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.
Is a Fix for Obamacare Taking Shape?
Senators on the Committee on Health, Education, Labor and Pensions heard from governors Thursday in the second of four scheduled hearings on stabilizing Obamacare. The common theme emerging from the testimony was flexibility: "Returning control to the states is prudent policy but also prudent politics," said Utah Gov. Gary Herbert, a Republican. He was joined by Democrat John Hickenlooper of Colorado, who said that states need room to innovate and learn from their mistakes. Much of what the governors said was in line with what the Senate panel is already considering, including the continuation of cost-sharing subsidies to insurance companies. (CBS News, Axios)
Senate Approves Trump's Deal with Dems. Will the House Go Along?
The Senate on Thursday voted to fund the government and increase the federal borrowing limit through December 8 as part of a deal that also included $15.25 billion in hurricane disaster relief funding and a short-term extension of the National Flood Insurance Program. The bill passed by a vote of 80-to-17, with only Republicans voting against the bill.
The package now goes back to the House, where it likely faces more strenuous resistance. The Republican Study Committee, a conservative caucus with more than 155 members, on Thursday announced it opposed the deal because it does not include spending cuts. Rep. Mark Walker, the group's chairman, sent a letter to House Speaker Paul Ryan listing 19 policy changes to "address the growing debt burden" or "begin draining the swamp" that could win conservative support for raising the debt ceiling. Some Democrats may also vote against the deal to signal their frustration with an agreement that they say weakened their hand in trying to protect undocumented immigrants who were brought into the country as children.
White House Backs Off Shutdown Threat…for Now
“Believe me, if we have to close down our government, we’re building that wall,” President Trump said of his planned border wall with Mexico 10 days ago. Just two days later, though, White House officials told Congress that a short-term spending bill to fund the government into December wouldn’t have to include $1.6 billion for the wall, The Washington Post reports.
Trump still wants money for the wall to be included in a December budget bill, and he could follow through on his shutdown threat at that point. For now, though, an agreement on a “continuing resolution” to keep the government running after September 30 seems likelier, allowing Congress to deal with some of the other pressing issues it faces this month.
Which Trump Agenda Items Are Companies Talking About With Wall Street?
Hamilton Place Strategies, a public affairs consulting firm, analyzed transcripts of earnings calls by publicly traded U.S. companies over the last three quarters. They found that tax reform was the policy issue companies discussed most on those calls with Wall Street analysts — but that mentions of the subject dropped by 38 percent from the fourth quarter of 2016 to the second quarter of 2017. Overall, the percentage of earnings calls mentioning government or policy issues fell from 41 percent to 16 percent. Health-care reform saw the largest increase.
Does this mean that businesses have given up on tax reform this year? Perhaps. More likely, it's simply the result of a lack of action on the tax overhaul. Hamilton Place notes that mentions of tax policy peaked in February just after the Senate Finance Committee advanced Treasury Secretary Steven Mnuchin's nomination and have spiked after other tax-related announcements. So mentions of tax reform on earnings calls could surge again the fall.
One other note about what businesses have been discussing: Calls mentioning President Trump fell by 84 percent from January to late August.
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Number of the Day: 51%
More than half of registered voters polled by Morning Consult and Politico said they support work requirements for Medicaid recipients. Thirty-seven percent oppose such eligibility rules.