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.
A Liberal Economist Shoots Down the GOP’s Fiscal Chicken Hawks
Republicans want a tax cut, but they don’t want to fully pay for it and may be willing to increase the deficit by $1.5 trillion over 10 years. This would continue a troubling cycle, economist Jared Bernstein writes, in which supposed fiscal conservatives “use the deficit argument to block spending, promote fiscal austerity, and small government, conveniently tossing deficit concerns aside when it comes to tax cuts.”
You’ll hear arguments about how increased economic growth will make up for the budgetary effects of the tax cuts, but don’t believe them. “Our fiscal history on this point is clear: Cutting taxes loses revenues, which, unless offset by higher taxes elsewhere or spending cuts, increases the budget deficit, which in turn raises the debt.” When this happens again, and the promised growth effects don’t materialize, the tax cutters will go back to pushing for spending cuts.
The country faces a number of serious challenges, including an aging population that by itself will require increased government spending, and we need a tax policy that does more than drive up the deficit. “The problem with structural deficits — ones that go up even in good times — is that they reveal that we’re unwilling to raise the necessary revenues to support the government we want and need. This enables those who whose goal is to shrink government to point to deficits and debt as their proof that we can’t afford it, whatever ‘it’ is, except when ‘it’ is tax cuts.” (New York Times)
Health Secretary Tom Price Under Fire for Use of Private Jets
Back in 2009, Tom Price spoke out against House Democrats who wanted to spend $550 million on private jets for lawmakers to use. A Republican representative from Georgia at the time, Price told CNBC that the purchase of the jets was “another example of fiscal irresponsibility run amok.” Now Secretary of Health and Human Services, Price seems to have changed his mind about the virtue of government officials using private jets at taxpayer expense. Just last week, Price used a chartered private jet to travel to three HHS events — including one at a resort in Maine — at an estimated cost of $60,000, Politico reports.
While previous HHS secretaries typically flew commercial, reports indicate that Price has been traveling by private jet for months. “Official travel by the secretary is done in complete accordance with Federal Travel Regulations,” an HHS spokesperson told Politico.
Critics on Twitter have been harsh:
More in-your-face kleptocracy from Tom Price.Take food stamps from poor, hungry kids- spend $25k from taxpayers to charter plane to Philly
— Norman Ornstein (@NormOrnstein) September 20, 2017
1️⃣ Attack Medicaid while trading health stocks.
— Harry Stein (@HarrySteinDC) September 20, 2017
2️⃣ Spend funds that could give someone 4 years of Medicaid coverage to fly a private jet. https://t.co/GO5cfJgWgO
First Mnuchin, now Tom Price. The @realDonaldTrump Cabinet has a big problem charging taxpayers for private flights. https://t.co/th1QbGdfT7
— Ben White (@morningmoneyben) September 20, 2017
Social Security Benefits Due for a Bigger Bump in 2018
In a few weeks the Social Security Administration will announce its cost-of-living adjustment, or COLA, for 2018. Inflation data for the month of August suggests that the adjustment could be the highest in five years, possibly over 2 percent, according to the Washington Examiner. Adjustments for the past five years have been relatively small: The cost of living adjustment for 2017 (announced last October) came in at a modest 0.3 percent, and the adjustment for 2016 was zero. Some retirees have complained in the past about small COLAs, but it’s worth remembering that higher adjustments are driven by higher inflation, which is bad news for people living on fixed incomes.
Americans Are Less Satisfied with Government Now Than a Year Ago
Gallup finds that just 28 percent of Americans are satisfied with the way the nation is being governed, down from 33 percent a year ago. And as we approach some potential fiscal battles, it's worth noting that the lowest satisfaction levels since Gallup started updating the measure annually in 2001 came in 2011 (19 percent) after a debt ceiling showdown that led to the U.S. credit rating being downgraded by S&P analysts and in 2013 (18 percent) during a federal government shutdown.
Maybe Don’t Count Out Obamacare Repeal Just Yet
Sen. Bill Cassidy (R-LA) told reporters on Friday that he’s getting close to securing enough votes to pass the last-ditch ACA repeal and replacement bill he’s put forth with Sens. Lindsey Graham (R-SC), Dean Heller (R-NV) and Ron Johnson (R-WI).
“I am pretty confident we’ll get there on the Republican side,” Cassidy said. “We’re probably at 48-49 [votes] and talking to two or three more.” And Senate Majority Leader Mitch McConnell has asked the Congressional Budget Office to estimate the effects of the Cassidy-Graham bill, which would speed up the scoring process.
Of course, those last two or three votes have been the challenge for the GOP all along, and they may not be any easier to round up this time. Sen. Rand Paul (R-KY), who voted for a prior repeal bill, said Friday that he won't support this one. Plus, opponents are already stepping up their criticisms about the effects of the bill. And time is running out: Cassidy and his colleagues only have until September 30 to pass the bill this year under a process that would require only 50 supporters in the Senate. So while the Obamacare repeal may still have life, it remains a longshot.