The National Commission on Fiscal Responsibility and Reform held its final meeting and voted on its proposals for resolving the nation’s fiscal problems. The Commission’s Chairmen Erskine Bowles and former Senator Alan Simpson were unable to garner 14 of the 18 members necessary to support the proposals necessary to issue formal recommendations. The final vote in support of the report was 11 to 7. However, the Commission released The Moment of Truth: Report of the National Commission on Fiscal Responsibility and Reform on December 1 which has already generated substantial discussion in Congress and the White House. While there is no official recommendation from the Commission, we can expect to see various Commission proposals surfacing over the next few weeks and months and throughout the 112th Congress as Congress and the White House struggle to address the federal deficit.
Many of the Commission proposals would have a devastating impact on people with disabilities or programs designed to support them. The following are a few highlights.
- The plan would increase the normal retirement age to 69.5 and the early retirement age to 64 over time. This is effectively a cut in benefits and could create pressure on the disability program for those who cannot work longer. The plan proposes a “hardship exemption”, with little detail.
- The plan proposes a change in the benefit formula that gradually reduces the benefits the workers will receive in retirement, except those in the very lowest income bracket.
- The plan would reduce the annual cost of living adjustment (COLA) amounts, effectively reducing benefits over time – by about 6 percent for a person receiving benefits for 20 years. A benefits “bump up” is included for people receiving benefits for 20 years, but it does not make up for the amounts lost to the reduced COLAs.
- The plan includes a minimum benefit equal to 125 percent of the poverty line for 30-year workers, which would benefit some low-income workers.
- The plan would very gradually (over 35 years) bring 90 percent of earnings into the FICA tax range (as it was in 1983). Only about 84 percent of earnings fall under the range now. Closing that gap immediately could nearly eliminate Social Security’s entire projected shortfall.
- The proposal calls for reform or repeal of the Community Living Assistance Services and Supports (CLASS) Act, which is the newly enacted voluntary, premium-based long term services insurance program to assist individuals to meet their needs without becoming impoverished for Medicaid eligibility. The CLASS program is required by law to be solvent over a 75-year period and is currently under development by the Secretary of Health and Human Services.
Medicare, Medicaid and other health care programs
The Commission recommends many changes to Medicare, Medicaid and other health care programs to reduce costs. They include accelerating or expanding many of the cost savings included in the Affordable Care Act. While the DPC will analyze each of the proposals for their impact on people with disabilities, below are examples of the changes most likely to impact our constituents:
- Increase cost-sharing for Medicare beneficiaries by creating a single annual deductible of $550 for both hospital care and medical care and a uniform 20% coinsurance on health spending above the deductibles. By 2015 this is estimated to save $10 billion in Medicare spending.
- Prohibit Medigap plans from covering the first $500 in health care spending and limit coverage to 50% for the next $5,000 in Medicare cost-sharing. The Commission’s plan would save an additional $4 billion by 2015.
- Reform the physician payment system and fully pay for all of the costs. Congress has been stopping large cuts to physicians and other health care providers that were implemented to save money in the Medicare program. If the cuts were allowed to take affect it would mean a 23% cut in payments to providers beginning in 2012. It is very expensive to fix the problem as the commission estimates that freezing payments from 2012 to 2020 would cost $267 billion.
- Place dual eligibles (people who receive both Medicare and Medicaid) in Medicaid managed care. This would save $1 billion by 2015.
- Reduce funding for Medicaid administrative costs. This would save $260 million by 2015.
- Place a global cap on all health care spending, which could include Medicaid block grants
- Reduce the tax benefit for employer-provided health insurance.
The Arc and UCP joined the Consortium for Citizens with Disabilities (CCD) in commenting on two important issues that were addressed in the Affordable Care Act (ACA). The Centers on Medicare and Medicaid (CMS) had issued a Notice of Proposed Rulemaking on new requirements for accountability and transparency in the review and approval of Section 1115 demonstrations. Section 1115 demonstrations are used by states to test new ideas in Medicaid coverage. Individuals with disabilities have much at stake when changes to Medicaid policy are considered and there must be an opportunity for input by individuals with disabilities, their families, providers that support them, and other state and national advocates when the state and federal government are considering changes. See our comments at http://www.thearc.org/document.doc?id=2784
The CCD also responded to the National Committee for Quality Assurance’s (NCQA) request for comment on standards for the new Accountable Care Organizations (ACOs). NCQA is a private, not-for-profit organization that develops quality standards and performance measures for a broad range of health care entities. ACOs are a new way of organizing health care delivery to encourage cost savings and improved quality and access to care. CCD urged NCQA to require ACOs to link costs savings to patient outcome measures so that the system provides incentives to both improve the quality of care and patient outcomes while working toward better efficiencies. See http://www.thearc.org/document.doc?id=2789
UCP and The Arc also provided comments on proposed regulations implementing additional fraud screening requirements and other proposals to prevent and stop fraud by providers and suppliers in the Medicare and Medicaid programs. UCP and The Arc sought clarification on how affiliates and chapters who provide Medicaid services would be treated under the new rules and provided comments on the proposed new payment suspension provisions when there is an investigation of an allegation of fraud.
The U.S. Department of Education hosted a celebration attended by several hundred advocates honoring the 35th anniversary of the enactment of P.L. 94-142, the Education for All Handicapped Children Act, now known as IDEA. Later that evening another IDEA celebration was held where three pioneers of special education policy who played instrumental roles in the enactment of P.L. 94-142 were honored: Dr. Edwin Martin, the Director of the then known federal Bureau for the Education of the Handicapped; Thomas Gilhool, who argued the landmark PARC v. Pennsylvania special education court case; and the DPC’s Paul Marchand, who helped lead the lobbying effort to pass the law.
DPC staff and representatives of other national disability organizations met with staff of the Senate Health, Education, Labor and Pensions (HELP) committee and learned that S.3895, The Keeping All Kids Safe Act, will not move forward in this session of Congress. It is possible that new legislation could be introduced in the next session of Congress. Senator Burr (R-NC) indicated his continuing interest in addressing restraint and seclusion in schools. Advocates will be looking for a Democratic sponsor given the retirement of Senator Dodd (D-CT) from the Senate.
Disability Policy Collaboration staff participated in a meeting of disability advocates with the leadership of the Department of Justice’s Civil Rights Division. Assistant Attorney General Tom Perez and his senior staff led a lengthy discussion of key issues being worked on by the Civil Rights Division. The DOJ officials reaped high praise from the disability community in relationship to their work on ADA and Olmstead implementation and enforcement. The participants also discussed other issues related to disability rights.
Disability Policy Collaboration staff participated in a two day Administration on Developmental Disabilities (ADD) Regional Summit held in Orlando. One of five planned regional summits, these meetings are intended to solicit stakeholder views on future priority directions for the ADD. ADD Commissioner Sharon Lewis led the Summit. There will be two more summits in this series – Detroit (December 2) and Denver (December 6). For more information, see http://www.envision2010.net/index.php
On Thursday, the U.S. Department of Education will host a celebration of the 35th Anniversary of the enactment of P.L.94-142, the Education for All Handicapped Children Act, now known as the Individuals with Disabilities Education Act (IDEA). DPC staff will be among the celebrants. Following that event, a Hill reception will be held where disability advocates who have played major roles in national special education public policy will be honored. The DPC’s Paul Marchand will be among the honorees.
The DPC’s Paul Marchand and Marty Ford participated in the invitation-only National Council on Disability’s Earning Forum in Detroit. This regional policy forum focused on employment and financial security for people with disabilities and built upon discussions begun at NCD’s Living, Learning, & Earning Summit in July which launched a national dialogue on disability policy in the wake of the 20th anniversary of the Americans with Disabilities Act. Participants discussed current challenges and opportunities to employment, the impact of health care reform, private employer perspectives, asset development and economic security, and a federal focus on employment. One half-day was devoted to employment issues specific to people with intellectual and other developmental disabilities. Additional regional forums are expected to focus on the living and learning aspects of the summit. See the agenda at http://www.ncd.gov/newsroom/news/2010/NCD%20Earning%20Forum%20Agenda%20_2_.pdf
The DPC staff will be attending The Arc’s annual convention on Orlando, Florida this week. Our offices will be closed from Wednesday, Nov 3 until Monday, November 8.