AND A SMALL NUMBER OF THE 1%) … HE’D HAVE BEEN A BILLIONAIRE PAYING A MAXIMUM INCOME TAX RATE OF …. FIFTEEN FUCKING PER CENT!

                    WHAT’S YOUR TAX RATE, SUCKER?

                    TRUMP WAS BORN ON THIRD BASE, THINKS HE HIT A TRIPLE!

                    TRUMP TOOK OFFICE ON THIRD BASE … EXPLODED THE DEBT … DOES WORSE THAN OABAMA ON ECONOMIC GROWTH AND NEW JOBS ,,, CANNOT POSSIBLY RESTORE INDUSTRIAL JOBS WITH THE WRONG FUCKING TAX CUT! (There have been ONLY TWO peacetime booms in the past 74 years … following IDENTICAL tax cuts by Kennedy, then Reagan … “Across the board. top to bottom, personal and corporate.” … REAGAN NEVER CUT TAXES FAVORING THE RICH, ONLY TRUMP DID THAT, IN ALL OF US HISTORY)

                    Any questions? 🙂

                    P.S. ALL PRESIDENTS FUCK UP. AND TRUMP FAR WORSE THAN OBAMA

                    P.P.S. The worst Democrat President ever was FRANKLIN DELANO ROOSEVELT, you hatred-spewing …..(fill in the blank)! (sneer)

                    1. Do you think President Trump will have more flexibility after the election?

                    2. ANOTHER COWARDLY EVASION, chickenshit

                2. MKE
                  What “things” are we talking about?

                  Umm, there was this massive recession, the third-worst since 1945. It was in all the papers. Google “great recession” (The great part is bullshit, like the “Great” depression )

                  1. Recession great, Obama recovery….not so much.

                    1. ONE MORE TIME FOR LYING SACK OF SHIT

                      OBAMA’S FINAL THREE YEARS
                      1) MORE new jobs than Trump’s first three.
                      2) MORE economic growth (GDP DECLINED last year)
                      3) Starting from the third worst recession in the past 74 years …. handed Trump the longest recovery EVER by an incoming President …

                      Trump’s first three years
                      1) first President to EVER increase deficit more than 40% in one year, DURING A LONG RECOVERY
                      2) Promised to pay off the entire debt in 8 years … instead added as much new 8-year debt in three years than Obama added AFTER 8 years,
                      3) The WORST President on debt EVER .,.. proposes ANOTHER UNPAID TAX CUT to explode the debt even more,

                      ***It’s just not true ,.,, your belief that reality disappears if you … close your eyes and cover your ears.

                      Severe denial is a mental affliction.

        4. (my attitude matches MKE’s)

          Spare me your ignorant lecture.

          Spare ME your abject stupidity on solutions … your IGNORANCE of the greatest obstacles to leaving poverty … and being a ventriloquist dummy for the political elites

          The point is that it is no way inconsistent with the medicaid statute to promote programs to further the transition of able bodied people out of that welfare program to conserve finite state resources for the truly needy.

          IT FAILS TO ADDRESS THE OBSTACLES … WHICH YOU DON’T EVEN KNOW,

          The court improperly overruled the Secretary’s exercise of statutory discretion to approve a temporary, experimental measure designed to address the damages done to the system by the over expansion of medicaid under Obama.You just gave away your PIGGISH GREED! (for proof, keep reading).

          Milton Friedman’s Negative Income Tax is the ONLY solution based on the REAL obstacles to our poorest .. not your total ignorance of how the safety net works.

          ***PAY ATTENTION
          WHY ARE HIGH MARGINAL TAX RATES A DISINCENTIVE TO YOU ….. BUT NOT TO THE POOR … WHERE MARGINAL RATES CAN BE AS HIGH AS 100%. HUH?

          WHAT? YOU NEVER KNEW THAT?

          Start at zero, As one works his way up, EVERY benefit declines at a different percentage (negative tax) …. some don’t decline at all with income gains …. but TOTALLY DISAPPEAR at a certain level, which is marginal tax rate of 100%.

          What? You never knew that EITHER?
          Here’s why THAT makes you INCOMPETENT on this issue, At ANY low poverty income level, YOU HAVE NO FUCKING CLUE what the NET gain is to a family, from ANY higher wage. It could be ZERO.
          BUT YOU BLAME THE VICTIMS!

          ***PAY ATTENTION … MILTON FRIEDMAN … A LIBERTARIAN, NOT A DUMBASS CONTARD OR PROGTARD … APPLIES COMMON SENSE … WHICH IS EASY, IF YOU KNOW WHAT THE HELL YOU’RE TALKING ABOUT

          1) REPEAL EVERY SAFETY NET PROGRAM, AT ALL LEVELS OF GOVERNMENT. FIRE ALL THE STAFF, SHUT DOWN ALL THE OFFICES,

          2) GIVE EVERYONE A CASH EQUIVALENT — MINUS A NEGATIVE TAX ON THEIR INCOME (ALSO WITH FAMILY DEDUCTIONS, LIKE YOURS)

          THE POOREST OF THE POOR WOULD THEN HAVE THE SAME INCENTIVES YOU DEMAND FOR YOURSELF …. WE LIBERTARIANS CALL THAT “EQUALITY.” AND IMMEDIATELY LOWER COSTS

          ****PAY ATTENTION …. OR PRIVATIZE IT ALL.
          TODAY’S PHONY CONSERVATIVES …. SHIT ON FREE MARKET OUTCOMES …. WHICH IS FASCISM.

          In a free market, there was 100% TREATMENT for the indigent … since the 1500s … most recently (pre-medicaid), by charity hospitals, financed by churches, charities, foundations, fraternals …. ALL DESTROYED BY MEDICAID.

          ***TO BE FAIR
          I am NOT saying that YOU are a selfish pig, liberty-hating fascist.
          But THAT is who you’ve allowed to manipulate you. Let’s find out.
          Do you care about solutions? … about equal rights? … about free-market OUTCOMES? …. or is it Party Uber Alles?

          1. You should understand TheLibertyTruthTeller, that your arguments, if they’re anything at all, are policy based positions, not legal arguments. Even the execrable Southern Poverty Law Center might be embarrassed to raise them in this case. But who knows? Give ’em a call, you’d probably get along.

            1. (Posted in DEFENSE of yet more aggression and bullshit)
              ANOTHER cowardly evasion … EVEN WACKIER THAN THIS!
              https://reason.com/2020/02/14/judge-sentelle-smacks-down-the-trump-administration/#comment-8131281

              ME:
              “IT FAILS TO ADDRESS THE OBSTACLES … WHICH YOU DON’T EVEN KNOW,”

              MKE
              “Your arguments, if they’re anything at all, are policy based positions, not legal arguments”

              la la la la la la

              1) They are the REAL obstacles … that you are clueless about … with SOLUTIONS to be passed into law … that you cannot grasp.

              2) You just CONFIRMED YOU HAVE NO CLUE ON THE REAL OBSTACLES … AND EVEN RAN AWAY FROM THEM!!!

              “THE FIRST STEP IN SOLVING ANY PROBLEM IS TO … KNOW WHAT THE HELL IT IS!” You do not.

              THE SPLC IS JUST MORE MINDLESS TRIBAL CHANTING FROM THE WACKO RIGHT …. LIKE ALL YOUR OTHER PROGRAMMED SLOGANS AND SOUNDBITES HERE.

              **I WARNED YOU NO MORE BULLSHIT THAT I’M A LIBERAL.
              ***I AM A LIBERTARIAN, CHUMP, WHICH IS WHY I CITED A LIBERTARINS (Friedman)
              ***WE DEFEND LIBERTY
              ***IF YOU “THINK” THERE ARE ONLY LIBERALS AND CONSERVATIVES …
              YOU ARE ONLY 50 YEARS OUT OF DATE. … OBSOLETE.

              OUR TWO PRIME MANTRAS — for 50+ years
              1) Liberals want government out of your bedroom but into your wallet. Conservatives want government out of your wallet but into your bedroom.

              2) Left – Right = Zero
              BOTH seeking to mandate their own preferred values by force of law, in an oppressive state.

            2. MKE
              “Your arguments, if they’re anything at all, are policy based positions, not legal arguments”

              INTELLIGENT PEOPLE USE POLICY ARGUMENTS TO PROPOSE .,…. LEGISLATION! …. THAT’S HOW IT’S DONE.

              ***WHY DO YOU SAY NO LAWS ARE NEEDED TO
              a) Replace all safety net programs with cash, all levels of government
              b) fire all the staff and close down all the offices, all levels
              c) Replace benefits reductions of 20-100% of added income with … A NEGATIVE INCOME TAX AT THE SAME LOW MARGINAL TAX RATES YOU ENJOY?

              ***WHO THE FUCK ARE YOU TO DEMAND SPECIAL TREATMENT?

              ***REPEAT: Do you care about solutions? … about equal rights? … about free-market OUTCOMES? …. or is it Party Uber Alles?

              We all heard your answer. 🙁

              1. I’m sure you hear a lot of things. Some advice, stop listening to those voices in your head.

        5. “Spare me your ignorant lecture.”

          I had to write it ignorant so you could follow.

          1. (spits coffee on keyboard)
            DAMMIT POLLOCK … GIVE US A WARNING BEFORE YOUR NEXT GRAND SLAM HOMER.

          2. Have fun with your crazy new fan James. Pares cum paribus. Maybe you can collaborate on his crazy website?

    2. That was manifestly not the intent of Congress.

  4. A guy who should have recused himself but instead supported a prosecutor who exposed a terrified young woman to shame and excoriation . . . and by the way did not emit a peep of complaint as he and so many other conservative white males jerked off over the publicly disseminated results . . . now is criticizing Trump? Maybe the “wind has gone out of his sails”. . . or maybe Trump can afford better testosterone injections.

    1. “and so many other conservative white males jerked off over the publicly disseminated results ”

      Seriously, it was that good? And you didn’t provide a link? Maybe it’s just you that got so aroused, not that there is anything wrong with that.

  5. So, it’s bad that the mean orange man is weeding out freeloaders and fraudsters to lessen the burden on taxpayers?
    Along with reducing regulations, rounding up and deporting criminal aliens, he’s now going after one of many groups of freeloaders.
    Shit, the bad orange man might get me to go out and vote for the first time since Ross Perot.

    1. Your anger, and violence is showing. Plus, you have no idea what you’re talking about, but please, more of your feels.

    2. “So, it’s bad that the mean orange man is weeding out freeloaders and fraudsters to lessen the burden on taxpayers?”

      People who are too sick to work are too sick to work. So fuck ’em.

      1. James, does it cause you any physical pain to be so completely ignorant of the facts? The experimental programs designed by the states applied to able bodied recipients.

        1. MKE
          James, does it cause you any physical pain to be so completely ignorant of the facts?

          MKE, to avoid MORE physical pain for YOU … bend over … while I jam this up your XXX …. AGAIN

          https://reason.com/2020/02/14/judge-sentelle-smacks-down-the-trump-administration/#comment-8131092

          1. You give a cite to the same comment section in which you’re posting comments? That’s taking circular feedback to a whole new stupid level. What progressive think tank created you?

            1. BWAAAAAAAAAAAAAAAA HAAAAAAAAAAAA

              bend over … while I jam this up your XXX …. AGAIN

              You give a cite to the same comment section in which you’re posting comments?

              TO JAM THE SAME PROOF UP YOUR ASS … AGAIN … AS I STATED … BECAUSE YOU KEEP REPEATING THE SAME CRAZED BULLSHIT …. FROM THE SAME IGNORANCE.

              Readers: Click that link. SEE me kick his ass on his IGNORANCE of the real obstacles to working out of poverty … and WHY Milton Friedman’s LIBERTARIAN solution is the ONLY one to EVER address those obstacles. (smirk)

              THAT’S HOW INTERNET FORUMS WORK, CHUMP.
              WE DON’T KEEP POSTING THE SAME FACTS OVER AND OVER.

              MKE just ridiculed me for using PROOF … versus his INFANTILE pussy whining and insults. NOT the brightest bulb on the tree (a SUPPORTED conclusion)

              ****ANOTHER CRAZY FUCKUP NEXT!
              ****GOOBERS ALWAYS SAY, “YOU’RE A LIBERAL” WHEN THEY’VE HAD THEIR ASSES KICKED … BECAUSE THEY CANNOT DEFEND THE MEMORIZED SLOGANS, PRGRAMMED BY THEIR MASTERS.

              What progressive think tank created you

              MORE proof you are a lying sack of shit
              The archive of my published political writing
              http://libertyissues.com/archive.htm

              Check my FREE-MARKET VIEWS, on
              1) TAXES
              2) HEALTH CARE
              3) GOVERNANCE (New Federalism)
              4) PROOF of GOP Tax Quack STUPIDITY
              5) Education

              (walks away laughing at you…. FIFTH TIME!)

  6. As much as I’d like to see work requirements for Medicaid, this looks like a solid conservative decision that needs to be applied more rigorously to federal regulations. Limiting regulations to achieve legislatively articulated congressional objectives seems like a good step to start cutting back on the administrative state.

    Fewer regulations is a worthy objective. If I were the Trump Administration i would start a task force to start identifying regulations that are designed to further objectives that aren’t spelled out in the authorizing legislation, and the revise the regulations accordingly. I think Trump has an affirmative duty to apply Sentelle’s decision broadly across all federal regulations.

    1. I agree. I think this bit of theatrical eyebrow raising is wholly misconceived :

      Maybe some higher-ups in the Administration thought that they could persuade conservative judges. If so, it is worth noting that the opinion was written by Judge Sentelle, who is definitely conservative. It is always a bit depressing to see courts line up strictly along party lines, and a bit refreshing when they don’t.

      I can’t say I’ve read it that carefully, but the “ratio” which is that HHS is only allowed to grant waivers to further Medicaid’s objectives, and that Medicaid’s objectives are statutorily defined as meeting the costs of medical care, seems well enough argued.

      It may be that “improving health outcomes for the poor” would be a more sensible objective for Medicaid to have, but that does not appear to be what the statute says.

      Consequently it’s a deeply conservative judgement, in the sense of obediently following the text, without scrabbling about dishonestly for a hidden, unstated, purpose that strikes the judge as being better policy than what Congress actually scribbled down.

      Perhaps Judge Sentelle, if he is conservatively minded from a political point of view, thinks that it would indeed be a better idea if Medicaid’s objectives were to improve health outcomes. But he seems to be doing a proper legally conservative job in appreciating that, when he’s on the bench, it’s none of his damn business what Congress ought to have done. All that matters is what it did do. If that fails to amuse a “conservative” administration – if that’s what the Trump administration is – the technical legal term is tough noogies.

      1. It may be that “improving health outcomes for the poor” would be a more sensible objective for Medicaid to have, but that does not appear to be what the statute says.How can health outcomes be improved, by totally ignoring people,

        Imagine, hypothetically, that you are forbidden to have health insurance, even if you would pay for it. Why do you say it’s “sensible” that your health would improve? And is that sufficient reason to simply ban all health coverage?

    2. Wait….can you unpack what you said? There was a lot implied there.

      Limiting regulations to achieve legislatively articulated congressional objectives seems like a good step to start cutting back on the administrative state.

      Can you explain your reasoning. I am tripping on legislative articulation. What do you mean by this?

      If I were the Trump Administration i would start a task force to start identifying regulations that are designed to further objectives that aren’t spelled out in the authorizing legislation, and the revise the regulations accordingly.

      Wouldn’t this spin off and endless series of costly lawsuits? I mean, you could identify those regs, whack ’em….and you know somebody will run to the district courts in SD-NY of ND-Ca (the uber-lib courts) to get a nationwide injunction. How would you address that, or is there no way to avoid it?

      1. I think “legislatively articulated” means “explicitly stated in the text of the law.”

        If I were the Trump Administration i would start a task force to start identifying regulations that are designed to further objectives that aren’t spelled out in the authorizing legislation..

        I think this is slightly missing the point. The reason why objectives came up in this case is that the text gives HHS power to grant waivers of various requirements to further the objectives of Medicaid. Ergo HHS does not have power to grant waivers that do not further the objectives of Medicaid. And the text of the law apparently goes on to specify what the objectives of Medicaid are – in brief, funding medical care.

        Thus the legal point is not about the global importance of hunting down Congressional objectives, but the general importance of confining the executive branch and its agencies within the powers explicitly granted by law. In another case, the powers of the agency may have nothing to do with objectives at all. Hence there is no point in beginning a general hunt for regulations that overstep objectives. The general hunt should be for regulations that overstep the agency’s powers.

        And even in this case, if the law had – as it does – insisted that waivers could only be granted to further the objectives of Medicaid, but the law had not stated what those objectives are, then HHS would have had a much better case.

        For the avoidance of doubt I am stating this from the perpspective of (very) old fashioned consrvative textualism. Your modern liberal judge is not going to care about the actual words and the actual powers. She is going to be casting around for an excuse to impose her own policy wearing a mask called “Congressional intent” or some such.

        In this case, several liberal judges agreed with old Sentelle, but that wa sundoubtedly because on this occasion the text was their friend. No “purposive” judge minds falling back on old fashioned textualism if the text suits her preferred conclusion.

        you know somebody will run to the district courts in SD-NY of ND-Ca (the uber-lib courts) to get a nationwide injunction

        Not entirely sure if an injunction is the right remedy if you don’t like the government saying “we’ve concluded this regulation is outside the agency’s power, so we’re not going to enforce it.” But you’re probably right that they’d think of something.

  7. Libertarians had a far better solution … decades ago … before the anti-gummint goobers shit on actually governing.

    Privatize Medicaid, which has HIGH uninsured rates. Pre-Medicaid, we had 100% TREATMENT, in hospitals, not just the ER. Provided by Charity Hospitals, funded by a complex network of private churches, charities, fraternals, foundations, etc. Fraternals had funded indigent care since the 1500s. (Like Rotary, Kiwanis and Eagles still do, in different goals)

    TODAY, we could say that government requires one size fits all. Privately, at the extremes, we’d see conservatives supporting REAL work-related support. I’m from Cleveland where, for decades, a nun raised money for almost an entire safety net … TO PEOPLE WHO WORKED AT RENOVATING HOMES IN THE GHETTO. (She had NO problem raising money!)

    Liberals would support lesser or zero requirements. Everybody gets what THEY want. Some would support NOTHING, as they did back then.

    Now, even the most extreme conservative and libertarian economists agree SOME role for government. So … what could government do that would best empower the free market, It could cover cancer treatment, for those enrolled in a private charity, GREATLY reducing their risks, for a small share of OVERALL health care costs. Or trim that down and provide a preventive annual checkup, also reducing the burden on charitables,
    Dozens of possibilities. That’s how liberty works!

    1. The 1500s, one person……you May want to analyze your anger, it’s ridiculous. Will you accept the deaths for Capitalism, and be honest about it, or just continue being ignorant.

      1. I just described capitalism, snowflake …. to replace the moral atrocity of Medicaid.

        Let’s explore YOUR ignorance.
        Political health care means betting your life, literally, that politicians, facing tough budgets, will ALWAYS increase your taxes, and NEVER cut your benefits. (snort)

        Here’s the proof, precious widdle snowlflake.

        MEDICAID,
        Just prior to ObamaCare’s Medicaid expansion, 1/4 of all our uninsured, 12 million Americans, were eligible for Medicaid or CHIP (children) but NEVER enrolled …

        PROOF, sucker: https://www.washingtonpost.com/wp-dyn/content/article/2008/04/25/AR2008042502855.html

        Medicaid pays 25-30% less than even Medicare, so more doctors REFUSE to accept it, especially in inner cities, where there are too few privately insured to overcharge and recover their losses.

        *MEDICAID ELIGIBLES HAVE THE HIGHEST UNNSURED RATE IN AMERICA … MORE MEDICAID ELIGIBLES DIE UNINSURED THAN THE PRIVATE MARKET. WHY?

        *PROGRESSIVE FUCKED THE POOR, SCREECHING “HEALTH CARE SHOULD BE A RIGHT, NOT DEPEND ON CHARITY.” BUT THEY REFUSE TO PAY FOR IT.

        *HOW CAN THE SAME GOVERNMENT MAKE $50 TRILLION IN UNPAID PROMISES FOR MEDICARE, BUT TRAGICALLY UNDERFUND MEDICAID?
        …..SENIORS VOTE. POOR PEOPLE DO NOT … POLITICAL HEALTH CARE

        SHAME ON YOU

        Canada’s medicare was ruled “AN UNCONSTITUTIONAL THREAT TO HUMAN LIFE” …. citing all the Canadians dying on waiting lists of a year or more.

        It took a court order, FORCING Parliament to restore all the funding they slashed … A COURT ORDER, FORCING POLITICIANS TO STOP KILLING THEIR OWN PEOPLE!

        *PROOF, sucker: Google “Chaoulli v Quebec”

        A MAJOR scandal in the UK. the Keogh Report found that THOUSANDS of Brits had “needlessly died” … many found in dead on their own excrement … having been rolled into empty rooms … AND ABANDONED. The cause: severe cuts in nursing staff, to reduce costs.

        *PROOF, snowflake: Google “Keogh Report”

        The prestigious Mayo Clinic has been REFUSING Medicare since 2010, as full payment for primary care … citing losses of $840 million for 2009. Hey snowflake, they can’t report a loss unless they write the checks …. so where did they find $840 million, HUH?

        THEIR ONLY OTHER SOURCE IS TO OVERCHARGE INSURANCE COMPANIES ,.. WHO PAID MAYO $840 MILLION TO SUBSIDIZE MEDICARE!!

        (Under the law, ANY provider can refuse to accept Medicare as full payment, They may add a surcharge. At Mayo, patients are invoiced for the Medicare reimbursement AMOUNT, PLUS a surcharge by Mayo (15% the last I checked). Patients must then file their own claim with Medicare, then forward the reimbursement to Mayo, PLUS THE SURCHARGE FROM THEIR OWN POCKET.

        Will you accept the deaths for Capitalism, and be honest about it, or just continue being ignorant.

        BWAAAAA HAAAAAA HAAAAAAA

        I AM smart enough to KNOW that you rank government MORE THAN HUMAN LIFE. You are SO suckered, snowflake … into barbarity. How totally shameful

        Anything else? 🙂

        1. Please consider fly fishing, or not posting here.

          1. When goobers FAIL on BOTH facts and proof … they go … infantile … while shouting down free speech.

            We libertarians have been calling out authoritarians — on both the left and right — for over 50 years.

            We even defend your Free Speech right to whine like a pussy!
            Yes, even proggies like you!!!!

  8. Better health outcomes are not a part of Medicaid statute??????
    Not allowed to measure deliverables, only expenditures???
    This is the reasoning of the swamp and why we have 19 trillion dollars in debt and growing fast.
    Enjoy the collapse when it comes, foolish, foolish people.

    1. Increasing coverage is the specified intent of Congress. Sorry if that enrages you.
      Change the law then.

      1. It’s not the law. Goober, it’s the reimbursements … which are 25-30% less than even Medicare … so even MORE doctors refuse Medicaid.

        Prior to the Medicaid expansion, 12 million Americans were eligible for Medicaid and CHIP (children) but NEVER ENROLLED. No doctors.

        After Obamacare … THE CON. Any uninsured who show up in the ER are automatically enrolled in Medicaid ….. BUT THE VAST MAJORITY STILL HAVE NO PERSONAL PHYSICIAN.

        Increasing coverage is the specified intent of Congress. Sorry if that enrages you.

        It may be specified … but if you BELEEB that’s their INTENT. you are a laughably brainwashed Sad Sack. I HOPE that enrages you. Does it?

      2. Better health outcomes are not a part of Medicaid statute??????

        Increasing coverage is the specified intent of Congress. Sorry if that enrages you.

        Outcomes are NOT synonymous with coverage, Sorry if literacy enrages you

  9. Someone who wanted to communicate better might have included a sentence with a link to what the dispute was. Or, failing that, a paragraph explaining who did what prior to the ruling.

    Congrats on your feelings about a court ruling about [whatever] though.

    1. Maybe do your own homework?

        1. Why?

          Because SarcastrO has no clue, is too lazy, and doesn’t really give a crap.

          1. Sarcastrated is just a mad cuck.

            1. Did we say the same think? 🙂

      1. I really don’t think it’s too much to expect a post like this to include a link to the opinion, or at the very least the name of the case.

        1. I can’t imagine being a big enough jackass to pretend that that is an unreasonable request.

  10. Overweight men who eat junk food and refuse to do serious work should not get free health care.

    Except if they’re rich, white and have orange hair.

    1. Do they pay taxes?
      Why do you oppose equal, unalienable and/or God-given rights?
      When you become our dick-tator ….

    2. Why are you fat shaming men?

      1. That was just a cover for progressive bullshit.
        The geniuses who don’t know the rich subsidize nearly half the entire personal income tax burden of the core middle class ($40-100k)

        He’s too busy slurping Bill Gates’ dick,

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  12. I’m sure Trump the Dictator will just issue an executive order overruling the DC Circuit and then mandate that the new regulations become law.

    1. Or, at least, he would, if he had any understanding of what was happening.

  13. Why no hyperlink to the opinion itself? Very disappointing.

    1. I don’t recall the writer’s name. Sadly, Volokh — who I’ve followed for several years, seems to be adding new writers that are well below his historical standards.

      He didn’t even name the case, which means (I think) that very few will be able to google it. Gresham v Azur
      https://healthlaw.org/wp-content/uploads/2020/02/Gresham-v.-Azar-DC-Circuit-Ruling-Feb-14.pdf

      FAR WORSE, this fails to report that Sentelle wrote the opinion of … A UNANIMOUS 3-JUDGE DECISION … which allows our local Trumpards to lambaste one judge as being treasonous to Truth, Justice and the American Way.

      The title of this page is also quite sloppy and deceiving.

      1. Thanks. That’s very helpful. I appreciate it.

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