Thursday, April 20, 2023

Why Republicans are proposing another enormous Medicaid cut

Story by Dylan Scott • Yesterday 

The House Republican majority has released its demands for major government spending cuts in exchange for increasing the federal debt limit. And they include a familiar target for conservatives: Medicaid.


In a Wall Street speech this week, House Speaker Kevin McCarthy laid out his party’s plans for the upcoming federal debt-limit negotiations, likely to include a proposed Medicaid work requirement.© Michael Nagle/Bloomberg via Getty Images

It’s a gambit that may be more than a decade out of a date and could pose a political risk to the party. For years, Republicans have believed that Medicaid, which primarily serves low-income Americans, is less politically potent than Medicare or Social Security, two of the other core features of the US social safety net, and therefore a safer target for proposed cuts.

There may be some truth to that notion — but Medicaid is plenty popular on its own terms. Over the past two decades, the health insurance program has become an increasingly crucial part of the safety net. Enrollment has roughly doubled from about 46 million people in 2007 before the Great Recession to more than 92 million today. More than 75 percent of the US public says they have very or somewhat favorable views of the program. Two-thirds say they have some kind of connection to Medicaid, either because they themselves or a loved one was enrolled.

In state after state, when the question of expanding Medicaid to working-age, childless adults has been put to voters in red states, they’ve voted in favor of giving more people access to health insurance. Even the Republican legislature in North Carolina recently made peace with expanding the program.

The House’s work requirement proposal — dubbed a “community engagement” requirement in the bill’s text — would roll back those coverage gains by requiring many recipients to be working, looking for work, or participating in another kind of community service. Children under 18, adults over 56, people with mental or physical disabilities, and parents of dependent children would be exempted.

The Congressional Budget Office has previously estimated requiring non-disabled, non-elderly childless adults to work in order to receive Medicaid benefits would slash the program’s spending by $135 billion over 10 years — largely because more than 2 million people would lose coverage for failing to meet the work requirement.

The last time Republicans tried (and failed) to pass significant cuts to the Medicaid program, in the first year of the Trump presidency as part of their Affordable Care Act repeal plans, they paid the price during the 2018 midterm elections. So if Medicaid has proven popular quite recently, why have Republicans seemingly convinced themselves that they can try to cut it again without penalty?

The answer is partly about the method they’ve chosen to cut the program: work requirements, which leaders think will go over well in competitive congressional districts. But it’s also about how Republicans have (in some cases reluctantly) embraced other facets of the social safety net, leaving themselves with few other options.

The GOP has tried to cut other social welfare programs and failed

Related video: Mississippi joins states expanding Medicaid under 'pro-life agenda' (Scripps News) Duration 4:21  View on Watch

Once upon a time, conservatives wanted to remake Social Security and Medicare just as eagerly as they still wish to overhaul Medicaid.

President George W. Bush invested much of his political capital in his second term in pursuing his doomed attempt to privatize Social Security. Paul Ryan, who became the party’s intellectual leader in the early 2010s as the Tea Party backlash to President Barack Obama was rising, made further privatizing Medicare a central plank of the Republican platform.

But those proposals proved politically disastrous. Democrats campaigned against Bush’s Social Security proposal when they gained seats in the 2006 midterms. The 2012 Obama campaign hung Ryan’s Medicare overhaul on Mitt Romney, who had picked Ryan to be his vice presidential candidate.

Then in 2016, the window for so-called entitlement reform slammed shut. Donald Trump bulldozed through the Republican primary, where he promised not to cut Medicare and Social Security as so many GOP candidates before him had pledged to do. When Republicans retook the House in 2022 and began plotting for the pending debt-limit debate, they preemptively took Medicare and Social Security cuts off the table.

But there’s a reason Republicans had targeted those programs in the past: they are two of the biggest outlays in the federal budget. Social Security alone accounts for 20 percent of federal spending. Medicare covers another 12 percent or so. If you assume Republicans are unwilling to cut defense spending and veterans benefits, that means almost half of the federal budget is off limits from the start.

So what is the GOP willing to cut, or at least to propose cutting to start its negotiations with the Biden White House and Senate Democrats? Enter Medicaid. In a Monday speech given at the New York Stock Exchange, House Speaker Kevin McCarthy laid out his party’s priorities in the debt-ceiling talks and sought to justify their proposed cuts to social programs. He said he wanted the government to give Americans “a hand up, not a handout.”

There is a certain logic to Republicans’ commitment to pursuing Medicaid cuts: Social Security and Medicare are universal programs. Everyone pays in while they work, and then enjoys the benefits when they retire. Medicaid, on the other hand, is targeted to people who have low incomes. Republicans argue that this program, like food stamps and cash welfare, discourages people from seeking work, since they only qualify for benefits if their income is below a certain threshold.

“Assistance programs are supposed to be temporary, not permanent,” McCarthy said. “A hand up, not a handout. A bridge to independence, not a barrier.”

The problem is their diagnosis may be wrong. For starters, about two-thirds of the people covered by Medicaid — those who are children, elderly, or disabled — are usually exempted from work requirement proposals. Working-age adults who are expected to meet them can end up losing coverage even if they are attempting to satisfy it, if they have irregular work hours for example, or if they have trouble filing the necessary paperwork. One estimate of a Medicaid work requirement proposal in Michigan found that only about one-quarter of the people expected to lose their coverage were considered “out of work,” meaning they could work but weren’t. The rest were already working, retired, caring for a loved home at home, or unable to work for some other reason.

In Arkansas, where implementation of a work requirement was eventually blocked by a court order, nearly 17,000 people lost coverage after the requirement was put in place. Analyses later found that Medicaid beneficiaries had not started working more or earning more money as a result of the policy. Instead, lots of people got kicked off Medicaid, but it didn’t lead to an improvement in their economic status; they simply became uninsured.

Still, a little more than half of the Republican base continues to consider Medicaid more akin to welfare than health care. Punchbowl News reported that internal House GOP polling showed that work requirements were popular among voters in the competitive districts that will determine future House control.

Public polling suggests it’s a little more complicated than that. As I wrote in 2018, Americans are of two minds about work requirements. When asked if they support requiring work in order to receive certain government benefits, the public will generally say yes. But when those policies are framed differently, and particularly when they are portrayed as cuts, their popularity drops.

That is the risk for House Republicans in this debt-ceiling gambit: Medicaid spending cuts are deeply unpopular with both the American public and lawmakers. Two-thirds of Americans now say they oppose cutting Medicaid’s spending.

There’s even a risk that the GOP’s attempts to overhaul the program could further reinforce its popularity. An analysis published last year in the American Political Science Review studied the effects of the party’s attempts to repeal the Affordable Care Act, of which Medicaid expansion is a core part. The threat to the law helped to solidify its standing with the public, partly because Republican voters became more resistant to the possibility of losing benefits. Two of the Republican senators who doomed the party’s plans cited the Medicaid cuts as a major factor in their vote.

And yet, the GOP continues to pursue Medicaid cuts — perhaps because, on other programs, they have boxed themselves in.

Here's what's included in the Republican bill to lift the debt ceiling

Yesterday 

House Speaker Kevin McCarthy on Wednesday unveiled a long-awaited GOP proposal to lift the debt limit and enact federal spending cuts.


What happens after US officially hits debt ceiling?  View on Watch  Duration 6:10

Speaking on the House floor, McCarthy outlined what's included in the so-called Limit, Save, Grow Act, designed to raise the debt limit into next year and also provide more than $4.5 trillion in savings.

"The American people have elected a divided government, and our government is a divine compromise," McCarthy said. "That is why the House, the Senate and the White House should be negotiating a responsible debt limit increase right now."


FILE - Speaker of the House Kevin McCarthy speaks in New York City, April 17, 2023.
© Brendan Mcdermid/Reuters, FILE

The legislation would claw back unspent COVID-19 money, block federal student loan cancellation, rescind billions of dollars for the Internal Revenue Service provided by the Inflation Reduction Act, end green tax credits and put in place stricter work requirements for federal aid programs. It would also limit government spending to pre-inflationary, fiscal year 2022 levels and limit spending increases to 1% per year, according to McCarthy

MORE: 'Clock is ticking': Lawmakers return to Washington facing fast-approaching debt limit 'X-date'

President Joe Biden, who gave the proposal a chilly reception, last met with McCarthy to discuss the debt limit in February. Their standoff has intensified in recent weeks as lawmakers stare down a fast-approaching summer deadline to lift the debt ceiling or risk an economically catastrophic default.

In recent days, the House speaker has tried to amp up pressure on Biden and Democrats to negotiate. Biden and other party leaders have so far declined to do so as they push for a "clean" debt limit increase not tied to federal spending cuts.

"President Biden is skipping town to deliver a speech in Maryland, rather than sitting down to address the debt ceiling," McCarthy said on Wednesday. "He's giving America's debt the Southern border treatment: ignore it and hope that it goes away."MORE: Biden, McCarthy standoff over budget intensifies as deadline looms

Biden shot back at the Republican leader during his Maryland event, taking aim at McCarthy's debt ceiling comments delivered Monday at the New York Stock Exchange.

"They say they're going to default unless I agree to all these wacko notions they have. Default would be worse than totally irresponsible," Biden said.


Biden warned a default "would destroy this economy. And who do you think will hurt the most? You, hardworking people, the middle-class, neighborhoods I got raised in -- not the super wealthy or the powerful, but working folks."


FILE - President Joe Biden speaks in the Rose Garden of the White House in Washington, April 18, 2023.
© Susan Walsh/AP, FILE

The legislative text of the House GOP bill, which clocks in at 320 pages, was released shortly after McCarthy's remarks.

McCarthy said the chamber will vote as early as next week on the plan. While it's not yet clear he'll have the 218 votes necessary to pass it, he expressed optimism about its prospects.

"We're going to get there," he told reporters. "I never give up. We'll get them."

-ABC News' Gabe Ferris, Justin Gomez contributed to this report.

House Republicans want to ban student-loan forgiveness and immediately end the payment pause in their new debt ceiling bill

Story by asheffey@businessinsider.com (Ayelet Sheffey) • Yesterday

U.S. House Speaker Kevin McCarthy. 
Alex Wong/Getty 

House Republicans unveiled their bill to raise the debt ceiling on Wednesday.

It includes banning student-loan forgiveness and immediately ending the payment pause.

The bill is unlikely to pass, but it comes at a time of extreme uncertainty for student-loan borrowers.

Republicans' debt ceiling bill is finally here, and it's bad news for student-loan borrowers.


On Wednesday, House Republicans unveiled a bill to raise the debt ceiling through March 2024, and alongside increasing the limit, they have 320 pages worth of proposed spending cuts alongside it. For example, the legislation includes strengthened work requirements for welfare programs like SNAP, clawing back unspent pandemic funds, and repealing environmental programs.

And President Joe Biden's student loan programs aren't off the hook. According to the bill text, Republicans want to end the student-loan payment pause immediately, prohibit the Education Department from carrying out Biden's plan to cancel up to $20,000 in student debt for federal borrowers, block the department's new income-driven repayment plan, and prohibit the department from making any new changes to debt relief programs without congressional approval.



1 of 9 Photos in Gallery©STEFANI REYNOLDS/AFP via Getty Images
How 10 student-loan borrowers are coping with the highs and lows of Biden's debt relief announcement
Biden announced up to $20,000 in student-debt relief at the end of August.
Since then, two lawsuits have blocked the plan, and its fate rests with the Supreme Court.
Here are 10 borrowers' stories on what they have experienced since Biden's August announcement.

Student-loan borrowers have had quite the year in 2022 — and millions are confused about what it means for their finances in 2023.

In August, a moment millions of federal borrowers had been waiting years for finally arrived when President Joe Biden announced $20,000 in student-debt cancellation for Pell Grant recipients making under $125,000 a year, and $10,000 in relief for other federal borrowers under the same income cap.

While the amount wasn't as expansive as many might have been hoping for — some Democratic lawmakers were pushing the president to cancel $50,000 in student debt — it still marked a significant step toward providing long-awaited relief to millions of Americans.

"For too many people, student loan debt has hindered their ability to achieve their dreams—including buying a home, starting a business, or providing for their family," Education Secretary Miguel Cardona said after the loan forgiveness was announced. "Getting an education should set us free; not strap us down!"

But the relief quickly ran into hurdles. Since the loan forgiveness had an income cap, the Education Department was unable to automatically cancel the debt and needed until October to make an online application available for borrowers. Conservative groups used that time to file lawsuits to block the relief, and Biden's administration responding by further narrowing the eligibility for the relief to exclude some borrowers with privately-held loans to avoid litigation.

Still, just weeks after the application opened in early October, a ruling from the 8th Circuit Court of Appeals paused the process, barring the department from processing any new applications, and another ruling from a Texas judge later ruled the relief is illegal.

Right before Thanksgiving, Biden extended the student-loan payment pause through June 30 or whenever the lawsuits are resolved — whichever comes first — meaning the fate of the relief ultimately rests with the Supreme Court, who will begin hearing arguments on February 28. Until then, borrowers' financial futures hang in the balance.


These proposals aren't surprising. Since Biden took office, many GOP lawmakers have slammed the president's debt relief plans, saying they are an overreach of authority and costly to taxpayers. After the president announced his broad debt relief plan at the end of August, two conservative-backed lawsuits paused its implementation, and the Supreme Court heard oral arguments in the cases in February.


Related video: House Speaker Proposes Plan to Raise US Debt Ceiling and Avoid Default (Wibbitz - Politics)
Duration 1:30   View on Watch

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In light of the lawsuits, Biden extended the student-loan payment pause through 60 days after June 30, or 60 days after the Supreme Court issues a final decision on the legality of the relief — whichever happens first — but Republicans have continued to oppose the relief, most recently introducing a resolution to overturn the debt cancellation without waiting for a Supreme Court decision.

The House is set to vote on the bill next week, but even if it passes the House, it's highly likely it will not get enough votes in the Senate. And even if it does, Biden will almost certainly veto it because he has repeatedly stated that raising the debt ceiling should be bipartisan — and without any spending cuts attached.

Even so, millions of student-loan borrowers remain in limbo. The Education Department is planning to resume payments this year with or without the broad debt relief, and while it's working to implement changes to income-driven repayment plans and the Public Service Loan Forgiveness (PSLF) program, the lack of additional funding from Congress in this year's budget is causing delays with carrying out those reforms.

In the meantime, Democratic lawmakers and advocates have been urging Congress to raise the debt ceiling and avoid a financially catastrophic default. The Joint Economic Committee released a report last month that found private student-loan payments could surge if the US defaulted on its debt. And Melissa Byrne, executive director of We, the 45 Million — an advocacy group pushing for debt relief — said in a Wednesday statement that "McCarthy announced that he will hold the debt ceiling hostage and risk crashing the global economy in order to hurt 40M student loan borrowers and our families. "

"Everyone in the House and Senate must reject the Speakers and GOP efforts to repeal student loan relief, changes to PSLF + IDR, and preventing future relief," she said. "The American people deserve bett

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