Republicans Push Ahead on Medicaid Restrictions
The Trump administration on Friday approved Ohio’s request to impose work requirements on Medicaid recipients. Starting in 2021, the state will require most able-bodied adults aged 19 to 49 to either work, go to school, be in job training or volunteer for 80 hours a month in order to receive Medicaid benefits. Those who fail to meet the requirements over 60 days will be removed from the system, although they can reapply immediately.
The new work requirements include exemptions for pregnant women, caretakers and those living in counties with high unemployment rates and will apply only to those covered through the expansion of Medicaid under the Affordable Care Act. There are currently about 540,000 people on Medicaid in Ohio who receive coverage through the expansion, according to Kaitlin Schroeder of The Dayton Daily News, compared to roughly 2.6 million Medicaid recipients in the state overall.
Once implemented, the work requirements are expected to result in 36,000 people losing their Medicaid eligibility, according to state officials, though critics say the reductions could be significantly larger. Similar work requirements in Arkansas pushed 18,000 people off the Medicaid rolls in six months.
A larger GOP project: The creation of new work requirements is part of a larger effort by Republicans to limit the expansion of Medicaid, says The Wall Street Journal’s Stephanie Armour. Since the Affordable Care Act passed in 2010, 36 states have expanded their Medicaid programs under the ACA and the number of people in the program has grown by 50 percent, from roughly 50 million to about 75 million. But many red-state governors have expressed concerns about the cost of Medicaid expansion and worries about a lack of self-sufficiency among the able-bodied poor, and are embracing new limitations on the program for both fiscal and political reasons.
In 2017, the White House in 2017 gave states the green light to explore ways to limit the reach and expense of their Medicaid programs. Governors have proposed a variety of new rules, which require waivers from the federal government to enact. Kentucky, for example, wants to drug-test Medicaid recipients, and Utah wants a partial expansion and a cap on payments. Kaiser Health News summarizes the variety of waivers states have requested, which are governed by Section 1115 of the Social Security Act, in the chart below.
Legal challenges: Efforts to restrict Medicaid have received legal challenges, and U.S. District Judge James Boasberg blocked work requirements in Kentucky last year. The same judge, who has expressed doubts about the administration’s approach to Medicaid, will rule on the legality of work requirements in both Kentucky and Arkansas by April 1.
The bottom line: The Trump administration is seeking fundamental changes in how Medicaid works. Even if Boasberg rules against work requirements, expect the White House and Republican governors to continue to push for new limitations on the program.
Tax Reform Is Hard, but the GOP Could Have Made This Easier
The Tax Policy Center’s William G. Gale writes that the GOP’s approach to the tax bill combines a $5.8 trillion tax cut with a $4.3 trillion tax increase to offset the costs. There may have been an easier way. “What if the House GOP simply tried to cut business and individual taxes by $1.5 trillion. No offsets needed. They could have distributed small tax cuts to middle-income individuals by, say, modestly expanding the earned income tax credit and raising the standard deduction. And they could have trimmed the top corporate tax rate by a few percentage points. It would not have been base-broadening tax reform, but neither is the current bill. ... Tax reform is never easy, but crafting the bill this way has vastly increased the challenge of passing it.”
Alan Greenspan: Deal with the National Debt Before Cutting Taxes
Former Federal Reserve Chairman Alan Greenspan is warning that sharply cutting taxes right now would be an economic “mistake.”
In an interview with Maria Bartiromo on the Fox Business Network Thursday, the 91-year-old Greenspan said it’s more important for President Trump and Congress to put the nation on a sustainable fiscal path by addressing rising entitlement spending driven by the aging of the U.S. population.
“Frankly, I think what we ought to be concerned about is the fact the federal debt is rising at a very rapid pace, and there’s nothing in this bill that will essentially stop that from happening," Greenspan said. "So my view is that we’re premature on fiscal stimulus, whether it’s tax cuts or expenditure increases. We’ve got to get the debt stabilized before we can even think in those terms.”
GOP’s Estate-Tax Repeal Details Would Save Super-Rich Tens of Billions Extra
It’s no surprise that the House Republicans’ tax bill includes the eventual repeal of the estate tax, a long-held GOP goal. But The Washington Post’s Glenn Kessler highlights an unexpectedly generous aspect of the current bill: It “allows the beneficiaries of estates to not pay capital gains taxes on the increase in value of assets held by the estates. That has not been a feature of most previous estate-tax bills.”
Currently, estates face a federal tax if they’re valued at more than $5.49 million for individuals or almost $11 million for couples. But, for tax purposes, the value of assets passed on to heirs gets “stepped-up” or reset to their value at the time of death. Kessler’s example: “Imagine a home that had been purchased for $250,000 but was now worth $1 million. The ‘stepped-up basis’ would be $1 million. If the heirs sold the house for $1.1 million, they would only owe capital-gains tax on the $100,000 difference, not the $850,000 difference from the original purchase price.”
The GOP bill repeals the estate tax, but also keeps the stepped-up basis — a seemingly small detail that creates a huge tax shelter. It means that heirs of large estates would save tens of billions of dollars a year when they sell assets that have appreciated in value over time — or, as Kessler puts it, that the bill will allow “tens of billions of untapped capital gains to remain beyond the reach of the U.S. government.”
Republicans Are Still Coming After Obamacare’s Individual Mandate
Speaker Paul Ryan said Sunday that House Republicans are still considering a repeal of the Obamacare individual mandate as part of their tax bill. "We have an active conversation with our members and a whole host of ideas on things to add to this bill. And that’s one of the things that’s being discussed," Ryan said on Fox News. President Trump touted the idea in a tweet last week, and Sens. Tom Cotton and Rand Paul have recently spoken in favor of using the tax bill to eliminate the mandate. The move would save the government $416 billion over 10 years as roughly 15 million people go without insurance due to lower spending on subsidies and health care services, according to the CBO. Those savings could be appealing as Republicans look for revenues in their revised tax bill. But if the controversial repeal of the mandate isn’t included in the tax bill, the White House is reportedly ready to roll out an executive order weakening the requirement that taxpayers provide proof of insurance to avoid paying a penalty.
Goldman Sachs Says Corporate Tax Rate Cuts May Get Phased In
Despite the challenges the Republican tax overhaul faces, Goldman Sachs still puts the chances of a plan becoming law by early next year at about 65 percent — but its analysts see some substantial changes coming before that happens. “The proposed tax cut is more front-loaded than we have expected; official estimates suggest a tax cut of 0.75% of GDP in 2018. However, we expect the final version to have a smaller near-term effect as competing priorities lead tax-writers to phase in some cuts—particularly corporate rate cuts—over time,” Goldman said in a note to clients Sunday.