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.
Small Business Owners Say They’re Raising Worker Pay
A record percentage of small business owners say they are raising pay for their workers, according to the latest monthly jobs report from the National Federation of Independent Business, based on a survey of 10,000 of the group’s members. A seasonally adjusted net 35 percent of small businesses say they are increasing compensation. “They are increasing compensation at record levels and are continuing to hire,” NFIB President and CEO Juanita Duggan said in a statement accompanying the report. “Post tax reform, concerns about taxes and regulations are taking a backseat to their worries over filling open positions and finding qualified candidates.”
The US Is Running Short on More Than 200 Drugs
The U.S. is officially running short on 202 drugs, including some medical staples like epinephrine, morphine and saline solution. “The medications most vulnerable to running short have a few things in common: They are generic, high-volume, and low-margin for their makers—not the cutting-edge specialty drugs that pad pharmaceutical companies’ bottom lines,” Fortune’s Erika Fry reports. “Companies have little incentive to make the workhorse drugs we use most.” And much of the problem — “The situation is an emergency waiting to be a disaster,” one pharmacist says — can be tied to one company: Pfizer. Read the full story here.
Chart of the Day: Could You Handle a Sudden $400 Expense?
More Americans say they are living comfortably or at least “doing okay” financially, according to the Federal Reserve’s Report on the Economic Well-Being of U.S. Households in 2017. At the same time, four in 10 adults say that, if faced with an unexpected expense of $400, they would not be able to cover it or would cover it by selling something or borrowing money. That represents an improvement from 2013, when half of all adults said they would have trouble handling such an expense, but suggests that many Americans are still close to the edge when it comes to their personal finances.
Kevin Brady Introduces Welfare Reform Bill
The Tax Policy Center’s Daily Deduction reports that Rep. Kevin Brady (R-TX), chair of the House Ways and Means Committee on Friday introduced The Jobs and Opportunity with Benefits and Services (JOBS) for Success Act (H.R. 5861). “The bill would rename the Temporary Assistance for Needy Families (TANF) program and target benefits to the lowest-income households. Although the House GOP leadership promised to include an expansion of the Earned Income Tax Credit as part of an upcoming welfare reform bill, this measure does not appear to include any EITC provisions.” The committee will mark up the bill on Wednesday.
Who Will Pay the AMT in 2018?
The GOP tax cuts expanded an exemption for the Alternative Minimum Tax (AMT) and changed tax breaks that often triggered the tax. As a result, The Wall Street Journal’s Laura Saunders reports, “This year’s AMT is a shadow of its former self. It is expected to raise about $5 billion for 2018, down from an estimated $39 billion under prior law, according to the Tax Policy Center.” The AMT will likely hit some 200,000 tax filers for 2018, down from roughly 5 million who would have had to pay if the tax cuts hadn’t been passed. And the number of people making $500,000 or less who owe the AMT will fall to about 120,000 this year from 4 million last year, a Tax Policy Center economist tells the Journal.