Tuesday, February 21, 2017

Health care policy update: ACA repeal details

The most important health policy news is coming out of Congress, but the impact statewide and locally will be huge.

In their repeal of the Affordable Care Act, leadership in the U.S. House of Representative is also proposing to repeal the expansion of Medicaid, as well as to restructure and cut Medicaid.

In Washington, 600,000 people gained coverage under the Medicaid expansion and uncompensated care was cut in half.

If you are on Apple Health, this will affect you. If you receive services through the state Developmental Disability Administration, this will affect you. Do you or your loved one get services through the Core, Basic Plus, CIIBS, Individual and Family Services, or Community Protection waivers? THIS AFFECTS YOU.

If you or a loved one is getting respite care, job coaching, or personal care support, this affects you.

Essentially the federal government is cutting Medicaid to pay for tax cuts. And Medicaid pays for health care AND the services that people with developmental disabilities rely on to live in the community.

How much is being cut? Over the course of a decade it could mean $20 billion or more, just for Washington. A loss of $2 billion a year, for 10 years, in federal funding could result in significant cuts to services to people with developmental disabilities.

If you haven't yet, start talking to your state legislators in addition to your representatives in Congress.

  • Find your representative in the U.S. House here (look in the upper right corner).
  • Contact Senator Patty Murray here.
  • Contact Senator Maria Cantwell here.
  • Find your Washington State representatives here.
Even if you think they already agree with you, CONTACT THEM. They need your story and voice. Following is a policy update from the national staff of The Arc. - Ramona Hattendorf, Director of Advocacy, The Arc of King County

Health Care - House Releases Outline of ACA Repeal

In advance of the President's Day recess, the House Majority Leadership released an outline of a plan to repeal the Affordable Care Act (ACA) and restructure and cut the Medicaid program. The outline indicates that the ACA's Medicaid expansion would be repealed. While states that have already accepted Medicaid expansion would be grandfathered, the federal match rate would be reduced from 90 percent to the state's traditional rate, reducing the incentive for states to continue the program. It would allow for an unspecified transition period, and then states that chose to keep the program open to new adult enrollees would be reimbursed at their traditional rate.

The plan would further destabilize the Medicaid program by reducing and capping federal spending. The proposal, known as a per capita cap/allotment, is a financing tool that will dramatically cut Medicaid funding. Unlike the current funding system, the amount provided under a per capita cap will not automatically increase when the cost of providing covered services to eligible individuals goes up. The intent of the per capita cap is to reduce federal spending by restructuring the program and significantly cutting the cost to the federal government. It is unlikely that states will be able to achieve these cuts without scaling back benefits, reducing reimbursement rates, or shifting costs to beneficiaries. Furthermore, states will no longer receive a federal match beyond the cap for changes that increase costs, such as increasing direct support professional wages. States would have the option to accept the per capita cap approach or a block grant (which would also have many of the same features).

The savings from the Medicaid per capita cap would help pay for the tax cuts included in the proposed plan. The outline proposes repealing the taxes on corporations and providers that helped pay for the ACA and the provisions that helped make health insurance affordable to the individual. The ACA replacement plan would combine a universal, refundable health care tax credit, based on age rather than income, to purchase insurance, changes to health savings accounts, and state funding for high risk pools or other projects. Health savings accounts are tax-advantaged savings accounts, tied to high-deductible plans.

The bottom line is that during the week of February 27 the House is expected to begin legislative action on a proposal to restructure the Medicaid program in a manner which will undermine the federal/state partnership upon which it has been built. If successful, this restructuring would result in cost savings to the federal government that will shift costs to the states and to individuals and their families. It will also ultimately reduce the availability of supports and services to people with disabilities in the community and through the health care system. Read The Arc's statement on the plan here