The Senate continues to try and move forward on a plan to repeal the Affordable Care Act (ACA). On July 17, plans to repeal the ACA and cap Medicaid were put on hold when four Republican Senators announced their intent to vote “no” on a motion to begin debate. The next morning, Senate Majority Leader Mitch McConnell (R-KY) announced that there would be a vote on Obamacare Repeal Reconciliation Act (ORRA), which does not include Medicaid per capita caps, but does repeal Medicaid expansion, the increased federal match for the Community First Choice option, the individual and employer mandates, the premium tax credits, and a number of other provisions. The bill would not take effect for two years, giving Congress time to develop a replacement. However, it is unclear whether insurers will continue to participate in the market when the long-term framework is unknown. Within hours of this announcement, three Republican Senators announced their opposition to voting to repeal and delay replacement with a new plan.
Senate Majority Leader McConnell then announced that there will be a vote on a motion to begin debate early this week. It is unclear whether the vote will be on the ORRA or a revised Better Care Reconciliation Act (BCRA). The Senate is also considering revising BCRA to includes $200 billion in non-Medicaid funds for expansion states in an effort to win support from Senators from the Medicaid expansion states. The Congressional Budget Office has evaluated the ORRA and BCRA and found that they will increase the number of uninsured Americans by 32 million and 22 million, respectively.
To further complicate the situation, the Senate Parliamentarian, who must review provisions to make sure they comply with the Senate rules, has found that several provisions could be challenged and would require 60 votes to keep them in the bill. The provisions include a prohibition of Planned Parenthood funding, ending the essential health benefits requirement in Medicaid, continuing funding for cost sharing subsidies, allowing states to change the requirement that plans spend at least 80% of premium income on health care, and the six- month waiting period prior to enrollment without continuous coverage. The Parliamentarian continues to review the bill and may issue additional findings. It is unclear if the Senate has the votes to pass any legislation at this point, but the leadership is expected to keep working to try and find agreement on repealing the ACA.
On July 13, the Senate released a new discussion draft of the Better Care Reconciliation Act (BCRA). The Senate was unable to secure support to pass the bill before the July 4 recess and Majority Leader Mitch McConnell (R-KY) and Administration officials continue to work hard to convince at least 50 Senators to support the bill. To address strong criticism regarding the impact on people with disabilities, the new draft includes $8 billion for a four-year home and community based services demonstration for rural states. This woefully inadequate one-time fund is much smaller than the $19 billion cut from the enhanced federal match (which is not time-limited) in the Community First Choice state option. Additionally, the draft bill still includes per capita caps, which, when combined with cuts to Medicaid expansion, will result in reductions in Medicaid spending by 35% by 2036, compared to current law. Additional changes include allowing insurers to sell plans that cover fewer services, increased funding to address the opioid crisis, and maintaining the Affordable Care Act’s high-income payroll tax and investment income tax. In a statement, The Arc warned that the new draft continues to pose a severe threat to people with disabilities.
Senate Majority Leader McConnell has announced that a vote on the BCRA will be delayed for at least a week. Advocates should continue reaching out to their Senators and organizing against the BCRA. Please call your Senators and take part in our emergency letter-writing campaign.
Senate Majority Leader Mitch McConnell (R-KY) continues to push hard for a Senate vote this week before Congress begins its July 4 recess. This process is expected to advance today or tomorrow with the release of the Congressional Budget Office’s (CBO) report projecting the Senate measure’s impact on the number of insured Americans and federal deficits. The CBO had projected that the House’s bill would result in 23 million fewer Americans having health insurance and over $830 billion in cuts to Medicaid over 10 years.
The Majority Leader will need to win over the five Republican Senators – four conservatives and moderate Dean Heller (R-NV) – who announced their opposition to the measure last week. Republicans control 52 seats and can afford only two defections to still pass the bill with Vice President Pence to break the tie, assuming no Democratic support.
Should the Senate measure pass, attention could immediately turn back to the House of Representatives to pass the Senate’s bill. President Trump has indicated his intent to sign Congress’ health care legislation into law.
This week marks a truly historic time in the lives of people with intellectual and developmental disabilities. The system of home and community based services that has taken decades to build with bipartisan support is facing unprecedented risk. The Arc urges its network of advocates across the country to make every effort to contact their Senators and urge them to vote NO. See Action Alert.
On June 22, 2017, the Senate Budget Committee released a discussion draft of health care reform legislation, the “Better Care Reconciliation Act of 2017.” Some Senators are claiming that provisions have been added to this bill to protect people with disabilities. However, provisions related to people with disabilities are wholly inadequate. Click here to see key points on why the disability provisions fail to provide any meaningful protections for people with disabilities.
The Senate draft is substantially similar to the harmful bill (H.R 1628) passedby the House in May. Among other things, both measures radically restructure the financing of the Medicaid program to pay for the repeal of the tax provisions and other revenue producing provisions of the Affordable Care Act. As a result, deep cuts to health care and community living supports for low income people would be used to fund tax breaks that largely benefit corporations and wealthy individuals.
Reactions to the Senate draft were swift and overwhelmingly negative from the disability community and others, evidenced by a highly-publicized protest in the Senate. Click here to watch MSNBC’s coverage of the protest which included numerous arrests and an extensive analysis of Medicaid’s significance to people with disabilities.
As The Arc’s CEO Peter Berns noted in his statement on the day the Senate draft was released, “This bill will have a devastating impact on individuals with intellectual and developmental disabilities and their families. Make no mistake – people’s lives and independence are on the line.”
Senate Majority Leader Mitch McConnell (R-KY) continues to seek Senate passage of the American Health Care Act (H.R. 1628), which passed the House of Representatives in May. News reports continue to indicate that the Senate may vote on the bill as soon as the end of June. While the Majority Leader has not released proposed Senate changes to the bill, reports continue to indicate that Medicaid per capita caps will remain in the bill, jeopardizing the availability of Medicaid home and community-based services for people with I/DD.
The Arc is continuing its efforts to preserve health care and long-term services and supports under the Affordable Care Act and Medicaid. On June 16, The Arc hosted a Facebook Live briefing (part 1, part 2) with Nicole Jorwic, Director of Rights Policy. On June 19, The Arc co-hosted a briefing on Capitol Hill on “Understanding the Devastating Impact of Medicaid Per Capita Caps on People with Disabilities” with Marty Ford, Senior Executive Officer for Public Policy, as a panelist. Additionally, The Arc released a fact sheetdetailing Medicaid’s optional and waiver services that are at risk if per capita caps are enacted.
Senate Majority Leader Mitch McConnell (R-KY) has placed the American Health Care Act on the Senate calendar with a vote planned by the end of June. The Senate is planning to skip the committee process. The bill is expected to be substantially similar to the version that passed the House. Very few details of the bill have been made public. One likely change is extending the time frame for phasing out the Medicaid expansion. However, Medicaid per capita caps are likely to remain in the bill, jeopardizing the availability of services for people with I/DD. The Arc is continuing its efforts to defeat the bill, and recently released a new video.
Javi, a man with autism and Ehlers-Danlos syndrome, and his mother Linda have benefitted from Medicaid. Linda became a single parent when Javi was just seven years old, and was able to work full time because of the support Javi received through Medicaid. Last week, The Arc released their story, the sixth in a series featuring people who rely on Medicaid and/or the Affordable Care Act. Please share this video widely with your networks to show the impact of cutting Medicaid and repealing major health care protections. For an especially easy option, retweet The Arc of the US and share our Facebook post.
If you missed The Arc’s first five videos, check them out & share them now:“If I could say one thing”, “Calvin’s Story”, “Meet Thelma”, “Meet Bryan.”, and “Meet Soojung & Alice”
Soojung’s daughter, Alice, was born with Rett syndrome and relies on Medicaid to get the health care and services she needs to survive and thrive. Last week, The Arc released their story, the fifth in a series featuring people who rely on Medicaid and/or the Affordable Care Act. Please share this video widely with your networks to show the impact of cutting Medicaid and repealing major health care protections. For an especially easy option, retweet The Arc of the US and share our Facebook post.
If you missed The Arc’s first four videos, check them out & share them now:“If I could say one thing”, “Calvin’s Story”, “Meet Thelma”, and “Meet Bryan.”
Last week, the Congressional Budget Office (CBO) released a new analysis of the House-passed American Health Care Act. The CBO estimates that the number of uninsured people will rise by 14 million by 2018, 19 million by 2020, and 23 million by 2026, all relative to current law. The number of Medicaid beneficiaries will fall by 14 million, most of whom will become uninsured. States that use waivers are likely to see more healthy enrollees join the market, while more people with chronic health conditions will likely be unable to find insurance. Overall, the bill cuts more than $830 billion out of Medicaid over a decade.
“We are at a critical juncture in our history as a disability rights movement. Now more than ever, people with disabilities, families, professionals in the field, and the general public need to rise up to protect the rights of people with intellectual and developmental disabilities to live a life like anyone else,” said Marty Ford, Senior Executive Officer, Public Policy, The Arc. Learn more in The Arc’s full statement on the CBO analysis.
The Center on Budget and Policy Priorities released a report detailing the likely impact of the Medicaid per capita caps in the American Health Care Act on home and community based services (HCBS). The report notes HCBS are optional, but are a large share of overall state spending and therefore they are likely targets for cuts. Additionally, the report notes that per capita caps would exacerbate direct care workforce shortages by limited federal funds available for provider reimbursement.
The Arc continues its efforts to fight this harmful proposal. To watch the latest in The Arc’s video series, see Meet Bryan and Meet Soojung and Aliceabout the critical importance of health care and Medicaid to people with intellectual and developmental disabilities and their families. Please share with your networks.
With the House passage of the American Health Care Act (AHCA), the bill is now being reviewed in the Senate. The Senate has formed a 13-member working group composed of Majority Leader Mitch McConnell (R-KY), Majority Whip John Cornyn (R-TX), and Senators John Thune (R-SD), John Barrasso (R-WY), Lamar Alexander (R-TN), Mike Enzi (R-WY), Orrin Hatch (R-UT), Ted Cruz (R-TX), Mike Lee (R-UT), Tom Cotton (R-AR), Cory Gardner (R-CO), Rob Portman (R-OH), and Pat Toomey (R-PA). Major areas of disagreement between Senate Republicans include the structure of tax credits, Medicaid per-capita caps, Medicaid expansion, essential health benefits, and pre-existing conditions. The Arc has released a fact sheet on the harmful impact of the AHCA on people with disabilities. The Congressional Budget Office is expected to provide cost information on the AHCA early in the week of May 22.
Click here to watch the latest in The Arc’s series of videos on the critical importance of health care and Medicaid to people with intellectual and developmental disabilities and their families. Please share with your networks.