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This week is an important week for Health and Long Term Care
June 22 marked the 18th anniversary of the U.S. Supreme Court's Olmstead v. LC decision (see Senator Casey's comments), which declared that people with disabilities have a civil right under the Americans with Disabilities Act to live and participate in their communities. June 22, 2017 now also marks the day the Senate released its bill, the Better Care Reconciliation Act, to repeal the Affordable Care Act. Like the House version, the Senate bill fundamentally alters the Medicaid program by imposing per capita caps and cutting the program. The new bill adds a penalty for anyone who does not have continuous coverage (coverage losses from the penalty are not included in today's CBO score).
A vote is expected this Thursday. The House could then pass the bill without a conference committee and the bill could be signed by July 4.
A new CBO score released late this afternoon estimates that at least 22 million people will lose health insurance coverage if the Senate bill is enacted. Fifteen million people on Medicaid will lose coverage by 2026. The estimate scores the Medicaid cuts lower - $772 billion than the House version - however, the Senate bill makes the Medicaid per capita caps growth rate slower, thus cutting the program more in the long run. This estimate does not consider the steep cuts to Medicaid that occur after the 10-year window the CBO uses for making estimates. Senate Finance Committee Ranking Member Sen. Ron Wyden (D-OR) today announced a letter to Congressional Budget Office (CBO) Director Keith Hall, asking the agency to examine and make public an analysis of the Senate Republican health bill's Medicaid cuts beyond the 10 year budget window.
This week it is imperative that AUCD members and other advocates continue to educate Senators and other policymakers about devastating impact this bill would have on people with disabilities, children, minorities, and women. Please see AUCD's Action Alert, press release, and toolkit for talking points, social media tips, and ways to continue sharing your story with Members of Congress during this critical time as well as CCDs statement on the Better Care Reconciliation Act. Also, please see these new resources provided by the Center for Law and Social Policy:
- fact sheet that highlights the benefit of the ACA for low-income young adults and how the AHCA would reverse its progress;
- brief that looks at how AHCA's Medicaid cuts would harm students and threaten state funding for postsecondary education; and
- brief that looks at work requirements and the nature of low-wage jobs and subsequent blog that looks at the Medicaid work requirement specifically.
In addition, the Center on Budget and Policy Priorities (CBPP) published two reports outlining the impact of cuts to Medicaid proposed by the Senate bill. One report points out that the Senate bill lowers the annual increase in State Medicaid funding under a per capita cap below the House bill's already inadequate rate starting around 2025 (i.e., the most devastating cuts will occur after the ten-year window, which the CBO score released today does not account for). Based on the cuts proposed by House, CBO estimates that this would cut federal Medicaid spending by $834 billion over ten years and cut enrollment by 14 million by 2026, relative to current law. CBPPs second report explains that State Medicaid enrollment cuts would be steep and that 30 States (including Washington, D.C.) could cut their Medicaid enrollment by up to 20 percent or more due to Medicaid cuts.
On June 22, about 60 members of the national disability rights organization ADAPT held a "die-in" at Senator Majority Leader Mitch McConnell's office in protest over the proposed cuts to Medicaid. Following this protest, MSNBC aired a segment highlighting the history of ADAPT, the activism of Americans of with disabilities' fight for equal rights, the importance of Medicaid for millions of Americans, and how the new healthcare bill threatens community based services. Please also see ADAPT's list of upcoming actions - and information on how to organize your own local action.
Territories
On June 21, Senator Mazie K. Hirono's (HI) introduced the Covering Our FAS Allies Act (COFA Act) in the Senate and Representative Colleen Hanabusa's (HI-01) introduced companion legislation in the House. If passed, the bill aims to restore access to federal health care programs, including Medicaid eligibility, for more than 56,000 Compacts of Free Association (COFA) individuals from the Federated States of Micronesia, Republic of the Marshall Islands and Republic of Palau who work and reside in the United States. Under US treaty, COFA individuals living in the US were eligible for federal health programs, including Medicaid; whereas under the American Health Care Act (AHCA), which passed the US House of Representatives in May, COFA communities would be excluded from tax credits and subsidies that are provided through the Affordable Care Act (ACA). For more information visit the Asian and Pacific Islander American Health Forum website.
Supreme Court
The Supreme Court today issued its first two rulings with a full court. One ruling allowed the Trump administration to implement parts of a revised travel ban, but also agreed to decide the legality of the controversial executive order later this year. President Trump is trying to temporarily ban U.S. entry by all refugees and foreign nationals from Iran, Libya, Somalia, Sudan, Syria and Yemen. The Supreme Court also ruled Monday that states cannot exclude religious organizations when distributing grant funding for state programs. The ruling was a 7-2 decision, with Justice Sonia Sotomayor and Justice Ruth Bader Ginsburg dissenting.
Education
ESSA
Education Secretary Betsy DeVos released a Q&A regarding the ESSA consolidated state plans. In a Dear Colleague Letter dated November 29, 2016, the Department notified State Educational Agencies (SEAs) that it would accept consolidated State plans on two dates: April 3 or September 18, 2017. The Department also released a Consolidated State Plan Template that States were required to use if they submit a consolidated State plan. See more policy guidance on the ED ESSA website. AUCD sponsored a webinar on June 15, 2017 for the network to inform state advocates about how to get involved in state plan development and monitoring.
Higher Ed
During a speech on June 20 to the Association of Public and Land-Grant Universities Secretary DeVos explained that the "Higher Education Act of 1965 may have outlived its usefulness [...] Why would we reauthorize an act that is like 50 or 60 years old". The legislation has been reauthorized several times since it was first passed. Its most recent iteration was set to expire in 2013, but was extended to allow legislators more time to work on a revised version. It is reported that Senator Lamar Alexander's (chair of the Senate education committee) top education priority during this Congress is reauthorizing the Higher Education Act (HEA); whereas, Secretary DeVos' priority is now to eliminate the HEA.
AUCD is concerned with the elimination of the HEA as this act has improved postsecondary educational access and opportunities for students with disabilities, while also strengthening the U.S. workforce through better preparation of all people, including people with disabilities. Reauthorizing the act would allow for improvements because legislators have a starting point and knowledge of which existing programs work and how they can work better.
Home and Community Based Services
Final Approval
On June 13, CMS granted Kentucky final approval of their Stateside Transition Plan (STP) (the third state after Tennessee and Arkansas). Final approval was granted because the state conducted a comprehensive site-specific assessment and validation of all settings, outlined a detailed plan for identifying settings that are presumed to have institutional characteristics including qualities that isolate, developed a process for communicating with beneficiaries who are living in a setting that the state has determined cannot or will not come into compliance, and established ongoing monitoring and quality assurance processes that will ensure all settings providing HCBS continue to remain fully compliant with the rule in the future. Approval for all state STP's is still 2019; the new compliance deadline is 2022. Please also note, CMS was previously including detailed feedback (aka Attachment 2) within the initial approval letters to states that laid out the remaining issues that the state needed to address before resubmitting for final approval; this detailed feedback is no longer being included. As such, it is recommended that state DD partners collaborate to request the state share any electronic communications from CMS.
New Appointments
Assistant Secretary for Aging, Department of Health and Human Services
On June 20, the President announced Lance Robertson to serve as HHS's Assistant Secretary for Aging (replacing form assistant secretary Kathy Greenlee). Robertson comes from Oklahoma where he served as the state's director of aging services for the past 10 years. He also worked as an administrator at Oklahoma State University for 12 years, where he co-founded the Gerontology Institute and was past president of the National Association of States United for Aging and Disabilities (NASUAD).
Assistant Secretary for Mental Health
On June 15, the President also submitted his nomination for Assistant Secretary for mental Health and Substance Use, Elinore McCance-Katz, to the Senate. McCance-Katz previously served as the first chief medical officer at SAMHSA, then worked in the same role at the Rhode Island Department of Behavioral Health. She's expected to get a hearing in the HELP Committee sometime after lawmakers return from the July Fourth recess.
Tuesdays with Liz: Disability Policy for All
In this week's edition of Tuesdays with Liz: Disability Policy for All, Liz interviews Sara Van Geertruyden about the importance of Person-Centered Care. In case you missed last week's edition, Liz interviewed Xian Horn about her experience at the annual Disability Policy Seminar and how the DREAM Fund made it possible for her and her personal care attendant to participate. They also spoke about how Medicaid helps her to work and live in the community.
For more from AUCD, follow @AUCDNews and like AUCD on Facebook
For updates from our Executive Director Andy Imparato, follow @AndyAUCD.
For more policy news, follow Kim on Twitter at @kmusheno
For definitions of terms used in In Brief, please see AUCD's Glossary of Legislative Terms
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