Economy

GOP Health Care Plan Seems Fixated on Denying Medicaid for One Group of Americans

The Republican Party's long-awaited replacement bill for the Affordable Care Act (ACA) was released Monday evening.

Comprising roughly 10 percent of the 66-page bill and buried in its many pages of repeals and changes to current law is nearly seven pages of how Republicans plan to reduce state Medicaid costs by kicking this tiny group of Americans off subsidized health insurance.

"Letting States Disenroll High Dollar Lottery Winners"

That's the title of the first part of Section 114, titled "Reducing State Medicaid Costs," which details exactly how states could cut down the amount of money spent on health care for low-income and disadvantaged residents by ensuring lottery jackpot winners don't receive the benefits they're technically entitled to.

It proposes to change current law and turn lottery winnings into income, thereby disqualifying winners from means-tested benefits. The bill includes page after page about what constitutes too much lottery income, how high dollar lottery winners will be notified they're losing their coverage, what happens if the lottery winner has a hardship exemption, what exactly constitutes lottery winnings, explicit confirmation that states can garnish lottery winnings to pay back the state for unearned Medicaid coverage, and the Medicare eligibility of the spouses of high dollar lottery winners.

Essentially, the new GOP plan takes away Medicare eligibility for anyone who wins a lump sum of cash from $80,000 and beyond.

The House of Representatives press office didn't return a request for comment from ATTN: as to why nearly 10 percent of the bill covers something so hyper-specific. However, a clue to its origin can be found in legislation proposed by a former House member, Joe Pitts.

The Pennsylvania Republican served ten terms and retired in 2017. During his last term, he sponsored H.R. 4368, "to clarify the treatment of lottery winnings and other lump sum income for purposes of income eligibility under the Medicaid program." While the bill died in committee, some of its language was rolled into another bill Pitts sponsored, H.R. 4725, the "Common Sense Savings Act." Language from that bill, which also died in committee, is in the GOP replacement plan, almost verbatim.

For example, the first paragraph of each section of the bill dealing with lottery winners is identical, other than the dates. The Pitts bill reads:

"(i) IN GENERAL.—In the case of an individual who is the recipient of qualified lottery winnings (pursuant to lotteries occurring on or after January 1, 2018) or qualified lump sum income (received on or after such date) and whose eligibility for medical assistance is determined based on the application of modified adjusted gross income under subparagraph (A), a State shall, in determining such eligibility, include such winnings or income (as applicable) as income received—"

While the beginning of the GOP health care bill's section on lottery winners reads:

"(i) IN GENERAL.—In the case of an individual who is the recipient of qualified lottery winnings (pursuant to lotteries occurring on or after January 1, 2020) or qualified lump sum income (received on or after such date) and whose eligibility for medical assistance is determined based on the application of modified adjusted gross income under subparagraph (A), a State shall, in determining such eligibility, include such winnings or income (as applicable) as income received—"

Philadelphia magazine didn't receive a reply from Pitts' office to a request for a comment. But when Pitts introduced the first bill in January 2016, he explained that "Medicaid is meant to help the poor—not big jackpot winners," adding that the bill would save taxpayers "$400 million over a decade."

A number of states have laws prohibiting jackpot winners from receiving public assistance, including Maine and Michigan, the latter of which claims it saved $2 million in benefits since 2012. But the provision in the Republican bill would be the first such national law - and it's not clear that such a law will have any appreciable effect on Medicaid.

The numbers of people who have won a substantial jackpot in a state lottery aren't public, but when the Congressional Budget Office (CBO) scored H.R. 4725, they found that between 90,000 to 100,000 jackpot winners per month would lose Medicaid eligibility - and the law would save around $475 million over ten years, as Pitts claimed.

As the CBO hasn't scored the new plan, it's not clear whether its lottery provisions will save enough money to justify their outsized length.