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Budget/Appropriations
The Senate returns from recess this week with a busy schedule. The Senate Appropriations Committee marks up its 10th out of 12 annual appropriations bills. The full Senate will likely vote on its version of the budget resolution (BR). The House is out on recess this week. Last week, the House passed its budget resolution and an emergency $36 billion funding bill for disaster aid.
Once the Senate votes on its BR, House and Senate may conference the two bills or the House could take up the Senate bill without changes. Whether they include health care cuts in the 2018 budget reconciliation bill or divide it up and do the tax cuts in the 2018 resolution and the health care cuts in 2019, they are still setting up to do massive tax cuts that will disproportionately benefit the more prosperous, offset by massive cuts to health care for seniors, people with disabilities, and other vulnerable populations. Our budget coalition has developed some key points too, regarding the possible impact of the BR on the Affordable Care Act and Medicaid.
Health Care
As was expected, President Trump signed an executive order (EO) last week aimed at "expanding access to loosely regulated health insurance plans." The order is expected to direct agencies to rewrite federal rules to allow trade associations and other groups to offer their own health plans, which would be exempt from some of ACAs regulations and could be sold across state lines. Larry Levitt of Kaiser Family Foundation (KFF) highlights several potential consequences:
- With broad expansion and loose regulations, the individual and small business insurance market could be severely destabilized (KFF analysis)
- Association plans (exempt from the ACA protections) could cherry pick people with lower health costs, making coverage unaffordable for those with pre-existing conditions
- Selling across state lines will undercut state insurance regulation
- Short-term insurance plans (example) could destabilize the marketplace
- Short-term plans are discriminatory - generally exclude pre-existing conditions, exclude mental health and maternity, and could lead to non-renewed if you get sick
What was not expected, was the President's decision to discontinue cost-sharing reductions (CSR). CSRs are payments to insurers to reimburse them for discounts they give policyholders with income under 250 percent of the federal poverty level. The CSRs are separate from the tax credit subsidies that help millions of people pay their premiums. Those are not affected by the President's decision.
These two actions, along with prior decisions to drastically cut funding for enrollment outreach and restricting enrollment periods, will certainly lead to higher premiums and exacerbate marketplace destabilization. For more details, see Kaiser Health News analysis.
Bipartisan negotiations between Senators Alexander (R-TN) and Murray (D-WA), chair and ranking minority member of the HELP Committee respectively, on legislation to stabilize the marketplaces have begun again. It is unclear at this time if the rest of Congress will have the political will to move such legislation forward.
Family Caregivers
AUCD is pleased to announce that bipartisan support for the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act (H.R. 3759/S. 1028) continues to increase. New cosponsors now include Representatives Stefanik (R-NY), Messer (R-IN), and Thompson (R-PA). It is critical to continue to generate a strong list of bipartisan cosponsors by calling or emailing your Representatives and urging their support for this bill.
Mental Health
On October 11, the Centers for Medicare & Medicaid Services (CMS) released a new set of frequently asked questions (FAQs) on the Mental Health and Substance Use Disorder Parity Rule for Medicaid and the Children's Health Insurance Program (CHIP). Under the March 2016 final rule, CMS applied certain mental health and substance use disorder parity provisions of the Mental Health Parity and Addiction Equity Act (MHPAEA) to the coverage provided to enrollees of Medicaid managed care organizations (MCOs), Medicaid alternative benefit plans (ABPs), and CHIP to ensure that financial requirements and treatment limitations on mental health and substance use disorder benefits generally are no more restrictive than the requirements and limitations that apply to medical and surgical benefits in these programs. CMS has received many questions regarding this final rule, and the purpose of this FAQ is to answer the most common questions and concerns.
AUCD Annual Conference
AUCD's upcoming annual meeting contains many exciting sessions and speakers related to public policy. On Tuesday morning, we will hear from Secretary of Labor Alexander Acosta. Following Secretary Acosta, AUCD's Policy Committee Co-chair, Kara Ayers, from the Cincinnati UCEDD and LEND will moderate a panel to include Mary Lazare from ACL Deputy Assistant Secretary at HHS and Kimberly Richey from Acting Assistant Secretary of OSERS at the US Department of Education. On Wednesday, prior to Hill visits, a dynamic plenary includes Vanita Gupta, the new CEO of the Leadership Conference on Civil and Human Rights, Representative Lisa Blunt Rochester, a freshman from Delaware with strong ties to the AUCD network, and two key Hill staffers about a new Bill that would accelerate the transition away from subminimum wage and segregated employment and toward competitive, integrated employment. All the speakers will talk about how disability issues are connected to a broader agenda for civil rights and social justice, and where there are opportunities to advance that agenda with bipartisan support in the current political climate.
AUCD members are encouraged to make appointments for Hill visits, before you arrive. Please call 202-224-312 to be referred to your Members of Congress then ask for staff that work on disability or health issues. Make an appointment for Wednesday, Nov. 8. If you have any questions or need assistance, contact AUCD policy staff.
Tuesdays with Liz: Disability Policy for All
In this week's edition of Tuesdays with Liz: Disability Policy for All Liz interviews Lee Page, Senior Associate Director of Advocacy at the Paralyzed Veterans of America. They discuss the American Disabilities Act Education Reform Act (HR 620). In case you missed last week, Liz King (Leadership Conference on Civil and Human Rights) talked to Liz about race and disability.
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