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Budget/Appropriations
With funding for the federal government set to expire February 8, Congress has yet to agree on a remaining FY18 budget or a stopgap measure to keep it functioning. Sources indicate that another short-term Continuing Resolution (CR) is likely, considering unresolved differences in a number of areas, including immigration, shoring up the healthcare marketplace, supplemental funding for territories, and border protection.
Another factor in the budget negotiations is the debt ceiling, or the accumulated debt limit Congress has placed on itself. Originally expected to be reached in March, the Congressional Budget Office has said this limit will be reached earlier, primarily due to the passage of the tax bill.
The debt ceiling is different than spending caps, which is another self-imposed limit Congress has enacted for controlling overall appropriation levels. Some grounding in this history will help put some of the moving budget pieces in context.
Background on spending caps:
- About one-third of the federal budget is determined through the appropriations process each year. It is referred to as "discretionary" spending because the laws establishing the programs and agencies give Congress the discretion to set funding levels through annual appropriations.
- A bit more than half of the budget is for the Defense Department and closely related programs; the rest falls into the broad category of "Non-Defense Discretionary" spending (often referred to as NDD). This category encompasses a wide range of activities, including, for example, law enforcement and courts, aid to education, scientific and medical research, housing programs, job training, public health, national parks and forests, some infrastructure, and the operating budgets of most federal agencies.
- The 2011 Budget Control Act (BCA) established legally binding caps on appropriations for each year from 2012 through 2021, with separate caps for the defense and non-defense categories. The BCA also called for additional deficit-reduction measures and set up a process known as "sequestration" to automatically cut spending if funding levels exceed the caps.
- Should sequestration occur, the principle of parity applies to defense and non-defense spending. This means if one area is cut the other is as well, and if one area has an increase in funding the other does, too.
Defense spending is something that has also become a variable in the budget negotiations. On January 20, the House - for the third time -- passed a defense funding bill for FY18. This one was for $659.2 billion. The proposal, approved by a vote of 250-166, is unlikely to be enacted into law. It is expected to be acted upon in the Senate once overall FY18 budget targets and spending amounts are negotiated.
As we enter month five of FY18 without a budget agreement, and continue to operate under a CR set at FY17 budget levels, note that the President's FY19 budget proposal is expected to be released on February 12. Watch for a summary of programs affecting AUCD members shortly after its distribution.
Health Care
Medicaid Waivers - Work Requirements
On February 2, Indiana became the second state (after Kentucky) to receive federal approval to add a work requirement for adult Medicaid recipients who gained coverage under the Affordable Care Act (ACA). Indiana plans to implement the requirements starting in 2019. Under the state's new rules, "able-bodied adults who are working-age and who gained Medicaid coverage under the ACA will have to work 20 hours a week or participate in a combination of other activities". Participants who fail to meet this requirement, will be dropped and blocked from enrollment for three months. Participants who fail to submit necessary paperwork or make payments in a timely manner will also be blocked from enrollment for three months, regardless of the hardship an individual may be facing.
As noted in In Brief, CMS has previously rejected proposals such as this stating that it "could undermine access to care and not support the objectives of the Medicaid program." It has also been shown that work requirements in other programs have failed to increase long-term employment, and some people who lose benefits under work requirements fall deeper into poverty. In contrast, Medicaid coverage supports work by giving low-income people access to the care they need to find and hold a job.
AUCD is concerned with potential unintended consequences of these waiver demonstrations, as it could negatively affect health equity, people with disabilities, and people who use reproductive health services. Though certain exemptions were made for people with disabilities, the definition for "people with disabilities" is determined by each state and could result in many enrollees with disabling conditions and serious health issues being adversely affected by these demonstrations. This Health Affairs article explains who is at risk of losing health coverage and identifies the implications of Medicaid work requirements.
Community Health Centers
The Community Health Center Fund (CHCF), a key source of funding for community health centers, expired on September 30, 2017, and has since been extended through March 31, 2018. The CHCF provides 70% of grant funding to health centers, which provide care to about 27 million low-income people in 9,800 rural and urban communities across the US. On February 2, House Energy and Commerce Committee Chairman Greg Walden (R-OR.) said that "lawmakers hope to add money for community health centers to the short-term spending bill" that is being considered before the February 8 deadline for funding the government. Due to funding uncertainty, health centers have taken or are considering taking a number of actions that will affect their capacity to provide care to their patients. About 20 percent of the centers have implemented hiring freezes, a quarter have cancelled or delayed a renovation or expansion, and 4 percent have laid off staff.
Advocates are also hoping that an extension for the Maternal, Infant, and Early Childhood Home Visiting program is included in the above short-term spending measure as well. This program, which similarly expired at the end of September, provides funding to help low-income mothers bolster their parenting knowledge.
RAISE Family Caregivers Act
On January 22, the President signed the bipartisan Recognize, Assist, Include, and Engage (RAISE) Family Caregivers Act into law (P.L. 115-119), which AUCD supports. The RAISE Family Caregivers Act will bring together stakeholders from both the public and private sector to create an advisory body. This advisory body will then develop recommendations for how government, communities, providers, employers, and others can better recognize and support the nation's more than 40 million caregivers.
CDC Director
Brenda Fitzgerald, director of the Centers for Disease Control and Prevention (CDC), abruptly resigned from her post last Wednesday, after a report from Politico revealed that she had purchased shares in a tobacco company just one month after being charged to lead the nation's top public health agency. CDC's chief operating officer, Sherri Berger, subsequently announced that Anne Schuchat, current principal deputy, will be acting director.
Money Follows the Person
As reported in last week's In Brief, AUCD organized three days of advocacy to educate Senators on the importance of the Money Follows the Person (MFP) program. This week remember to email your Senators. Use and share this toolkit to call your Senators, for sample tweets, talking points, graphics, and a pre-crafted email that you can personalize.
Background: Senators Portman (R-OH) and Cantwell (D-WA) introduced the bipartisan Empower Care Act (S. 2227), which extends and improves MFP. Currently this bill only has one co-sponsor. Given the positive impact MFP has had on people with disabilities as well as on state budgets, it is critical that advocates share theirs stories with Senators on the importance of supporting this needed program.
Education
IDEA Report
The Individuals with Disabilities Education Act (IDEA) requires that the Department of Education report annually on the progress made toward the provision of a free appropriate public education to all children with disabilities and the provision of early intervention services to infants and toddlers with disabilities. The reports focus on the children and students with disabilities being served under IDEA, Parts C or B, nationally and at the state level. The most recent report can be found here.
Hearings
On January 20, the Senate HELP Committee held a hearing on Reauthorizing the Higher Education Act: Accountability and Risk to Taxpayers. You can access an archived recording and witnesses here. The Committee will hold another hearing on February 6 - Reauthorizing the Higher Education Act: Improving College Affordability - which is also available on the Committee site.
Members of Congress
Sources indicate that Representatives Aderholt (R-Ala), Granger (R-TX), and Cole (R-Okla) have emerged as potential successors to the retiring House Appropriations Chairman Rodney Frelinghuysen.
2018 Disability Policy Seminar
Please remember to register for the Disability Policy Seminar (DPS). Registration for the AUCD Trainee Summit, on Sunday, April 22, will be open soon! DPS is a great opportunity to learn about disability policy, advance the grassroots movement for people with intellectual and developmental disabilities, advocate for access to health care, community living supports and civil rights, share your story with Members of Congress, and more. Also, remember to schedule meetings with your Senators and Representatives before you come to DC (tips sheets on how to do this will be shared soon).
Tuesdays with Liz: Disability Policy for All
The Tuesdays with Liz series is taking a break while Liz Weintraub is on detail working with the Senate Aging Committee. Tuesdays with Liz will return to a regular taping schedule and new episodes will air in the late Spring when Liz returns to AUCD. Until then, we will be highlighting some of our favorite Tuesdays with Liz episodes from this past year here and on social media at @AUCDnews.
This week, let's take a look back at some of Liz's favorite videos from 2017 in the 2017 Recap Episode.
For more from AUCD, follow @AUCDNews and like AUCD on Facebook
For updates from our Executive Director Andy Imparato, follow @AndyAUCD.
For definitions of terms used in In Brief, please see AUCD's Glossary of Legislative Terms
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