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.
Martin Feldstein Is Optimistic About Tax Cuts, and Long-Term Deficits
In a new piece published at Project Syndicate, the conservative economist, who led President Reagan’s Council of Economic Advisers from 1982 to 1984, writes that pro-growth tax individual and corporate reform will get done — and that any resulting spike in the budget deficit will be temporary:
“Although the net tax changes may widen the budget deficit in the short term, the incentive effects of lower tax rates and the increased accumulation of capital will mean faster economic growth and higher real incomes, both of which will cause rising taxable incomes and lower long-term deficits.”
Doing tax reform through reconciliation — allowing it to be passed by a simple majority in the Senate, as long as it doesn’t add to the deficit after 10 years — is another key. “By designing the tax and spending rules accordingly and phasing in future revenue increases, the Republicans can achieve the needed long-term surpluses,” Feldstein argues.
Of course, the big questions remain whether tax and spending changes are really designed as Feldstein describes — and whether “future revenue increases” ever come to fruition. Otherwise, those “long-term surpluses” Feldstein says we need won’t ever materialize.
JP Morgan: Don’t Expect Tax Reform This Year
Gary Cohn, President Trump’s top economic adviser, seems pretty confident that Congress can produce a tax bill in a hurry. He told the Financial Times (paywall) last week that the Ways and Means Committee should be write a bill “in the next three of four weeks.” But most experts doubt that such a complicated undertaking can be accomplished so quickly. In a note to clients this week, J.P. Morgan analysts said they don’t expect to see a tax bill passed until mid-2018, following months of political wrangling:
“There will likely be months of committee hearings, lobbying by affected groups, and behind-the-scenes horse trading before final tax legislation emerges. Our baseline forecast continues to pencil in a modest, temporary, deficit-financed tax cut to be passed in 2Q2018 through the reconciliation process, avoiding the need to attract 60 votes in the Senate.”
Trump Still Has No Tax Reform Plan to Pitch
Bloomberg’s Sahil Kapur writes that, even as President Trump prepares to push tax reform thus week, basic questions about the plan have no answers: “Will the changes be permanent or temporary? How will individual tax brackets be set? What rate will corporations and small businesses pay?”
“They’re nowhere. They’re just nowhere,” Henrietta Treyz, a tax analyst with Veda Partners and former Senate tax staffer, tells Kapur. “I see them putting these ideas out as though they’re making progress, but they are the same regurgitated ideas we’ve been talking about for 20 years that have never gotten past the white-paper stage.”
The Fiscal Times Newsletter - August 28, 2017
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The IRS Gives Hurricane Harvey Victims a Break
The tax agency announced Monday that “victims in parts of Texas have until Jan. 31, 2018, to file certain individual and business tax returns and make certain tax payments.”