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.
New Tax on Non-Profits Hits Public Universities
The Republican tax bill signed into law late last year imposed a 21 percent tax on employees at non-profits who earn more than $1 million a year. According to data from the Chronicle of Higher Education cited by Bloomberg, there were 12 presidents of public universities who received compensation of at least $1 million in 2017, with James Ramsey of the University of Louisville topping the list at $4.3 million. Endowment managers could also get hit with the tax, as could football coaches, some of whom earn substantially more than the presidents of their institutions.
Government Revenues Drop as Tax Cuts Kick In
Corporate tax receipts in June were 33 percent lower than a year ago, according to data released by the Treasury Department Thursday, as companies made smaller estimated payments due to the reduction in their tax rates. Total receipts were down 7 percent, while payroll taxes were 5 percent lower compared to June 2017.
“June receipts to US government were our first mostly-clear look at the revenue effects of the new tax law, with lots of estimated payments and little noise from the 2017 tax year,” The Wall Street Journal’s Richard Rubin tweeted Friday.
Surprisingly, the deficit was smaller in June compared to a year ago, narrowing to $74.86 billion from $90.23 billion last year. The drop was driven by a 9 percent reduction in government outlays that reflected accounting changes rather than any real changes in spending, Rubin said in the Journal.
“More broadly, the federal deficit is swelling as government spending outpaces revenues,” Rubin wrote. “The budget gap totaled $607.1 billion in the first nine months of the 2018 fiscal year, 16% larger than the same point a year earlier.”
Kyle Pomerleau of the Tax Foundation pointed out that the drop in corporate tax receipts is a permanent feature of the Republican tax cuts, tweeting: “Even in a Trump dream world in which these cuts paid for themselves, corporate tax collections would remain below baseline forever. It would be higher income and payroll receipts that made up the difference.”
Deficit Jumps in Trump’s First Fiscal Year
The federal budget deficit rose by 16 percent in the first nine months of the 2018 fiscal year, which began last October. The shortfall came to $607 billion, compared to $523 billion in the same period the year before, according to a U.S. Treasury report released Thursday and reported by Bloomberg. Both revenue and spending rose, but spending rose faster. Revenues came to $2.54 trillion, up 1.3 percent from the same nine-month period in 2017, while spending came to $3.15 trillion, up 3.9 percent.
Where’s the Obamacare Navigator Funding for 2019, PA Insurance Commissioner Asks
Pennsylvania’s insurance commissioner sent a letter this week to Health and Human Services Secretary Alex Azar and Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma requesting that they “immediately release the funding details for the Navigator program for the upcoming open enrollment period for 2019.” Navigators are the state and local groups that help people sign up for Affordable Care Act plans.
“In years past, grant applications and new funding opportunities were released by CMS in April, CMS required Navigator organizations to apply by June and approved applications and new funding by late August,” Pennsylvania’s Jessica Altman wrote. “The current lack of guidance has put Navigator organizations – and states - far behind in their planning and creates an inability for the Navigator organizations to design a successful plan for helping people enroll during the 2019 open enrollment period.”
Chart of the Day: Why US Fertility Rates Are Falling
U.S. fertility rates have fallen to record lows for two straight years. “Because the fertility rate subtly shapes many major issues of the day — including immigration, education, housing, the labor supply, the social safety net and support for working families — there’s a lot of concern about why today’s young adults aren’t having as many children,” Claire Cain Miller explains at The New York Times’ Upshot. “So we asked them.”
Here are some results of the Times’ survey, conducted with Morning Consult. Read the full Times story for more details.
