Republicans Push Ahead on Medicaid Restrictions

Republicans Push Ahead on Medicaid Restrictions

U.S. President Trump listens to reporters during bill signing ceremony in the Oval Office of the White House in Washington
JOSHUA ROBERTS
By Michael Rainey

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.

About 90% of Trump Counties Have Received Trade War Farm Aid

FILE PHOTO: A combine drives over stalks of soft red winter wheat during the harvest on a farm in Dixon, Illinois
Jim Young
By The Fiscal Times Staff

President Trump won more than 2,600 of the nation’s 3,000-plus counties in the 2016 election, and residents in nearly 90% of those counties – or more than 2,300 – have received some level of aid from the administration’s Market Facilitation Program, a $16 billion effort that compensates farmers for losses incurred as a result of Trump’s trade war with China.

Drawing on a new report from the Environmental Working Group, The Washington Post’s Philip Bump says the data “show the extent to which [the farm] subsidies overlap with Trump’s base of political support.”

To be fair, about 80% of the counties Hillary Clinton won also received some degree of aid, Bump says, but there are many fewer of them, given the concentration of her supporters in urban areas.

Overall, residents in more than 2,600 counties in the U.S. have received payments from the farm aid program, with the heaviest concentration in the Midwest.

Number of the Day: $1.57

iStockphoto
By The Fiscal Times Staff

A new study from the Bipartisan Policy Center says that Medicare would save $1.57 for every dollar it spends delivering healthy food to elderly beneficiaries who have recently been discharged from the hospital. The savings would come from a reduction in the rate of readmissions to the hospital for patients suffering from a wide range of common ailments, including rheumatoid arthritis, congestive heart failure, diabetes and emphysema.

“If you were going to offer meals to every Medicare beneficiary, it would be cost-prohibitive,” said BPC’s Katherine Hayes. “By targeting it to a very, very sick group of people is how we were able to show there could be savings.”

Budget Deal Moving Ahead, Despite Outrage on the Right

A cyclist passes the U.S. Capitol in Washington
CHRIS WATTIE
By Michael Rainey

The bipartisan deal to suspend the debt ceiling and increase federal spending over the next two years will get a vote in the House on Thursday, House Majority Leader Steny Hoyer (D-MD) said late Tuesday. Leaders in both parties have expressed confidence that the bill will pass before lawmakers leave town for their August recess.

"We're gonna pass it," Hoyer told reporters. "I think we'll get a good number [of votes]. I don't know if it's gonna be huge, but we're gonna pass it."

President Trump announced that he backs the deal, removing one possible hurdle for the bill. “Budget Deal gives great victories to our Military and Vets, keeps out Democrat poison pill riders. Republicans and Democrats in Congress need to act ASAP and support this deal,” he tweeted Tuesday evening.

Despite widespread agreement that the bill will pass, however, not everyone is on board.

Grumbles from the left: Some progressive Democrats have been critical of the deal, portraying it as too easy on Republicans. Worried that the agreement could set up a budget crisis in 2021, Rep. Ro Khanna (D-CA) said he was “concerned that it was a two-year deal. Why not a one year deal?... It seems like it’s basically handcuffing the next president.” Other liberals, noting that Democratic leaders have agreed to avoid “poison pill” riders on controversial issues such as abortion and funding for the border wall in the funding bills that must pass this fall, lamented their loss of leverage in those negotiations.

Outrage on the right: Resistance to the deal was more pronounced on the right, with the hardline House Freedom Caucus announcing Tuesday that it would not support the bill due to concerns about the growing national debt. “Our country is undeniably headed down a path of fiscal insolvency and rapidly approaching $23 trillion in debt. … All sides should go back to the drawing board and work around the clock, canceling recess if necessary, on a responsible budget agreement that serves American taxpayers better—not a $323 billion spending frenzy with no serious offsets,” the 31-member group said in a statement.

The deficit hawks at the Committee for Responsible Federal published “Five Reasons to Oppose the Budget Deal,” which include its purported $1.7 trillion cost over 10 years. CRFB noted that the agreement would increase discretionary spending by 21 percent during President Trump’s first term, pushing such spending to near-record levels.

Sen. John Kennedy (R-LA) was more colorful in his criticism, saying, “You don’t have to be Euclid to understand the math here. We’re like Thelma and Louise in that car headed toward the cliff.” Nevertheless, Kennedy said he would consider supporting the deal.

Is the deficit hawk dead? The budget deal represents “the culmination of years of slipping fiscal discipline in Washington,” said Robert Costa and Mike DeBonis of The Washington Post, and it highlights the declining influence of fiscal conservatives in the capital, at least as far as policy is concerned. Sen. James Lankford (R-OK) said the Republican Party’s credibility on fiscal restraint is “long gone.”

Although it may be too early to declare the fiscal hawk extinct – plenty of critics say the bird will return as soon as there’s a Democratic president – it certainly seems to be in ill health. As the University of Virginia's Larry Sabato said Wednesday: “A battered bird has been named to the list of endangered species. The ‘deficit hawk’ is on the road to extinction. Rarely spotted around Washington, D.C., the deficit hawk’s last remaining habitat is found in some state capitals.”

Some Republicans said that fiscal conservatism was never really a core Republican value, dating back to President Reagan’s tax-cut-and-spend policies, and that Paul Ryan’s emphasis on fiscal issues was an aberration. “It was never the party of Paul Ryan,” former House Speaker Newt Gingrich told the Post. “He’s a brilliant guy, but he filled a policy gap. The reality here is that Republicans were never going to get spending cuts with Speaker Pelosi running the House, and they didn’t want an economic meltdown or shutdown this summer.”

Is the whole debate missing the point? William Gale of the Brookings Institution, who served on President George H.W. Bush’s Council of Economic Advisers, said he wasn’t sure why the budget deal was producing so much hostility, since it basically maintains the status quo and – more importantly – is focused solely on discretionary spending. “There *is* a long-term budget issue,” Gale tweeted Tuesday, “but cutting [discretionary spending] is not the way to go.”

Instead, Gale says that any serious fiscal plan must focus on the mandatory side of the ledger, where the rapidly increasing costs of health care and retirement are straining against revenues reduced by repeated rounds of tax cuts. Gale recommends a combination of entitlement reductions and revenue increases – a standard mix of policy options that faces an uncertain future, with well-entrenched interest groups standing opposed to movement in either direction.

N&V2

By The Fiscal Times Staff

Here's what we have our eye on today:

NEWS
  • Trump Wants a ‘Phase Two’ of Tax Cuts  – CNBC
  • Congress Has Until March 23 to Fund the Government. Three Ways This Could Go – Vox
  • The First Target on Drug Prices: Pharmacy Benefit Managers – Axios

News & Views

By The Fiscal Times Staff

Here's what we have our eye on today:

NEWS

VIEWS