The Senate overwhelmingly approved a permanent fix to the reimbursement rates for Medicare providers, sending the measure to be signed by President Obama. If Congress had not acted, Medicare health care providers faced a 21% cut to their reimbursement. In addition to permanently fixing the reimbursement problem, the legislation extends the Children’s Health Insurance Program for two years, and extends the therapy cap exceptions process. Senator Ben Cardin (D-MD) offered an amendment to eliminate the therapy caps. The amendment failed by two votes to reach the 60 vote threshold needed to be included in the legislation. The bill also permanently extends the Qualified Individual (QI) program under the Medicare program, which helps low-income Medicare beneficiaries pay for premiums and permanently extends the Transitional Medical Assistance (TMA) program, which helps families on Medicaid maintain their coverage for one year as they transition from welfare to work.
As expected, the House and Senate passed their Fiscal Year 2016 Budget Resolutions last week. The measures passed with votes nearly along party lines of 228-199 and 52-46, respectively. Both contain drastic cuts to the entitlement and discretionary programs that people with disabilities rely on. They would cut funding by block granting the Medicaid program (called “flexible state allotments”), privatizing the Medicare program, and freezing discretionary funding over the next decade.
Additionally, the House budget resolution includes several harmful provisions on Social Security Disability Insurance (SSDI). It reiterates a House rule that creates roadblocks to preventing a 20 percent across-the-board SSDI benefit after 2016, and proposes cutting SSDI for people who also receive Unemployment Insurance after trying to work, but losing their job. The Senate budget resolution does not include these provisions.
Passage of the two resolutions paves the way for the House and Senate to begin negotiating a joint budget resolution. See The Arc’s statement on the passage of the budget resolutions.
See a more detailed summary of what is in the budget resolutions in last week’s edition at:
By an overwhelming margin, the House passed H.R. 2, the Medicare Access and Chip Reauthorization Act, which would change the way Medicare reimburses physicians and would extend funding for the Children’s Health Insurance Program (CHIP) for two years. The bipartisan bill passed 392-37. The Senate is planning to take up the measure when it returns in two weeks. If Congress does not act, Medicare providers face a 21% cut in their reimbursement for medical care provided to eligible Medicare beneficiaries. The bill also would make permanent a program to help low income Medicare beneficiaries pay for premiums and would permanently expand a Medicaid provision that helps families on Medicaid maintain their coverage for one year as they transition from temporary assistance to work. The bill also would extend the therapy cap exceptions process and the Family –to-Family Health Information Centers for two years. The Arc supports making these provisions permanent as well as a longer extension of CHIP.
Rep. Tom Price (R-GA), Chairman of the House Budget Committee, released the proposed House FY 2016 Budget Resolution on March 17. The measure was passed by the Budget Committee the next day. While Congressional budgets are merely blueprints, they set the tone for spending and revenue priorities. The proposed House budget would cut overall spending by $5.5 trillion and reduce revenues by at least $1.5 trillion over 10 years. Included in the spending cuts are combined cuts to the Medicaid program of $1.8 trillion. The proposed budget contains numerous specific provisions that would be devastating for vulnerable populations, including people with disabilities. Prime among these are:
- Medicaid. The House budget would cut Medicaid by $913 billion over 10 years through “flexible state allotments,” resulting in a cut of more than 30 percent by 2025. The federal government would no longer pay a fixed share of states’ Medicaid costs, starting in 2017. Instead, states would get a fixed dollar amount known as block grants or “state flexibility funds” (the process for determining the amounts of these funds is not specified).
- Repeal of the Affordable Care Act (ACA), including Medicaid expansion. The Affordable Care Act (ACA) expanded Medicaid to cover people with incomes up to 133% of the poverty level ($15,654 for an individual). The proposed House budget would repeal the ACA, resulting in millions of people losing access to health care.
- Medicare. The House budget would fundamentally restructure the Medicare program, including privatization and over $100 billion in spending cuts over 10 years.
- Discretionary Programs. Non-defense discretionary programs would be cut starting in 2017. The total 10 year cut would be $759 billion, or 14 percent below the current caps. Included in this category are many disability related programs such as housing, education, employment, transportation, and protection and advocacy.
- Social Security. The House budget would cut benefits for Social Security Disability Insurance (SSDI) beneficiaries who also receive Unemployment Insurance because they have attempted to work, but lost their job through no fault of their own. It also reiterates a provision in the House rules for the 114th Congress that sets up hurdles to a routine replenishment of Social Security’s disability fund, needed to prevent across-the-board SSDI benefit cuts at the end of 2016. Finally, the House budget recommends establishing a commission to look at Social Security’s long term finances.
Senator Mike Enzi (R-WY), Chairman of the Senate Budget Committee, released the proposed Senate FY 2016 Budget Resolution on March 18, one day after the release of the House Budget. In a party-line vote, the Senate Budget Committee passed the measure on March 19. The proposed Senate budget provides for a slightly smaller overall spending cut goal of $5.1 trillion over 10 years, with $4.3 trillion cut from mandatory programs and $97 billion from discretionary programs. The combined Medicaid cuts would exceed $1.3 trillion over ten years. Specific provisions of great concern to the disability community are:
- Medicaid. The Senate budget would radically restructure Medicaid by converting much of it into two block grants (no information is provided on how the funding levels would be set). It “improves Medicaid based on the CHIP model” and “increases state flexibility in designing benefits and administering its programs, to encourage efficiency and reduce wasteful spending” for long term services and supports. (Fortunately, it makes no changes to the funding of acute care services for the low-income elderly and persons with disabilities.)
- Repeal of the ACA, including Medicaid expansion. The Senate budget seeks to repeal the ACA.
- Medicare. $435 billion in Medicare savings is proposed, none of it specified.
- Discretionary Programs. The Senate budget “strengthens the caps” on discretionary spending. It would maintain full sequestration in 2016, and cuts funding for non-defense discretionary programs at least $236 billion below the sequestration levels through 2025. By 2025, total funding for non-defense discretionary programs would be at least 24 percent below the 2010 level adjusted for inflation.
The Arc is pleased to share a new Q&A document designed to be a resource to assist advocates understand the impact of the HCBS Settings Rule as the March 17, 2015 deadline for states to submit a transition plan to the Centers for Medicare and Medicaid Services (CMS) approaches. The document provides answers to frequently asked questions about the Rule as well as links to primary source documents and additional information members of The Arc may find helpful as they advocate for the full inclusion and community participation of people with I/DD.
Marilyn Tavenner, the chief administrator for the federal agency that oversees Medicaid, Medicare and most of the Affordable Care Act is resigning at the end of the month. She was confirmed overwhelmingly by the Senate in May, 2013 and oversaw the roll out of the Affordable Care Act. Prior to her announcement, several other key leaders at CMS had resigned including Cindy Mann, who was the Deputy Administrator and Director of the Center for Medicaid and CHIP Services. Under the leadership of Ms. Tavenner and Ms. Mann, several important initiatives were advanced and there was increased openness to working with advocates and stakeholders.
Last week, Senator Ron Wyden (D-OR), along with 44 colleagues, introduced “A resolution commemorating 50 years since the creation of the Medicare and Medicaid Programs,” S.R. 25. In his introductory remarks, Senator Wyden recalled the historical importance of these programs to people, including those with disabilities, stating “Medicare and Medicaid were bipartisan efforts, and the enactment of these programs shows that Congress can craft bipartisan solutions to complex problems. As this new Congress begins, I hope we can use that 50-year-old spirit to strengthen, protect, and improve Medicare and Medicaid to keep that guarantee strong, ensure health care to those who need it most, and protect a program that has been a lifeline to millions of Americans.”
Last week, the House Energy and Commerce Committee Subcommittee on Health, Chaired by Rep. Joe Pitts (R-PA), held a hearing on “Setting Fiscal Priorities” to hear testimony related to key policy decisions the Committee may face in the 114th Congress related to health care spending by Medicaid and Medicare. Visit the Committee’s web site to view testimony and archived video of the hearing.
Last week, the Centers for Medicare & Medicaid Services (CMS) announced several changes to the Medicaid.gov website including a new home page with quick links including federal policy guidance and other new technical assistance resources. Additionally, they have expanded State Medicaid and CHIP profiles to provide a more complete picture of the many policy and programmatic features that make up each state’s Medicaid and CHIP programs. New elements include a state-specific list of approved state plan amendments and waivers and links to detailed Medicaid managed care profiles.