Happy Fourth of July!  As we head off to celebrate Independence Day, we hope that everyone will take this week to speak up to legislators.  Call, email, social media or stop by their local offices.



Last week, we learned about the Better Care Reconciliation Act (BCRA), which is the senate version of efforts to repeal and replace the Affordable Care Act.

Unfortunately it proposes primarily to reduce federal funding to Medicaid by 35% over 20 years (estimated just yesterday by the Congressional Budget Office).  

Below after the call to action is a summary of some of the key provisions in the BRCA.  However, we are already hearing about changes to the bill – “Horse Trading” between Senator McConnell and Republicans to try to get to the 50 Republicans they need to pass the bill.  This includes adding additional dollars to fight the opioid crisis, dollars for an innovation fund and dollars to support tax credits for health savings account.  They are working to get the votes over the holiday so they can come back the week of July 10 and vote on a revised bill.  We have heard from the Arc of the US that the House is at the ready to immediately vote to pass whatever the Senate agrees to.  WE NEED TO WORK AS HARD TO FIGHT ALL CUTS TO MEDICAID!  This is the time to Act!


  1. Call your Senators to ask them to “Oppose any cuts or caps to Medicaid”.  Go through this link so we can track who is calling.  Although our senators are supportive of Medicaid, it is still important to share stories, photos and impact of possible cuts.  You can email, call or link to them on social media (@SenatorDurbin, @SenatorDuckworth).
  2. Call, email or connect on social media with your Representatives – the need to keep the education up as well!  Go through this link so we can track who is calling.
  3. Use social media to engage your friends and families with the hashtags #SaveMedicaid; #NoCutsNoCaps, #JoinOurFight.
  4. Stop by legislative offices or check out this resource listing scheduled town hall meetings across the country (it is regularly updated) and find out if your Senators are hosting one.

You have probably been seeing great actions especially led by ADAPT around the country in Senators’ offices.  We need to keep the pressure on with stories, social media.

Overall Key Points About the Medicaid Provisions

  • The Senate bill is far worse than current law.
  • The Senate bill’s Medicaid changes are even more devastating than the House bill’s.
  • The Senate bill maintains the damaging per capita cap structure proposed in the House bill. Any per capita cap scenario will inevitably lead to loss of Medicaid eligibility and services for children and adults with disabilities as states cut eligibility and services under dramatically reduced overall federal funding levels.
  • The Senate bill continues to use cuts and caps to Medicaid as the source of revenue to pay for repealing taxes on health insurance, prescription drugs, medical devices, and numerous other provisions that fund the current law.
  • The Senate bill ends the extra matching funds for the Medicaid expansion states by 2024. No additional states would be allowed to expand Medicaid to cover low income adults.

The Senate bill includes provisions that appear to acknowledge several concerns raised about the Medicaid cuts in the House bill – but these provisions fail to fix the problems: 

  1. Harm to children who are blind or have disabilities
    The Senate bill exempts from the formula for calculating federal funding to states under the per capita caps “children under 19 years of age who are eligible for medical assistance under this title on the basis of being blind or disabled.”  However, there is no specific language in the bill that provides protections against cuts for children with disabilities or that further defines who these children are.  If this language targets children who are eligible for Supplemental Security Income (SSI) (about 1.2 million children), it would leave out many children who have health needs or disabilities but do not meet SSI’s strict income and disability standards.

    In reality, most states will not be able to make up the difference from the deep cuts under per capita caps and will not be able to protect any group. States will be focused on keeping Medicaid spending under the cap, or face penalties. The Senate bill’s cuts to Medicaid are expected to be similar in magnitude to the House bill’s (which cut $830 billion over 10 years). To make up for this massive loss of federal funding, states will be forced to cut services, eligibility groups, reimbursement rates for providers, make across the board cuts, or take other actions to cut costs.

    The net effect is that children with disabilities will not be protected.

  2. New penalties punish states for investing in Medicaid services
    Under the House bill, states with low Medicaid spending would forever be locked into current spending levels. States would not have resources to invest in rebalancing their service systems for people with disabilities, improving wages for direct support workers, or any other state priority. The Senate bill does the opposite of addressing this concern. It creates provisions to drive down spending in many states. Every year the federal government would compare each state’s spending to the average national spending. If your state is significantly below average spending in the different categories (kids, adults, people with disabilities older people) the state might get a bump in funding but if a state is above average the state may receive a cut in funding. This financially punishes the states that have invested the most in providing services to people with disabilities, seniors, and children. For many people with disabilities, being able to access timely needed care is a life or death matter—this is a crude and unfair attempt to ease the negative impact of per capita caps on low-spending states simply by shifting the harm to states that have prioritized their Medicaid programs. The penalties for states that spend more money on care do not account for key demographic and economic factors that shape differences in state spending.
  3. Meaningless Medicaid Home and Community Based Services (HCBS) Waiver Language
    Medicaid cuts and per capita caps will harm people with disabilities who need home and community-based services (HCBS) because with dramatically reduced federal funding, “optional” and “waiver” HCBS will likely be cut first. States will be forced to provide mandatory services like nursing home care before HCBS.  The Senate bill directs the Secretary of Health and Human Services to implement procedures to encourage states to address the issue – a meaningless and wholly inadequate response to this critical concern.

Additional Resources


Meg Cooch Signature
Meg Cooch
Executive Director
The Arc of Illinois
20901 S. LaGrange Rd. Suite 209
Frankfort, IL 60423
815-464-1832 (OFFICE)