On June 22, Speaker of the House Paul Ryan (R-WI) unveiled his plan to replace the Affordable Care Act and fundamentally restructure the Medicaid and Medicare programs. The proposal is not a detailed legislative draft, but a blueprint for expected action in the next Congress. The proposal provides states the option to choose a block grant for the Medicaid program or a per capita cap. A block grant provides a set amount of federal spending regardless of enrollment. A per capita cap does adjust for enrollment while establishing a limit on how much to reimburse states per enrollee. Either option is a fundamental restructuring of Medicaid financing with the goal of achieving federal savings. If costs are above per enrollee amounts, the states would need to cover the costs or make cuts to provider reimbursement, eligibility, or services, or shift costs to individuals receiving services or their family members. The plan proposes to give states additional flexibility to increase cost sharing, add waiting lists, and limit benefits. Additionally, the plan proposes to add a work requirement to the Medicaid program, end the option to expand Medicaid, and phase out the increased federal match for the states that have already expanded Medicaid. The Arc is very concerned about the impact of these major changes on people with disabilities and their family members and will continue to provide input to Congress about these proposals.
On Wednesday, June 15, the House Committee on Energy and Commerce unanimously approved the Helping Families in Mental Health Crisis Act (H.R. 2646). In its original form, the bill contained many provisions that caused concern for The Arc and other organizations. Many of these provisions have been scaled back. The provision that limits the scope of Protection and Advocacy for Individuals with Mental Illness to investigate only incidents of abuse abuse and neglect was removed. Broad exceptions to the Health Insurance Portability and Accountability Act health care privacy protections were replaced with a provision directing the Department of Health and Human Services to issue clarifying regulations. It is estimated that 30-35% of people with intellectual and/or developmental disabilities also have a psychiatric disorder. The Arc is currently in the process of reviewing the amended bill.
Last week, Representative Jim McDermott (D-WA), the Ranking Member of the Ways and Means Subcommittee on Health, introduced the Medicare Dental, Vision, and Hearing Benefit Act of 2016 (H.R. 5396). The legislation would strengthen the Medicare benefit package by expanding it to provide comprehensive coverage of dental, vision, and hearing care. The benefits would be gradually phased in and would fill a gap in the coverage for the traditional Medicare program.
The National Safe and Healthy Housing Coalition is holding a webinar to launch Find It, Fix It, Fund It: a Lead Elimination Action Drive on Wednesday, May 25, 2016 at 1:00 pm, EDT. The drive has four components: a National Roundtable to develop new policies and promote legislation and administrative advocacy; a Policy Workgroup focused on federal funding; a Grassroots Workgroup; and a Media Outreach Workgroup. Participants will have the opportunity to provide input and sign up for the drive’s components. Registerhere.
On May 18, the House passed a freestanding $622 million funding bill, the Zika Response Appropriations Act (H.R. 5243), to address the Zika virus. The costs for this supplemental spending bill are fully offset by using $352 million in “unobligated” money for the Ebola outbreak in 2014 and $270 million in “unused administrative funding” from the Department of Health and Human Services. Funds would be allocated for fiscal year 2016, which means they could be used during the next five months. The Senate followed suit on May 19 by passing a two-bill spending measure (H.R. 2577) that includes a $1.1 billion agreement on responding to the Zika virus for four months. Passage of bills with such significant differences in the amount of funding promises a complicated conference process between the House and Senate. Public health and disability advocates are seeking amounts closer to the President’s request of $1.9 billion which may have to play out over time with additional spending bills.
On Friday, May 13, HHS released an advanced notice of a final ruleimplementing Section 1557 of the Affordable Care Act (ACA). The final rule clarifies the responsibilities of covered providers and insurers regarding non-discrimination on the basis of race, color, national origin, sex, age, or disability. It applies to Health Insurance Marketplaces and every program or activity administered by HHS, with the exception of Medicare Part B. The Arc will be reviewing the regulations and will provide additional analysis.
The Equal Employment Opportunity Commission (EEOC) is issuing two final rules making changes to the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA) regulations as they relate to employee wellness programs. The ADA regulation changes provide guidance on the extent to which employers may use incentives to encourage employees to participate in wellness programs that ask them to respond to disability-related inquiries and/or undergo medical examinations. The GINA regulation addresses the extent to which an employer may offer an inducement to an employee for the employee’s spouse to provide information about the spouse’s manifestation of disease or disorder as part of a health risk assessment (HRA) administered in connection with an employer-sponsored wellness program. The regulations will be published in the Federal Register on May 17 and The Arc will provide additional analysis.
The House Committee on Energy and Commerce has approved H.R. 4725, the Common Sense Savings Act of 2016. This bill, introduced by Congressman Joe Pitts (R-PA), makes major cuts to Medicaid and other health programs, many of which will negatively impact our community. These cuts are achieved by including certain one-time, lump-sum payments in determining income eligibility, such as: lottery winnings, damages received in a law suit or settlement, and inheritance; shifting certain Medicaid and Children’s Health Insurance Program costs to states; and repealing the Prevention and Public Health Fund.
On February 2, the National Council on Disability (NCD) released, “Monitoring and Enforcing the Affordable Care Act (ACA) for People with Disabilities”. This is the final report in a three-part series on ACA and describes key legal protections in the ACA. NCD is an independent federal agency that makes policy recommendations to Congress and the Administration.
On February 2, The House voted 241-186 to override the veto of H.R. 3762, “Restoring Americans’ Healthcare Freedom Reconciliation Act” which repeals substantial parts of the Affordable Care Act (ACA). The vote was short of the two-thirds majority needed to override a presidential veto. Among the provisions that would have been repealed are the penalties used to enforce the mandates that most individuals have health coverage and that large employers offer it to their workers. In 2018, it would have repealed the law’s Medicaid expansion and its subsidies to help low and middle-income individuals buy health coverage through the new insurance exchanges. A number of the taxes used to help offset the cost of the health law would also have been repealed.