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.
Number of the Day: 44%
The “short-term” health plans the Trump administration is promoting as low-cost alternatives to Obamacare aren’t bound by the Affordable Care Act’s requirement to spend a substantial majority of their premium revenues on medical care. UnitedHealth is the largest seller of short-term plans, according to Axios, which provided this interesting detail on just how profitable this type of insurance can be: “United’s short-term plans paid out 44% of their premium revenues last year for medical care. ACA plans have to pay out at least 80%.”
Number of the Day: 4,229
The Washington Post’s Fact Checkers on Wednesday updated their database of false and misleading claims made by President Trump: “As of day 558, he’s made 4,229 Trumpian claims — an increase of 978 in just two months.”
The tally, which works out to an average of almost 7.6 false or misleading claims a day, includes 432 problematics statements on trade and 336 claims on taxes. “Eighty-eight times, he has made the false assertion that he passed the biggest tax cut in U.S. history,” the Post says.
Number of the Day: $3 Billion
A new analysis by the Department of Health and Human Services finds that Medicare’s prescription drug program could have saved almost $3 billion in 2016 if pharmacies dispensed generic drugs instead of their brand-name counterparts, Axios reports. “But the savings total is inflated a bit, which HHS admits, because it doesn’t include rebates that brand-name drug makers give to [pharmacy benefit managers] and health plans — and PBMs are known to play games with generic drugs to juice their profits.”
Chart of the Day: Public Spending on Job Programs
President Trump announced on Thursday the creation of a National Council for the American Worker, charged with developing “a national strategy for training and retraining workers for high-demand industries,” his daughter Ivanka wrote in The Wall Street Journal. A report from the president’s National Council on Economic Advisers earlier this week made it clear that the U.S. currently spends less public money on job programs than many other developed countries.
Economists See More Growth Ahead
Most business economists in the U.S. expect the economy to keep chugging along over the next three months, with rising corporate sales driving additional hiring and wage increases for workers.
The tax cuts, however, don’t seem to be playing a role in hiring and investment plans. And the trade conflicts stirred up by the Trump administration are having a negative influence, with the majority of economists at goods-producing firms who replied to the most recent survey by the National Association for Business Economics saying that their companies were putting investments on hold as they wait to see how things play out.