Last week, the House and Senate advanced the most important spending bills for disability programs – Labor, Health and Human Services, Education, and Related Agencies (L-HHS-ED). Both would maintain overall sequestration funding levels and include a number of substantial cuts to programs, earning the promise of a veto by President Obama.
L-HHS-ED – Senate – The Senate bill passed the Appropriations Committee along party lines on June 25. The bill’s discretionary funding level is $3.6 billion below the Fiscal Year (FY) 2015 enacted level and includes numerous policy riders that would limit the activities of federal agencies. Several federal agencies would receive significant cuts and a small number would receive increases. Notable examples include:
- LABOR: Includes a 4% cut for Workforce Innovation and Opportunity Act (WIOA) programs.
- HHS: Includes a 28% cut for the Centers for Medicare and Medicaid Services (CMS) program management that would restrict the agency’s ability to operate the Affordable Care Act programs, Medicare, and Medicaid.
- EDUCATION: Includes a $1.1 billion cut for the Department. However, the IDEA state grant program would receive a nearly 1% increase.
L-HHS – House – The House bill passed the full Appropriations Committee along party lines on June 24 and would provide discretionary funding at $3.7 billion below the FY 2015 level. The bill also includes numerous policy riders. The House bill included spending cuts and select increases similar to those in the Senate bill:
- LABOR: Includes a 2% cut for the Employment and Training Administration that helps to implement Workforce Innovation and Opportunity Act (WIOA) programs.
- HHS: Includes a $344 million cut for CMS.
- EDUCATION: Includes a cut of $2.8 billion to the Department of Education. However, this includes an increase of $12 billion (4.3%) for IDEA grants to states.
See the funding levels for specific disability related programs.
The U. S. Supreme Court upheld the Affordable Care Act (ACA) again in deciding King v. Burwell. The justices, in a 6-3 ruling, said that Congress intended for federal subsidies to be available in every state, regardless of whether the state created its own marketplace. The Arc applauded the decision as a major victory for people with disabilities and others who need access to affordable health care.
The ACA is important to people with disabilities. It expanded coverage and reformed insurance to end discrimination against people with disabilities and enhance access to health care. The private health insurance marketplaces allow individuals or small businesses to shop for coverage and potentially receive subsidies to help offset the cost of insurance. The subsidies are key to ensuring affordable coverage. The health insurance reforms, the protections from high premium increases or out-of-pocket costs, and the coverage of “essential health benefits”, including mental health care and rehabilitative/habilitative services and devices, help assure that people with disabilities have affordable health care that meets their needs. To read The Arc’s statement visit our blog.
The House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies (L-HHS-ED) approved its Fiscal Year 2016 appropriations bill on an 8-4 party line vote. Funding for these agencies is reduced by 2.5% overall with cuts mostly targeted on the Affordable Care Act, family planning, and the Agency for Healthcare Research and Quality. Disability-related programs were largely level funded, and one received a sizable increase – the Individuals with Disabilities Education Act (IDEA) grants to states. The IDEA state grant would receive an increase of 4.3% over the 2015 funding level, bringing the federal share of the additional cost of providing special education from 16% to 17%. A detailed funding chart will be provided when more detailed line item funding is made available by the committee. The full House Appropriations Committee markup is scheduled for tomorrow and the Senate L-HHS-ED Subcommittee will take up their bill later this week.
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.
Open enrollment for health insurance offered through the marketplaces ended February 15, 2015. Extra time is allowed for people who started the enrollment process but did not finish. There are also special enrollment periods for people who lose their health coverage or experience another qualifying change in their situation. The administration is reporting that 11.4 million people signed up or were re-enrolled for health insurance during the open enrollment period. For more information about health insurance visit: https://www.healthcare.gov.
Open enrollment for health insurance marketplaces under the Affordable Care Act ends February 15. This is an opportunity for people who do not have health insurance to purchase it. There is also help with paying the costs of health insurance for low and moderate income individuals. To learn more about what is available in your state visit the health care website.
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.
On November 14, the White House released a new public service announcement on the Affordable Care Act and people with disabilities. It explains how individuals with disabilities can no longer be denied health coverage because of health history. The public service announcement was released to coincide with open enrollment, which began on Saturday, November 15, and ends on February 15. This time period will be a chance for individuals already enrolled in healthcare to re-enroll and for individuals not yet enrolled to sign up to begin receiving healthcare. To see the new announcement view it on The White House YouTube page. For additional information on coverage, please visit www.healthcare.gov.
Now is the time for individuals who are uninsured or looking for affordable health insurance to investigate the private health insurance plans available through state marketplaces (to find your state information visit the health care website. During “open enrollment”, a person can purchase private health insurance through the marketplace in each state. There may also be financial assistance to help with health care costs available for low and moderate income. It is also important for people who currently have insurance through the marketplace, to look at the plan and determine if it will continue to meet the needs of the person, or select a better plan. Individuals who do not take action will be automatically re-enrolled in the current plan. Re-enrollment is also an important opportunity for people to report any changes in income.
2015 Open Enrollment
November 15, 2014 – Open enrollment begins
December 15, 2014 – Enroll before this date to have coverage January 1, 2015
February 15, 2015 – Open enrollment ends
For more information and where to get help, read more on The Arc’s blog.