Medicaid Cuts in Tax Bill
Several changes to the Medicaid program have been proposed in order to help offset the costs of extending the 2017 tax cuts. States would be required to impose strict work requirements for beneficiaries between the ages of 19 and 64 to prove that they are working, doing community service or participating in an educational program for at least 80 hours per month (exclusions would exist for pregnant women, disabled people and caregivers of dependent children). The bill would also allow states to charge up to $35 per health service for adults who are covered under the ACA Medicaid expansion and earn between 110% and 138% of the federal poverty level and increase the frequency of eligibility checks from once per year to once every six months. Financing restrictions would also restrict states from creating new provider taxes to make up for loss of federal funding and prevent Medicaid for paying for any services at providers that focus primarily on family planning or reproductive health if they provide abortions.
We asked two professors and authors of ALM's Tax Facts with opposing political viewpoints to share their opinions about the proposed changes to the Medicaid program in the current version of the GOP tax bill.
Below is a summary of the debate that ensued between the two professors.
Their Votes:
Their Reasons:
Byrnes: These changes to the eligibility rules for Medicaid are necessary and will help us preserve the aspects of the program that are essential to those who really need the benefits. Under the Affordable Care Act, Medicaid spending has spiraled out of control. The proposed changes will help ensure that we're able to pass the tax cuts that hardworking Americans need without adding an unacceptable amount to the national deficit.
Bloink: An estimated 7.6 million low-income Americans will lose their health coverage over the next ten years if these changes to Medicaid are implemented. Many of those will be children because, after all, an estimated 40 million children are covered by Medicaid. We can't sugarcoat this. What this is, exactly, is the GOP's attempt to take healthcare away from millions of struggling families in order to pay for tax cuts for the wealthiest Americans.
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Byrnes: Why shouldn't we impose work requirements on able-bodied adults before they're eligible to benefit from this expensive federal program? Sure, Medicaid provides important benefits, but Americans who are fully able to work and access their own private health insurance should not be entitled to freeload off the system.
Bloink: Allowing the government to charge $35 for a health service for families of four who make between $35,365 to $44,367 of the poverty line will absolutely make those health services inaccessible for many families, essentially resulting in a system where low-income families don't receive health care until it's an emergency.
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Byrnes: Health coverage is one of the largest areas in federal spending and it must be reined in. We cannot cut Medicare for our older population. Modifying the Medicaid system to impose strict work requirements and requiring families who earn enough to contribute to their own health costs are two changes that are absolutely vital to the strength of our Medicaid program.
Bloink: When someone doesn't have access to basic health care, everyone suffers, not just low-income Americans who can't afford to pay. Lack of access to preventative services is a system that increases the cost of health care for all Americans when the individual can't afford to pay for their emergency care and medical providers have no choice but to absorb those costs. This is precisely what these Medicaid cuts will cause — a less healthy population and more expensive health care services. I'd also add that the work requirements would not become effective until 2029—when the current president's time in office is over.