The cruelest cut in the Republican budget bill, explained
Medicaid may be about to change in a big way: Republicans in Congress are getting closer to passing a bill that, along with cutting taxes and imposing new immigration restrictions, would require people to work — or else risk losing government health benefits. It’s a change the party has long desired.Right now, if you qualify for Medicaid, the government health insurance program for low-income people, based on your earnings, assets, and life circumstances, you can receive health coverage through the program — no other questions asked. Nearly 80 million people are currently insured by Medicaid, making it the single largest insurance program in the US. Under the current law, there is no obligation to work or fulfill any other community service requirement in order to receive your Medicaid benefits.But now, the GOP’s One Big Beautiful Bill Act, which passed the House by one vote early Thursday morning, would establish nationwide work requirements for the program for the first time, starting at the end of 2026. If the bill becomes law, people who became eligible for the program under the Affordable Care Act — generally, adults without children living in or near poverty — would be required to report at least 80 hours of work every month or another community activity such as volunteering, or they could lose their benefits. Seniors, people with disabilities, caregivers for dependent people, and pregnant people are supposed to be exempted under the bill as currently written, but there’s some gray area here. Some of the decisions about how to implement the requirements will be left to the states: They could, for example, require Medicaid enrollees to report their activities every month or every six months.The Congressional Budget Office estimates that 10.3 million people would lose their Medicaid coverage by 2034 under the GOP bill, about half of them due to the work requirement provision. Other losses would result from a number of smaller provisions, according to the estimate. These include things like more frequent and stringent eligibility checks that will also require people to jump through more hoops to keep their benefits. Outside projections are even higher: The left-leaning Center for Budget Policy and Priorities estimated that as many as 14.4 million people could lose benefits in the next decade.In a recent New York Times op-ed, a number of Trump officials, including Health and Human Services Secretary Robert F. Kennedy Jr. and Medicare and Medicaid administrator Mehmet Oz, outlined the Republican rationale for the requirements: They argue that too many able-bodied people are choosing not to work so they can stay on Medicaid, and more stringent requirements will force those people into the workforce and into better-paying jobs that provide their own health insurance.“This is about opportunity,” they wrote. “We believe that work is transformative for the individual who moves from welfare to employment.”But based on the best available estimates and past experience, Medicaid work requirements likely won’t achieve what Republicans want. The Senate will now consider the legislation and more changes could still be made, but if these requirements do ultimately become law and take effect, millions of Americans could lose their insurance over the next decade — and not necessarily because they aren’t working. Why work requirements will cause a lot of harm without doing much goodMedicaid was founded in 1965 as an entitlement program: If you qualify by your income and you sign up, you get the benefits. No extra red tape. More than half of the program’s enrollment is estimated to be people over 65, people with disabilities, and children. Many of the adults covered by Medicaid are either pregnant mothers, who can receive up to a year of postpartum coverage, or parents of young children. For most of the program’s history, adults who were not disabled and did not have kids were not eligible in most states. But in 2010, the ACA changed that, extending eligibility to anyone whose income was 133 percent of the federal poverty levelor lower. The expansion added roughly 20 million people to the rolls.Republicans have long argued for work requirements for people who receive benefits across a variety of programs — Medicaid, food stamps, cash assistance — and even successfully instituted them for food stamps in 1996 as part of President Bill Clinton’s welfare reform legislation. After Medicaid was expanded by the ACA and then Republicans failed to repeal the law in 2017, work requirements became one of their top priorities for the program. Medicaid expansion had proven too popular to totally undo, but instituting work requirements would reduce coverage for a group many in the GOP do not want covered by Medicaid at all.But our country has already tested this — and it didn’t go so well: During President Donald Trump’s first term, the administration allowed states to apply to experiment with work requirements and approved the first-ever Medicaid work requirements in a handful of states on a preliminary basis. One state, Arkansas, actually implemented the policy before it was blocked by the courts.In just a matter of months, 18,000 Arkansans lost their health insurance — most of them losing coverage because they were found ineligible after not reporting their information correctly to the state. After the policy was implemented, respondents were required to report their work activities by paper forms, phone calls, or an online portal each month; that included those who were exempt. But Arkansas was criticized for the arduous reporting process and for failing to clearly explain the change: An analysis from Harvard researchers found that 70 percent of the people who were supposed to satisfy the work requirement were confused about the policy’s specifics and did not know whether it was actually in effect. During one month, according to state data, less than 15 percent of the people who were supposed to report their work activities to the state actually did.About 25 percent of the people who were supposed to comply with the new work requirement lost coverage from June 2018 to March 2019 — even though experts estimated 95 percent of the affected population should have been exempted or were meeting the obligations.As I have written before, the Medicaid population can be hard to reach: People with lower incomes are more likely to change addresses, more likely to have irregular work schedules, and less likely to have regular internet access. For all of these reasons, these people can struggle to send paperwork by mail or complete an online form. And if they fail to do so when a Medicaid work requirement is in effect, they will lose their health coverage.Based on the Arkansas experience, the Center for Budget Policy and Priorities estimated that two out of every three people who could lose coverage under the Republican bill would be people who are working or who should qualify for an exemption — but who fail to submit their paperwork properly or experience another administrative snafu.The GOP argues these incentives will lead to more people getting jobs or earning higher wages, but Arkansas’s experience doesn’t inspire much confidence there either. Employment rates stayed flat. The Harvard researchers concluded that the Arkansans who were subjected to the Medicaid work requirement did not see an increase in their employment or their earnings. The policy failed to push people into the workforce — it just pushed them out of the safety net. Multiple studies have found that Medicaid is literally a life-saving program. When people lose Medicaid benefits, they are more likely to face medical debt and push off medical care because of the cost. In Arkansas, according to the Harvard analysts, 56 percent of people who lost their coverage because of the work requirement said they delayed a medical service and 64 percent of them said they delayed taking a medication because of its cost.That’s the new world that the Republican bill would create, one in which failing to turn in the right paperwork could mean you can no longer afford your blood pressure or diabetes drugs.See More:
#cruelest #cut #republican #budget #bill
The cruelest cut in the Republican budget bill, explained
Medicaid may be about to change in a big way: Republicans in Congress are getting closer to passing a bill that, along with cutting taxes and imposing new immigration restrictions, would require people to work — or else risk losing government health benefits. It’s a change the party has long desired.Right now, if you qualify for Medicaid, the government health insurance program for low-income people, based on your earnings, assets, and life circumstances, you can receive health coverage through the program — no other questions asked. Nearly 80 million people are currently insured by Medicaid, making it the single largest insurance program in the US. Under the current law, there is no obligation to work or fulfill any other community service requirement in order to receive your Medicaid benefits.But now, the GOP’s One Big Beautiful Bill Act, which passed the House by one vote early Thursday morning, would establish nationwide work requirements for the program for the first time, starting at the end of 2026. If the bill becomes law, people who became eligible for the program under the Affordable Care Act — generally, adults without children living in or near poverty — would be required to report at least 80 hours of work every month or another community activity such as volunteering, or they could lose their benefits. Seniors, people with disabilities, caregivers for dependent people, and pregnant people are supposed to be exempted under the bill as currently written, but there’s some gray area here. Some of the decisions about how to implement the requirements will be left to the states: They could, for example, require Medicaid enrollees to report their activities every month or every six months.The Congressional Budget Office estimates that 10.3 million people would lose their Medicaid coverage by 2034 under the GOP bill, about half of them due to the work requirement provision. Other losses would result from a number of smaller provisions, according to the estimate. These include things like more frequent and stringent eligibility checks that will also require people to jump through more hoops to keep their benefits. Outside projections are even higher: The left-leaning Center for Budget Policy and Priorities estimated that as many as 14.4 million people could lose benefits in the next decade.In a recent New York Times op-ed, a number of Trump officials, including Health and Human Services Secretary Robert F. Kennedy Jr. and Medicare and Medicaid administrator Mehmet Oz, outlined the Republican rationale for the requirements: They argue that too many able-bodied people are choosing not to work so they can stay on Medicaid, and more stringent requirements will force those people into the workforce and into better-paying jobs that provide their own health insurance.“This is about opportunity,” they wrote. “We believe that work is transformative for the individual who moves from welfare to employment.”But based on the best available estimates and past experience, Medicaid work requirements likely won’t achieve what Republicans want. The Senate will now consider the legislation and more changes could still be made, but if these requirements do ultimately become law and take effect, millions of Americans could lose their insurance over the next decade — and not necessarily because they aren’t working. Why work requirements will cause a lot of harm without doing much goodMedicaid was founded in 1965 as an entitlement program: If you qualify by your income and you sign up, you get the benefits. No extra red tape. More than half of the program’s enrollment is estimated to be people over 65, people with disabilities, and children. Many of the adults covered by Medicaid are either pregnant mothers, who can receive up to a year of postpartum coverage, or parents of young children. For most of the program’s history, adults who were not disabled and did not have kids were not eligible in most states. But in 2010, the ACA changed that, extending eligibility to anyone whose income was 133 percent of the federal poverty levelor lower. The expansion added roughly 20 million people to the rolls.Republicans have long argued for work requirements for people who receive benefits across a variety of programs — Medicaid, food stamps, cash assistance — and even successfully instituted them for food stamps in 1996 as part of President Bill Clinton’s welfare reform legislation. After Medicaid was expanded by the ACA and then Republicans failed to repeal the law in 2017, work requirements became one of their top priorities for the program. Medicaid expansion had proven too popular to totally undo, but instituting work requirements would reduce coverage for a group many in the GOP do not want covered by Medicaid at all.But our country has already tested this — and it didn’t go so well: During President Donald Trump’s first term, the administration allowed states to apply to experiment with work requirements and approved the first-ever Medicaid work requirements in a handful of states on a preliminary basis. One state, Arkansas, actually implemented the policy before it was blocked by the courts.In just a matter of months, 18,000 Arkansans lost their health insurance — most of them losing coverage because they were found ineligible after not reporting their information correctly to the state. After the policy was implemented, respondents were required to report their work activities by paper forms, phone calls, or an online portal each month; that included those who were exempt. But Arkansas was criticized for the arduous reporting process and for failing to clearly explain the change: An analysis from Harvard researchers found that 70 percent of the people who were supposed to satisfy the work requirement were confused about the policy’s specifics and did not know whether it was actually in effect. During one month, according to state data, less than 15 percent of the people who were supposed to report their work activities to the state actually did.About 25 percent of the people who were supposed to comply with the new work requirement lost coverage from June 2018 to March 2019 — even though experts estimated 95 percent of the affected population should have been exempted or were meeting the obligations.As I have written before, the Medicaid population can be hard to reach: People with lower incomes are more likely to change addresses, more likely to have irregular work schedules, and less likely to have regular internet access. For all of these reasons, these people can struggle to send paperwork by mail or complete an online form. And if they fail to do so when a Medicaid work requirement is in effect, they will lose their health coverage.Based on the Arkansas experience, the Center for Budget Policy and Priorities estimated that two out of every three people who could lose coverage under the Republican bill would be people who are working or who should qualify for an exemption — but who fail to submit their paperwork properly or experience another administrative snafu.The GOP argues these incentives will lead to more people getting jobs or earning higher wages, but Arkansas’s experience doesn’t inspire much confidence there either. Employment rates stayed flat. The Harvard researchers concluded that the Arkansans who were subjected to the Medicaid work requirement did not see an increase in their employment or their earnings. The policy failed to push people into the workforce — it just pushed them out of the safety net. Multiple studies have found that Medicaid is literally a life-saving program. When people lose Medicaid benefits, they are more likely to face medical debt and push off medical care because of the cost. In Arkansas, according to the Harvard analysts, 56 percent of people who lost their coverage because of the work requirement said they delayed a medical service and 64 percent of them said they delayed taking a medication because of its cost.That’s the new world that the Republican bill would create, one in which failing to turn in the right paperwork could mean you can no longer afford your blood pressure or diabetes drugs.See More:
#cruelest #cut #republican #budget #bill
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