On October 19, the Senate Health, Education, Labor and Pensions Committee held a hearing on “Examining How Healthy Choices Can Improve Health Outcomes and Reduce Costs.” Witnesses were Steve Burd, Founder and CEO, Burd Health; Michael F. Roizen, MD, Chief Wellness Officer and Founding Chair of the Wellness Institute at the Cleveland Clinic; David A. Asch, MD, MBA, John Morgan Professor, Perelman School of Medicine and the Wharton School, Executive Director, Center for Health Care Innovation, University of Pennsylvania; and Jennifer Mathis, Director of Policy and Legal Advocacy, Judge David L. Bazelon Center for Mental Health Law. In her testimony, Mathis discussed the negative impact that regulations that define programs as “voluntary” when they charge penalties for non-participation have on the rights of people with disabilities. Visit the committee web site to review opening statements and archived video.
Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA), along with 22 other co-sponsors (11 Republicans, 10 Democrats, 1 Independent), released a bill to continue cost-sharing reductions payments under the Affordable Care Act for two years. The bill also partially restores federal funding for consumer outreach and enrollment assistance. Additionally, it makes changes to the Section 1332 waiver process, making it easier for states to get waivers of certain parts of the law, provided certain standards are maintained. For more information, read The Arc’s blog post.
On October 12, President Trump issued an executive order aimed at weakening protections in the Affordable Care Act (ACA). The order instructs agencies to identify and consider ways in which plans can be offered that do not meet the ACA’s requirements. These changes, if implemented, have the potential to drive up the cost of plans that provide adequate benefits and coverage for people with disabilities and chronic health conditions. See The Arc’s statement here.
Later that day, the White House announced that it would stop cost-sharing reduction payments. The ACA requires insurance companies to substantially reduce out-of-pocket expenses for beneficiaries with incomes under 250% of the poverty level and provides for reimbursement from the federal government. According to the Congressional Budget Office, this decision is likely to increase the number of uninsured Americans, premiums, and the federal deficit. For more information, see The Arc’s blog post.
On October 4, The House Energy and Commerce Committee also approved several bills addressing a variety of issues supported by The Arc including extending funding for community health centers (H.R.3922), a two year extension of the Family to Family Health Information Centers, extending the Medicare Independence at Home Medical Practice Demonstration (H.R.3263) making permanent a provision that allows Medicare coverage for speech generating devices (H.R.2465) and several other bills. Unfortunately, the Committee also voted to reduce $6.35 billion from the Prevention and Public Health Fund over 10 years. The fund supports many prevention and public health programs throughout the country.
On October 4, the Senate Finance Committee passed the Keeping Kids’ Insurance Dependable and Secure (KIDS) Act (S.1827). This bipartisan bill reauthorizes federal funding for the next five years to the Children’s Health Insurance Program (CHIP), a program which currently provides low-cost health insurance to roughly 8.9 million children under the age of 18 who do not qualify for Medicaid or have access to private insurance. Current federal funding expired on September 30 at the end of FY 2017. However, some states have been able to carry over this federal funding and keep their programs running longer than others. The Finance Committee has not yet indicated how they plan to fund the $8 billion needed for CHIP to continue. The bill is set to move to the Senate floor for consideration after the forthcoming recess.
Also on October 4, the House Energy and Commerce Committee passed the Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable (HEALTHY KIDS) Act of 2017 (H.R.3291). This bill also reauthorizes the federal funding for the CHIP program for five years. While there was bipartisan agreement on the reauthorization, the Committee members disagree about how to pay for the bills. The bill included an increase in Medicare premiums for high income people, changes to Medicaid third party liability provisions and changes to the treatment of lottery winners to pay for the reauthorization.
Last week, Senate Majority Leader Mitch McConnell (R-KY) cancelled plans to hold a vote on the Graham-Cassidy bill. With Fiscal Year (FY) 2017 having ended on September 30, Congress can no longer use that fiscal year’s budget reconciliation process to pass the bill with a simple majority vote. It now requires 60 votes. This victory would not have been possible without the disability community. Had this bill become law, it would have:
- Capped growth in per capita Medicaid spending at below the cost of providing services;
- Replaced premium tax credits and Medicaid Expansion funds with a block grant that grows more slowly than current law and expires after 2026;
- Redistributed funds away from states that accepted Medicaid expansion; and
- Allowed states to let insurers sell plans that cover fewer services and charge more based on health status or disability.
The Senate Finance Committee hearing on the Graham-Cassidy-Heller-Johnson Proposal on September 25 was marked by high attendance of disability advocates. Protesters from ADAPT started a chant of “No cuts to Medicaid, save our liberty” and their arrests delayed the start of the hearing by 15 minutes. Senator Robert Casey (D-PA) mentioned The Arc’s advocacy and showed the stack of letters with stories from our advocates across the country.
While the cancellation of the vote on the “Graham-Cassidy” bill closed the door on Congress’s best opportunity to pass this legislation for now, there are still major challenges ahead. The 115th Congress can write two more budgets, one each for FY 2018 and FY 2019. With each budget, there is an opportunity for one reconciliation bill which requires only a simple majority to pass in the Senate. The reconciliation bill for FY 2018 will most likely focus on tax cuts. It is possible that Congress will attempt to cut Medicaid, Medicare, Supplemental Security Income, or other programs that pay for basic livings needs of people with disabilities as a way to offset revenue reductions. Additionally, Congress could attempt to pass an Affordable Care Act Repeal with Medicaid per capita caps and major tax legislation in one package. In summary, fewer pathways now exist to cut program that cover basic living expenses, but threats still remain. See article above for Congressional efforts to develop a new budget resolution similar to the most recent efforts which allowed for consideration of major Medicaid cuts and repeal of the Affordable Care Act in 2017.
On October 4, the House Committee on Energy and Commerce will hold a markup on a bill to reauthorize funding for the Children’s Health Insurance (CHIP) program. This markup will come after the program’s funding expires. Some state’s programs ran out of funding on September 30. The Arc urges swift passage of legislation to continue this vital program. See the committee’s announcement for more information.
The growing Senate interest in the Graham-Cassidy-Heller-Johnson bill last week has derailed bipartisan efforts by the Senate Finance Committee to reauthorize the Children’s Health Insurance Program (CHIP). The bipartisan leadership of the Senate Health, Education, Labor, and Pensions Committee has also ended efforts to stabilize the health insurance market places by extending the programs that help make health insurance affordable for people and making other small changes to the Affordable Care Act. These two efforts are critical to maintaining affordable health insurance for children and people in the individual health insurance market and The Arc urges Congress to address these critical issues.
Over the weekend, the Graham-Cassidy-Heller-Johnson proposal was revised. The new version appears to make adjustments to the funding provisions designed to benefit certain states. It also allows more state flexibility to waive requirements in the law such the essential health benefits, prohibiting discrimination based on disability, age, and other factors, covering preventive services without cost-sharing, charging people with pre-existing conditions higher premiums, and other provisions. It is unlikely that the bill will be scored by the Congressional Budget Office in time for a vote this week. The new version does not appear to alter the Medicaid per capita cap provisions which cuts and caps the traditional Medicaid program. The Arc continues to oppose this proposal and is deeply concerned about the impact it will have on people with disabilities who rely on the Medicaid program for access to health care and long term supports and services.
Today, September 25, at 2:00 PM EDT, the Senate Finance Committee is holding a hearing to consider the Graham-Cassidy-Heller-Johnson Proposal. Witnesses will include: Senator Lindsey Graham (R-SC); Senator Bill Cassidy (R-LA); former Senator Rick Santorum (R-PA); Dennis G. Smith, Senior Advisory for Medicaid and Health Care Reform, Arkansas Department of Human Services; Teresa Miller, Acting Secretary, Department of Human Services, Commonwealth of Pennsylvania; Cindy Mann, Former Deputy Administrator and Director of the Center for Medicaid and CHIP Services, Centers for Medicare & Medicaid Services, United States Department of Health and Human Services; and Dick Woodruff, Senior Vice President, Federal Advocacy, American Cancer Society Cancer Action Network. The is the first hearing on the legislation. Visit the Committee web site for more information or to access the hearing live today. Read The Arc’s written testimony here.
While the Congressional Budget Office announced it will not have time to analyze the health care coverage impact of the bill before the September 30 deadline, it is expected to release a report this week on the fiscal implications of the bill. Avalere released an analysis showing that there will be a total reduction of $215 billion between 2020 and 2026 compared to current law with all but 16 states seeing funding reduced. Kaiser Family Foundation estimates there will be a reduction of $160 billion compared to current law with all but 15 states losing funding. Overtime the overall cuts to the Medicaid program would total over $4 trillion through 2036. Cuts to the traditional Medicaid program would be more than $1 trillion over two decades.
The Senate has until September 30 to pass the Graham-Cassidy-Heller-Johnson bill with a simple majority vote. After that date, the legislation will require 60 votes to pass, unless Congress passes a budget resolution for fiscal year 2018 that contains reconciliation instructions intended to address health care. Last week, Majority Leader McConnell (R-KY) said that he intended to have a Senate vote this week. The vote is expected to be very close. If successful, expectations are that the bill would go immediately to the House floor for passage and then to the President for signature. This would be a devastating blow to people with disabilities and their families who have worked so hard this year to prevent block grants and per capita caps from destroying the Medicaid program – a program which provides basic health care and long term supports which make it possible for millions of people to live as independently as possible in their communities. The Washington Post printed a letter to the editor from The Arc’s Marty Ford expressing these concerns.