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.
Orrin Hatch Signals Just How Complicated Tax Reform Will Be
GOP leaders said Wednesday that they'd issue a more detailed framework of their tax overhaul the week of September 25. But while lawmakers are eager to get more details about the outline being hashed out by the so-called Big Six team of negotiators, Republicans are still divided on key elements of the plan — going from blueprint to bill is bound to be a contentious process.
In his opening remarks at a Senate Finance Committee hearing today on individual tax reform, Sen. Orrin Hatch (R-UT) said the plan from the Big Six — of which he is one — "will not dictate the direction" the tax-writing committee takes. "Anyone with any experience with the Senate Finance Committee knows that we are not anyone’s rubber stamp," he said. "If a bill – particularly on something as consequential as tax reform – is going to pass in this committee, the members of the committee will have to be involved in putting it together."
Oh, and remember: Republicans also need to agree on a budget before they can push through tax reform without Democratic votes.
Aging Baby Boomers Drive Down the Uninsured Rate
About 10,000 boomers turn 65 every day, becoming eligible for Medicare on their birthdays. The Census Bureau says that the sheer number of boomers entering Medicare is affecting the uninsured rate for the whole population. That rate fell to 8.8 percent in 2016, down from 9.1 percent a year earlier, with most of the decline driven by the aging of the post-war generation. (Wall Street Journal)
Social Security Kept 26.1 Million Out of Poverty Last Year
Social Security kept more than 26 million people out of poverty last year, according to a new report from the Census Bureau. Refundable tax credits such as the one for earned income kept 8.2 million people out of poverty, while food stamps lifted 3.6 million above the line, housing subsidies reduced the number of poor people by 3.1 million and unemployment insurance kept 680,000 out of poverty. Overall, the Census Bureau reported, the poverty rate was 12.7 percent, while a more sophisticated alternative measure that factors in government programs for low-income families put the rate at 13.9 percent, down from 14.5 percent in 2015.
Read more about the new Census Bureau numbers here.
Tax Reform on Menu for Trump's Dinner with Dems
President Trump is set to host three moderate Democratic senators for dinner on Tuesday as part of his push for tax reform, Politico reports. The Democrats on the guest list: Sens. Joe Manchin of West Virginia, Heidi Heitkamp of North Dakota and Joe Donnelly of Indiana, all of whom are up for reelection in 2018 in states Trump won last November. Vice President Mike Pence and GOP Sens. Orrin Hatch of Utah, John Thune of South Dakota and Pat Toomey of Pennsylvania are also slated to attend.
Trump and Schumer Will Try to Scrap the Debt Ceiling
The president and the Senate Democratic leader agreed to seek out a more permanent debt ceiling solution that would end the perpetual cycle of fiscal standoffs. “There are a lot of good reasons to do that, so certainly that’s something that will be discussed," Trump said Thursday. It might not be easy, though, as conservatives see the borrowing limit as a way to keep government spending in check. Paul Ryan said Thursday he opposes doing away with the debt ceiling.