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.
The House Budget Committee approved a Budget Resolution on a 22-14 party-line vote. The 10-year budget plan includes:
- $4.4 trillion in cuts from Mandatory programs:
- $1.5 trillion cut from Medicaid and other health programs (includes House-passed American Health Care Act cuts plus additional cuts)
- $487 billion cut from Medicare
- $4 billion cut from Social Security disability insurance (SSDI)
- Almost $2.5 trillion cut from other mandatory programs like SNAP (food stamps) and other income security programs
- $1.3 trillion in cuts to Non-defense discretionary (NDD) programs below the current cap, while defense is increased $930 billion above the cap. This would put NDD funding (which includes many disability-related programs such as housing, employment, education, and transportation) at 17% below 2010 levels when factoring in inflation.
The House budget also provides “reconciliation instructions” for 11 committees to fast-track a package of spending cuts and tax cuts, requiring only 50 votes in the Senate to pass. Since the instructions specify “deficit-neutral” rather than “revenue-neutral” tax reform, the Ways & Means Committee will be able offset the costs of tax cuts with cuts to mandatory spending, such as Medicaid and Medicare. The House of Representatives is expected to take up this measure in September. The Arc strongly opposes the House Fiscal Year (FY) 2018 Budget Resolution.
Reps. Jared Huffman (D-CA), David McKinley (R-WV), Timothy Walz (D-MN), David Reichert (R-WA), Kurt Schrader (D-OR), and John Katko (R-NY) introduced the Individuals with Disabilities Education Act (IDEA) Full Funding Act (H.R. 2902). This bipartisan bill would increase spending over the next decade to bring the federal share of funding for special education up to 40 percent, the amount committed to when the law was first enacted in 1975. Currently the federal government currently covers 15.7 percent of these costs. The Arc supports this legislation.
The Department of Education released its final rule eliminating the r-word from its regulations and replacing it with “intellectual disability” or “intellectual disabilities.” This rule does not make any change to the meaning of the regulations, but rather brings them in line with Rosa’s Law, the 2010 law which eliminated the term from all statutes under the jurisdiction of the Senate Health, Education, Labor and Pensions Committee.
Last week, the Social Security Board of Trustees released “The 2017 Annual Report of the Board of Trustees of the Federal Old-Age and Survivors Insurance and Federal Disability Insurance Trust Funds.” The 2017 report finds that, in 2016, Social Security took in roughly $35 billion more than it paid out (in total income and interest). Social Security’s reserves were $2.85 trillion at the end of 2016. The Trustees continue to project that Social Security’s combined Trust Funds can pay all scheduled benefits through 2034, at which point the Trust Funds would be able to pay approximately 77 percent of scheduled benefits. The Trustees also find that Social Security Disability Insurance Trust Fund can pay full scheduled benefits through 2028, after which the fund will be able to pay about 93 percent of scheduled benefits. This is 5 years longer than projected in the 2016 Trustees Report, due to declines in applications, awards, and the number of people receiving Social Security disability benefits. Additional key points about the Trustees Report are available from the Consortium for Citizens with Disabilities Social Security Task Force.
The Social Security Subcommittee of the House Committee on Ways and Means held a hearing on the 2017 Trustees Report. The witness was Stephen C. Goss, Chief Actuary, Social Security Administration. Visit the Committeeweb site to view testimony and archived video.
On July 12, Representative Mark DeSaulnier (D-CA) and eight co-sponsors introduced H.R. 3199, the Improving Access to Higher Education Act. This bill would amend the Higher Education Act to improve college access and completion for students with disabilities. The Arc supports this comprehensive legislation that would provide students and institutions with improved training, greater resources, and expanded services, and includes improvements to the Transition and Postsecondary Programs for Students with Intellectual Disabilities.
The House of Representatives continued advancing several funding bills for Fiscal Year (FY) 2018 which begins on October 1. On Wednesday, the House Appropriations Committee released its draft bill for the Departments of Labor, Health and Human Services, and Education (L-HHS-ED) which includes the vast majority of discretionary disability-related programs and passed it out of subcommittee the following day. The bill provides funding of $156 billion, a $5 billion (3.1%) cut from FY 2017 levels. The Department of Education has the most significant cut of $2.5 billion (though IDEA programs received a small increase), while the Department of Labor would face a $1 billion cut and HHS faces around $500 million in cuts. See summary here. Line item figures are expected to be made available soon. A markup by the full House Appropriations Committee is planned for July 19.
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.
According to a Rutgers University research report, people with disabilities and their families accounted for 25% of the electorate in 2016. Yet, people with disabilities register and vote at rates that continue to lag behind voters without disabilities.
Let’s change that! This is National Disability Voter Registration week – and it’s time to Register! Educate! Vote! Use your Power! Join the REV UP Campaign and use this quick and easy link to Register to Vote Now!
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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.