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.
The Hidden Tax Bracket in the GOP Plan
Politico’s Danny Vinik: “Thanks to a quirky proposed surcharge, Americans who earn more than $1 million in taxable income would trigger an extra 6 percent tax on the next $200,000 they earn—a complicated change that effectively creates a new, unannounced tax bracket of 45.6 percent. … The new rate stems from a provision in the bill intended to help the government recover, from the very wealthy, some of the benefits that lower-income taxpayers enjoy. … After the first $1 million in taxable income, the government would impose a 6 percent surcharge on every dollar earned, until it made up for the tax benefits that the rich receive from the low tax rate on that first $45,000. That surcharge remains until the government has clawed back the full $12,420, which would occur at about $1.2 million in taxable income. At that point, the surcharge disappears and the top tax rate drops back to 39.6 percent.”
Vinik writes that the surcharge would have affected more than 400,000 tax filers in 2015, according to IRS data, and that it could raise more than $50 billion in revenue over a decade. At a Politico event Friday, House Ways and Means Chairman Kevin Brady said the surcharge, sometimes called a bubble rate, was included to try to drive more middle-class tax relief.
Read the Republican Tax Bill, Plus the Talking Points to Sell the Plan
House Republicans on Thursday released a 429-page draft of their "Tax Cuts and Jobs Act." Read the bill below, or scroll down for the House summary or a more digestible GOP list of highlights.
Another Analysis Finds GOP Tax Plan Would Balloon Deficits
A study by the University of Pennsylvania’s Wharton School, using the Penn Wharton Budget Model (PWBM), finds that three modeled versions of the plan would raise deficits by up to $3.5 trillion over 10 years and as much as $12.2 trillion by 2040. The lowest-cost plan modeled in the study — a version that would tax corporate income at 25 percent instead of the GOP’s proposed 20 percent and pass-through income at 28 percent instead of 25 percent, among a host of other assumptions and tweaks — would lose $1.5 trillion over 10 years, or $1 trillion after accounting for economic feedback effects. (The budget adopted by Republicans last week allows for up to $1.5 trillion to the added to the deficit.) The study also found that workers’ wages would increase by about 1.4 percent over a decade, far shy of the estimated benefits being claimed by the White House.
The Budget Vote May Depend on a SALT Deal
House GOP members concerned about the proposal to repeal the deduction for state and local taxes are supposed to meet with party leaders Wednesday evening. They’re reportedly looking to reach a compromise deal to keep the tax break in some form — and the budget vote might be at stake, Bloomberg reports: “House Republicans hold 239 seats and need 217 votes to adopt the budget — a critical step to passing tax changes without Democratic support. That means 23 defections could sink the budget resolution — assuming no absences or Democratic support.”
Can Trump Bring Democrats Along on Taxes?
Although Republicans are prepared to go it alone on tax reform, President Trump suggested creating a bipartisan working group on the topic during a Wednesday meeting with senators from both parties. Some senators were open to the idea, but it doesn’t look like Republicans have much interest in slowing down the process with in-depth negotiations. “I don’t really personally see the benefit of creating additional structure. I think we’ve got all the tools we need,” said Sen. John Cornyn (R-TX), who attended the meeting, according to Politico. Democrats appear skeptical, too. Sen. Ron Wyden (D-OR) said he told Trump that the distance between what Republicans were saying about their plan and what it actually does is a serious problem.