Budget /Medicaid – Majority and Minority Congressional Committee members submit separate deficit reduction proposals to the Joint Select Committee on Deficit Reduction; proposals largely divided along partisan lines
The House and Senate Committees had until the end of Friday, October 14 to submit their proposals for reducing the deficit to the Joint Select Committee on Deficit Reduction. The Joint Committee has received many recommendations from Congressional Committees as well as interest groups, advocates, and think tanks. It appears that most of the Committees did not submit recommendations from the full committees, opting instead to submit separate majority and minority recommendations.
House Democrats are urging the Committee to raise revenue, protect most programs from big cuts, and focus on job creation. Regarding health care, House Democrats’ recommendations came from the ranking members of the Ways and Means Committee; the Oversight and Government Reform Committee, and the Energy and Commerce Committee. All three called on the Joint Committee to maintain the basic promise of Medicare and Medicaid, to maintain the current Medicare eligibility age, and not to shift costs onto states or beneficiaries. They argued that such cost-shifting would transfer a financial burden to those who can least afford it and do nothing to reduce actual health care costs. The Democrats said that any health savings should be used to fix immediate Medicare problems, primarily by replacing the formula for reimbursing physicians who see Medicare patients. Although there is near-universal agreement that the formula needs to be replaced, the estimated cost of repealing it is $300 billion over 10 years and Democrats did not offer a detailed solution. The Democrats did say that money could be saved by the continued implementation of President Obama’s health care overhaul and by reducing waste, fraud, and abuse in government health care programs. Letters from ranking Democratic members in the House of Representatives are available on Nancy Pelosi’s website.
Of note are recommendations that would restructure the Medicaid program. Senate Finance Committee Republicans offered their recommendations, urging the panel to avoid any tax increases while overhauling entitlement programs, including Social Security. For Medicaid, the Senate Finance Republicans recommended “modernization of the program using the successful welfare reform model of the 1990s with states and governors leading the way through: Implementing fiscal responsibility by giving states defined budgets and empowering states to implement solutions for their citizens by giving states flexibility to modernize eligibility determination; developing and implementing provider reimbursement systems that encourage value over volume of services; designing benefits that comport with private-sector coverage, encouraging healthy beneficiary behavior, and better managing chronic disease; providing long-term care benefits with approaches that promote cost-effectiveness and self-directed services; and partnering with the federal government in providing more coordinated care for beneficiaries eligible for both Medicare and Medicaid.
CLASS Program – Obama Administration announces plans to halt work for now; House Energy and Commerce Committee schedules hearing
On October 14, Department of Health and Human Services Secretary Kathleen Sebelius released A Report on the Actuarial, Marketing, and Legal Analyses of the CLASS Program. The report details the work of the Administration in preparation for implementation of the Community Living Assistance Services and Supports (CLASS) Program, a national premium-based, long term supports insurance plan designed to assist people to meet their long term service needs without requiring them to become impoverished for Medicaid eligibility. In his September 20th Actuarial Report on the Development of CLASS Benefit Plans, Bob Yee, CLASS Office Chief Actuary, concluded, “We believe the CLASS Benefit Plan can be designed to be a value proposition to the American workers as the CLASS Act prescribed it. Much work remains to be done on plan development. The ultimate size of its enrollment will depend on marketing efforts to produce wide public acceptance of the CLASS Program.” Despite that conclusion by the actuary, Secretary Sebelius announced on October 14, that “despite our best analytical efforts, I do not see a viable path forward for CLASS implementation at this time.” Other concerns, including legal and marketing concerns, played a role in the Secretary’s decision. The Arc and other advocates of the CLASS Program will continue to work with Congress and the Administration to resolve the problems identified so that the program can move forward to address this critical area of unmet need.
In the meantime, the House Energy and Commerce Committee’s Subcommittees on Health and on Oversight and Investigations will hold a joint hearing titled “CLASS [Community Living Assistance Service and Supports] Cancelled: An Unsustainable Program and Its Consequences for the Nation’s Deficit.” has scheduled for Wednesday morning.
Health Care Reform – Medicaid eligibility
The House Ways and Means Committee approved H.R. 2576 a bill to that would affect eligibility determination in 2014 for Medicaid and the subsidies for health insurance coverage under the Affordable Care Act. The bill makes changes to how the modified adjusted gross income (MAGI) is calculated. MAGI is used in determining eligibility for the programs. The bill requires that the MAGI include all Social Security Income including disability and survivor benefits rather than just the taxable amount of Social Security. The Congressional Budget Office estimates that there may be a net loss in health insurance coverage with between 500,000 and one million people losing Medicaid eligibility in 2014 and after. Many of these individuals may be eligible for premium subsidies in the health insurance exchanges.
Education – Elementary and Secondary Education Act Reauthorization introduced
Senator Tom Harkin (D-IA), Chair of the Senate Committee on Health, Education, Labor and Pensions, introduced a bill to reauthorize the Elementary and Secondary Education Act. Under the bill, each state would be required to adopt “college and career ready” standards in reading, math, and science that would allow students to take courses at a public college without needing remedial coursework. Gone would be the requirement that all students be proficient in reading and math by 2014.
The Senate bill would allow states to design their own accountability systems, and measure student growth in addition to meeting a specific proficiency standard. The accountability system would identify chronically struggling schools – the bottom 5% – and another 10% with the largest achievement gaps among subgroups of students, including students with disabilities, for intervention. A new competitive grant program would target schools with very high dropout rates. The bill emphasizes rewarding good principals and teachers and would allow states to design their own personnel evaluation systems. The HELP committee will begin marking up the legislation on October 18 and Chairman Harkin hopes to have the bill on the Senate floor before Thanksgiving. For more information and to see a copy of the proposed Senate bill, go to the HELP committee website.
Child Abuse – Bill introduced to Stop Child Abuse in Residential Programs for Teens
The Stop Child Abuse in Residential Programs for Teens Act was introduced in the Senate by Sen. Tom Harkin (D-IA) (S. 1667) and in the House by Rep. George Miller (D-CA) and Rep. Carolyn McCarthy (D-NY) (H.R. 3126). The legislation seeks to end child abuse in residential programs for teens by providing the reporting mechanisms, funding, surveillance, and training requirements needed to ensure that residential programs for teens are staffed with qualified, equipped, and safe personnel. The Arc supports efforts to ensure that people with disabilities are free from abuse, neglect, or any kind of mistreatment and to assure a well-trained workforce.
Major Events This Week
FY 2012 Appropriations – Deadline looming for stopgap spending bill with important decisions still to be made
With a month to go before stopgap spending runs out, Congressional leaders must resolve a number of issues before Congress can wrap up the Fiscal Year 2012 budget cycle. Appropriators are waiting for leaders to decide how to divide the $1.043 trillion in discretionary funds allocated for the 12 annual spending bills set by the Budget Control Act. House and Senate leaders also will have to devise a legislative strategy for clearing a spending law. The two likeliest options are packaging small groups of bills into what are called “minibus” measures or writing one catchall omnibus bill. That decision could depend on how well the Senate handles its three-bill minibus this week, one of which is the Transportation-HUD spending bill that includes funding for disability related housing and transportation programs.
Appropriators hope to finish work by Nov. 18, both to avoid another stopgap continuing resolution and to beat the deadline for the Joint Select Committee on Deficit Reduction to issue its recommendations. However, a November finish is very ambitious as the House has passed six of its 12 bills while the Senate so far has passed only one. In addition, larger ideological issues are likely to complicate the process for some bills, particularly the Labor, HHS, and Education funding bill which funds the majority of disability-related discretionary programs. A draft House version of the Labor-HHS-Education bill would block funding for the health care reform law, which would be unacceptable to Democrats.
Survey on Rehabilitative and Habilitative Services
The ITEM Coalition is continuing to collect responses to their survey on private health insurance coverage of rehabilitative and habilitative services and devices. The coalition is collecting information on typical coverage of these services and devices by employer-sponsored health insurance plans. The Coalition is particularly interested in things like physical therapy, occupational therapy, speech therapy, etc. and devices (durable medical equipment) and things like orthotics, prosthetics, or other assistive devices.
If you – or someone you can respond for – has health insurance through an employer and have ever had a disability or chronic condition, please take a moment to respond to this quick 10 question, anonymous survey called “Insurance Coverage of Rehabilitative and Habilitative Devices,” at http://www.surveymonkey.com/s/LY58SY5. The results will help the ITEM coalition members to advocate for comprehensive coverage of these services and devices within the new insurance exchanges.
ADA – US Access Board announcement
The US Access Board announced that it will develop guidelines to address acoustics in classrooms that are newly constructed or significantly renovated. For additional information, please see http://www.access-board.gov/acoustic/index.htm.
The Federal Emergency Management Agency (FEMA) in the Department of Homeland Security announced that it was hiring Regional Disability Integration Specialists in each of its 10 regional offices. Advocates have urged FEMA to put disability specialists in the regions to help ensure that the needs of individuals with disabilities are addressed during disaster planning, response, and recovery efforts.
Tony Paulauski Executive Director
The Arc of Illinois
20901 S. LaGrange Rd. Suite 209
Frankfort, IL 60423