The chapter is by Scott Winship.
rather than instituting work-promoting reforms program-by-program, there is much to be said for consolidating them, thoughtfully modifying phase-out rates to transparently encourage people [to] move to work, and offering supports outside the confines of specific programs.
As part of SNEP, I have a somewhat specific proposal that attempts to do this. Winship refers a proposal by Oren Cass that sort of sounds like mine, but as I look closer the resemblance seems to go away. You can read Reihan Salam’s write-up from last year on the Cass proposal.
As an alternative, Winship writes,
Congressman Paul Ryan, who chairs the Budget Committee, has spoken favorably of the United Kingdom’s “universal credit.” Under this approach, various means-tested programs would again be consolidated, and benefits would be distributed to families as a single amount rather than through separate programs with their own applications procedures and bureaucracies. A universal credit may be designed with a single phase-out schedule as beneficiaries move into work
Yes. I need to find out more about the British experience, which I understand ran into a number of implementation snafus.
Again, I raise the issue of coherence. The big enchilada of means-tested programs is Medicaid. If you going to have a coherent policy document, then you need to decide whether or not Medicaid reform is going to consist of folding into a universal credit. Instead, the chapter on health care reform talks about a completely different approach to Medicaid.
I want to see a policy playbook, and that means that the ideas have to fit together. Relative to that expectation, RtG comes across to me like a bunch of vendors standing outside the ballpark, all shouting. “Tax credits!” Getcher health care reform here!” “Gotta have higher ed reform!”
Would SNEP flex-dollars give people an actuarially adjusted amount depending on age? Old people cost a lot more and would need more money.
One problem with Medicaid is that a huge chunk of it – about a third, $130B – goes to long-term nursing home care for an elderly population that is just a small fraction of the total average enrollment. Medicaid payments dominate the market and constitute about two-thirds of all long term care spending.
Expenditures on behalf of the non-nursing home Medicaid population (average enrollment around 48 million or so) are about $500/month per person when federal and state contributions are combined. That’s still a lot – it’d be $24K a year for an average family of four, imagine paying those premiums. But for the seniors in care it is several thousand a month for each of them.