Alice Ollstein

Alice Ollstein is a reporter at Talking Points Memo, covering national politics. She graduated from Oberlin College in 2010 and has been reporting in DC ever since, covering the Supreme Court, Congress and national elections for TV, radio, print, and online outlets. Her work has aired on Free Speech Radio News, All Things Considered, Channel News Asia, and Telesur, and her writing has been published by The Atlantic, La Opinión, and The Hill Rag. She was elected in 2016 as an at-large board member of the DC Chapter of the Society of Professional Journalists. Alice grew up in Santa Monica, California and began working for local newspapers in her early teens.

Articles by Alice

Attorneys for Kentucky Gov. Matt Bevin (R) will tell a federal court this Friday that that the governor plans to take his ball and go home if he can’t get his way on Medicaid work requirements, premiums, and other restrictions. Bevin, who campaigned on ending the Medicaid expansion but backed down from that threat once elected, is now arguing that he will scrap the state’s Medicaid expansion if the controversial new rules are struck down by federal courts.

Kentucky was the first state in the nation to win permission from the Trump administration to impose the new Medicaid rules, which are expected to throw nearly 100,000 Kentuckians off the program. With at least a dozen other states looking to adopt their own Medicaid work requirements, the outcome of the case could determine the future of the program not only in Kentucky but across the country.

Kentucky and the Trump administration are jointly fighting a lawsuit from a dozen-plus Kentucky residents who fear the work requirements and other hurdles will strip them of their Medicaid coverage. The plaintiffs are arguing, among other points, that the new rules do not further Congress’ original intent for Medicaid — to provide affordable health care to low-income people.

Kentucky’s waiver will allow the state to deny coverage to any non-disabled adult who cannot prove they are working at least 20 hours per week. The state also will be able to charge low-income Medicaid recipients health care premiums, eliminate full coverage of dental care, vision services, and over-the-counter medications for many adults, end retroactive Medicaid coverage, and implement a six-month lockout period for people who fail to re-enroll in time or report a change in income.

In the state’s legal filings, Kentucky responds that the challengers don’t have legal standing because they can’t prove they will be harmed by the new rules, which are set to go into effect in July. The state additionally says the lawsuit should be thrown out because Bevin’s promise to scrap the Medicaid expansion entirely if he loses in court means that the challengers’ claims are not “redressable” — essentially, they’re screwed and will lose their Medicaid coverage no matter which way the court comes down.

“Governor Bevin has made it unmistakably clear that Kentucky will withdraw from expanded Medicaid if this case ultimately succeeds in invaliding Kentucky HEALTH,” the state’s reply brief states. “In fact, he has given that conclusion the force of law.”

That “force of law” is an executive order Bevin signed in January that would trigger the termination of Kentucky’s Medicaid expansion within six months if the work requirements waiver is blocked by courts and all appeals are exhausted, meaning that about half a million people would lose their health coverage.

“No matter how much Plaintiffs want expanded Medicaid and no matter how hard they work to keep it, that ultimate decision is not up to them,” the state’s legal brief asserts bluntly. “That decision is Kentucky’s to make.”

In their own legal briefs leading up to Friday’s oral arguments, the Kentuckians challenging the waiver push back with three main counterpoints. First, they say Bevin may not be able to completely kill the expansion even if he wants to.

“It’s not like he can just snap his fingers and the expansion is done,” said Leonardo Cuello, the director of health policy at the National Health Law Program, one of the organizations representing the plaintiffs in court. “In fact, there are serious questions as to whether he can legally undo the expansion.”

Cuello told TPM that their attorneys also plan to implore the judge not to endorse Bevin’s hostage-taking tactic, arguing that doing so would be “rewarding bad threats.”

“If you were to allow Kentucky to get away with this argument, you’d be saying that anytime someone can come up with a threat worse than the harm the plaintiff is identifying, they can strip away someone’s standing,” he explained. “That sends the message that any government official could avoid lawsuits by saying, ‘If you grant this challenge, we’ll do this other thing that’s even worse.'”

Finally, the plaintiffs counter Kentucky with a somewhat wonky argument based on a past federal case involving housing subsidies. They say that even if the court takes Bevin’s “Medicaid waiver or nothing” threat into account, that should not prevent the court from protecting the plaintiffs from a clearly imminent danger.

“All we need to show is that the waiver is a clear step on the path to injury, and that removing it is necessary to removing the threat of injury,” Cuello said. “Our plaintiff’s claims are redressable, because striking down the waiver would be removing an absolute barrier to them, even if it doesn’t prevent other barriers down the line.”

The arguments over Kentucky’s waiver come as many other states move to implement their own restrictive Medicaid rules. Some, including Michigan, have included a provision similar to Kentucky’s, where any outside threat to the work requirements would trigger the abolition of the entire Medicaid expansion.

Cuello told TPM that those states should think twice before crafting such a set-up, calling it “an irresponsible game of chicken.”

“It’s out of your control whether the Department of Health and Human Services approves the waiver and whether courts strike it down,” he said. “It’d be like saying you’ll terminate the Medicaid expansion if the stock market in Japan dips below a certain threshold.”

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The Trump administration’s new attempt to have key pieces of the Affordable Care Act struck down in federal court — particularly the ban on insurance companies turning people away or charging them higher premiums based on a pre-existing condition — could have a serious and damaging domino effect throughout the health care sector. Insurance trade groups, health care experts and lawmakers say the fallout is likely to extend beyond the individual market, impacting many of the tens of millions of Americans who get their health insurance from an employer.

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The legality of Kentucky’s Medicaid work requirements and other health-care restrictions will be on trial this Friday in DC’s District Court — a case with major national implications. More than a dozen low-income Kentuckians with health problems or family obligations that prevent them from being able to work are suing their Republican governor and the Trump administration for green-lighting the new rules, saying they will be unlawfully booted from the Medicaid rolls as a result. If they fail to convince the judge to enjoin the program, the work requirements, premiums, cuts to dental and vision coverage, and six-month lockout period for those who fail to file their paperwork on time will go into effect in July.

Though the fate of such laws is still up in the air, several other states are moving rapidly to adopt them.

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In a dramatic move, the Trump administration declared its intention to refuse to defend the Affordable Care Act from a federal lawsuit by 20 GOP-controlled states who are arguing that Congress’ repeal of the individual mandate renders parts of the rest of the health care law unconstitutional, according to a filing from the Department of Justice Thursday evening.

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After five years of fierce, partisan battles, amid chants of “Yes we did” from the crowd of spectators, Virginia Gov. Ralph Northam signed a bill Thursday afternoon that will expand Medicaid under the Affordable Care Act to cover up to 400,000 more low-income people in the state.

“It has been a long road to get here,” Northam said. “It took longer than we would have liked. But I couldn’t be happier to sign this and give Virginians access to the care they need to live healthy and successful lives.”

Citing the Founding Father who designed the capitol building behind him, Northam thanked the lawmakers and advocates who made the passage of Medicaid expansion possible: “As Thomas Jefferson said, ‘Without health there is no happiness.'”

But the triumphant bill signing on the capitol’s steps in Richmond will not be the culmination of the state’s Medicaid wars, but rather the beginning of a new chapter. The bumpy road ahead includes requesting permission from the Trump administration to implement work requirements and to require that Medicaid beneficiaries pay premiums. Those conservative policies won the GOP votes necessary to get the bill over the finish line, and, if approved, are likely to be the stuff of political and legal battles for years to come.

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Wisconsin may soon become the first state in the nation to require hundreds of thousands of its Medicaid recipients to take drug tests in order to maintain their health coverage. The state has been waiting for nearly a year for approval from the Trump administration to move forward with the proposal, and the answer is expected in the next few months.

Health care workers, legal experts, and patient advocates in the state tell TPM that the proposed measures will cause thousands of Wisconsins to lose their health coverage — both those who attempt to comply and fall through the cracks and those deterred from applying due to the new requirements. Though the Trump administration has already approved Medicaid work requirements in four states, and has signaled that at least eight more could be on the way, the mandatory drug testing is a new and legally questionable frontier — never before allowed in Medicaid’s half-century history.

The Centers for Medicare and Medicaid Services (CMS) declined to answer TPM’s questions on when a decision will be made on Wisconsin’s waiver and how the administration views the drug testing proposal. Wisconsin’s Department of Health Services declined to answer TPM’s questions about the new requirements.

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Medicare’s trust fund for inpatient care will become insolvent in 2026, three years earlier than previously expected, the trustees reported Tuesday. The insolvency date for Social Security stayed steady, with a projection of 2034. That does not mean, however, that the funds will be exhausted by those dates. Rather, those are the dates that the programs’ costs will exceed the tax revenue coming in. The report found that the programs will be able to cover about three-quarters of promised benefits for the next half-century without any policy changes.

Announcing the report, Treasury Secretary Steve Mnuchin insisted that the tax cuts Republicans passed earlier this year will generate so much economic activity that they will more than cover the benefits of the tens of millions of American who depend on the programs.

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