AUCD Legislative News In Brief

February 10, 2014

AUCD Legislative News In Brief
  February 10, 2014   |  Vol. XIV, Issue 6
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Congressional Schedule

The House and Senate are in session this week. The Senate will vote today on repealing cost-of-living adjustments for veterans included in the Bipartisan Budget Act of 2013. The House may begin work this week on legislation to raise the debt limit, which Treasury Secretary Jack Lew has said must be raised by February 27. The Congress will be out on President's Day recess next week - a good time to meet with your Members about issues important to you while they are in your state/district.  Topics could include funding for disability programs, reauthorization of the Combating Autism Act, passing the ABLE Act, co-sponsoring the Keeping All Students Safe Act, reauthorizing the Workforce Investment Act, and ratifying the Disability Treaty.  See AUCD's public policy page or Action Center for more information.

Combating Autism Act Reauthorization

The Office of Autism Research Coordination (OARC) released the long-awaited Report to Congress on Activities Related to Autism Spectrum Disorder and Other Developmental Disabilities Under the Combating Autism Act of 2006 and Combating Autism Reauthorization Act of 2011 (FY 2010-FY 2012). This report is required by the Combating Autism Reauthorization Act (CARA) of 2011 to update Congress on progress that has been made by Departments of Health and Human Services and Education in fulfilling the mandates of the Act. The report highlights accomplishments made in the areas of research, early screening, diagnosis, and effectiveness and outcomes of interventions developed as a result of the Combating Autism Act of 2006 and the Combating Autism Reauthorization Act of 2011.  While the report concludes that collaborative efforts mandated by the Act have resulted in many research advances and improvements in services, all of the federal agencies acknowledge the growing needs of the community and the work that remains to be done. Continued collaborative efforts between public and private sectors will be essential to drive the innovations that will lead to improved identification, interventions, services, and policies that will enhance the lives of people with ASD and their families. The law will sunset after September 30, 2014 if it is not reauthorized.  AUCD has begun meeting with key Members of Congress to stress the need to reauthorize the law this year.

Budget & Appropriations

The Congressional Budget Office (CBO) has released the Budget & Economic Outlook: 2014 to 2014 that projects federal budget deficits or surpluses and economic growth for the next 10 years and serves as the official baseline for legislation. The CBO continues to project the "Nike swoosh" shaped graph - showing deficits falling this year and in 2015, but then rising again after 2016. By law, the CBO makes these projections assuming no legislative changes so as to set a baseline for proposed law. Under this "current law" scenario, CBO projects the federal budget deficit will fall from 4.1% of Gross Domestic Product (GDP) last year to 2.6% in 2016, then rising again to about 4% of GDP by 2024. The nation's overall debt follows the same pattern, declining slightly between 2014 and 2017 to 72% of GDP, then rising in later years reaching 79% of GDP by the end of 2024. Short term fiscal austerity measures have caused the decline in immediate deficits and debt, but have not addressed the long term fiscal challenges caused by the aging of the population and rising costs of health care.

Affordable Care Act

The ACA and Employment

The Congressional Budget Office (CBO) "Budget and Economic Outlook" (see Budget & Appropriations section) also included estimates of the labor market effects of the Affordable Care Act. The CBO projected that the ACA will reduce the total number of hours worked by about 1.5% to 2% from 2017 to 2024. This is slightly higher than the CBO originally projected and due mainly to reduction in "job lock" - where workers maintain suboptimal employment in order to access health insurance - as well as a small disincentive to work created through income-based eligibility. The CBO projects that the ACA will create more options to access health insurance, creating more flexibility for workers who may retire early or start a small business. The CBO made clear that the drop is almost entirely due to these effects, not in a reduced demand for labor by businesses.

Risk Adjustment, Reinsurance, and Reinsurance

Three ACA programs meant to stabilize health insurance markets will take effect this year. The three programs - risk adjustment, reinsurance, and risk corridors - are intended to stabilize health insurance markets and premiums by spreading risk among health insurers while the new ACA rules take effect. All three programs mitigate risk for health insurance plans that end up with a relatively high proportion of high-cost enrollees. Sometimes called a "bailout" for health insurance companies, the programs are a planned part of the ACA and are a standard part of health reform efforts, most recently in the creation of Medicare Part D prescription drug coverage. For more information, see the Kaiser Family Foundation's brief  Explaining Health Reform: Risk Adjustment, Reinsurance, and Risk Corridors.

Medicare Physician Payment Rates

The three committees reforming the physician payment schedule in Medicare - Senate Finance, House Energy & Commerce, and House Ways & Means - reached a bipartisan agreement last week on a new formula to replace the broadly disliked and ineffective sustainable growth rate (SGR). The new payment program would provide 0.5% annual increases from 2014 to 2018, and then maintain rates through 2023. Starting in 2018 providers' payment rates would be adjusted based on a new Merit-Based Incentive Payment System that includes measures of quality, meaningful use of electronic health records, and clinical practice improvement activities. After 2024 providers participating in alternative payment models would receive 1% annual updates; fee-for-service providers would receive 0.5% annual updates. Providers could receive bonus payments for participating in alternative payment models or an improved-quality program in traditional Medicare fee-for-service. Congress must pass a Medicare physician payment bill before March 31 to avoid the 24% cut in physician payments (and affiliated cuts in other provider payments) required by the SGR.

The bill does not include the package of "extenders" that usually accompany SGR legislation and the bill does not yet include any cuts to offset the cost of the reform. Both issues concern the disability community. AUCD has signed onto a Consortium for Citizens with Disabilities letter urging Congress to avoid cuts harmful to people with disabilities and to continue funding for the "extenders," including the Family-to-Family Health Information Centers that assist families of children with serious health conditions and disabilities. The letter also asks that they include an amendment by introduced by Senators Stabenow (D-MI), Blunt (R-MO), and Grassley (R-IA) based on Stabenow's Excellence in Mental Health Act that would create a demonstration program to expand access to community-based mental health services (for more on Stabenow's bill see December 16 In Brief).

Restraints and Seclusion in Schools.

On Wednesday, February 12, Senator Tom Harkin (D-IA), Chairman of the Committee on Health, Education, Labor, and Pensions (HELP), will host an event at the Capitol to announce his introduction of the Keeping All Students Safe Act and to discuss findings of the committee's investigation of obstacles faced by parents whose children were secluded or restrained in public schools. While the use of seclusion and restraints are prohibited in other settings, tens of thousands of children are subjected to these practices in the classroom each school year. This investigation documents the inability of some families to effectively address the use of seclusion and restraints practices and to positively affect change in school practices. The Keeping All Students Safe Act aims to ensure effective implementation of positive behavioral interventions in our nation's schools. Representative George Miller (D-CA) has introduced a companion bill in the House also called the Keeping All students Safe Act. AUCD continues to strongly support the legislation and has signed on to a Consortium for Citizens with Disabilities letter of support. For more information, see AUCD's Restraint & Seclusion policy page and action alert supporting the bill.

Disability Treaty

AUCD is participating in meetings with targeted Senators this week to urge ratification of the Convention on the Rights of Persons with Disabilities (CRPD), or Disability Treaty. Negotiations on a package of Reservations, Understanding, and Declarations have stalled since Sen. Corker (R-TN), the ranking minority member of the Foreign Relations Committee, stated that he would not support the ratification. Advocates are looking for a new Senator to take the lead on the negotiations. The House and Senate will be in their home states next week for President's recess.  We only need a few more Senators to get to the 67 (or 2/3 present) to successfully ratify the Treaty. Please meet with your Senators while they are home and let them know how important it is to you to support the ratification of the Treaty (let us know how it goes!).  For talking points, see AUCD's Treaty page.  For an easy and fast way to email your Senator, use AUCD's Action Center. We can do this if we try! 

Older Americans Act

On Tuesday, February 11 the House Education and the Workforce Committee will hold a hearing on the Older Americans Act (OAA). Witnesses include representatives from the National Health Policy Forum, an Area Agency on Aging, the National Hispanic Council on Aging, and the Wood County Committee on Aging. AUCD has signed onto a Consortium for Citizens with Disabilities letter encouraging two changes in the OAA: the inclusion of parents of adult children with disabilities in the National Family Caregiver Support program and the provision of future planning services through Aging and Disability Resource Centers. The letter will be posted on the CCD website soon.

Supplemental Nutrition Assistance Program

President Obama signed the Agricultural Act of 2014, ("Farm Bill"), a nearly $1 trillion spending package that guides a substantial portion of our nation's agricultural and nutrition policy.  The compromise measure includes an $8.6 billion cut to the Supplemental Nutrition Assistance Program (SNAP), while far less than an original $40 billion House proposal, is expected to result in benefit reductions of about $90 per month for 850,000 households who also participate in the Low-Income Home Energy Assistance Program.  The bill, however, maintains funding for SNAP nutrition education, includes new Food Insecurity Nutrition Incentive Grants, and authorizes the Healthy Food Financing Initiative.  For a summary of the nutrition provisions from the Center on Budget and Policy Priorities.

Minimum Wage

The Coalition on Human Needs is hosting a webinar on the issue of increasing the minimum wage featuring Senator Tom Harkin (D-IA) on February 13 at 3:00 p.m. ET.  The minimum wage has only been raised three times in the last 30 years.  Senator Harkin (D-IA) and Rep. George Miller (D-CA) are sponsoring the Fair Minimum Wage Act, which would increase the federal minimum wage in 3 steps to $10.10/hour.  The bill also raises the wages of tipped workers, from the current impossibly low minimum of $2.13/hour - workers depending on tips haven't seen an increase since 1991. Senator Harkin and National Employment Law Project Executive Director Christine Owens will discuss the need to raise the minimum wage. Register here.


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For definitions of terms used in In Brief, please see AUCD's Glossary of Legislative Terms

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