All eyes are on Washington, D.C. as debate continues over repealing the Affordable Care Act and making dramatic cuts and caps to the Medicaid program. Minnesota disability organizations and individuals are among the voices from around the country fighting to save the needed funding and health care coverage. The vote is expected the second week of July.
As Access Press went to press the push was on to block the Better Care Reconciliation Act. The bill would repeal the Affordable Care Act and bring about the changes to Medicaid. Medicaid in Minnesota is known as Medical Assistance or MA. In Minnesota alone, more than 200,000 children and adults with disabilities receive MA.
It’s estimated that nationally, more than 10 million people would be affected. Lives are on the line, especially the ability to live and work in the community. People with disabilities make up 15 percent of Medicaid recipients but rely on 42 percent of the funding. Cuts could mean longer waits for service, reductions in some services and even elimination of services such as home and community-based waivers. School services are a huge worry.
According to the PACER Center, Minnesota schools annually receive approximately $45 million in Medicaid reimbursements for health-related services for students with disabilities, such as occupational, physical and speech therapy, assistive technology and specialized equipment. “If this bill became law, the important services and programs that Medicaid funds to support children with disabilities at home, school, and in the community would be at risk,” an alert from PACER said.
The impact could be greatest in Greater Minnesota. According to the Children’s Defense Fund of Minnesota, new research analysis shows that Medicaid plays a larger role in providing health coverage to people living in small towns and rural communities than it does in metropolitan areas. That is a trend nationally and in Minnesota that is particularly striking among children.
The report also found that the Affordable Care Act’s Medicaid expansion is having a disproportionately positive impact on small towns and rural areas. For everyone with disabilities, the Medicaid changes could affect clinic and hospital visits, personal care attendants, equipment, assistive technology and various behavioral, personal and employment services and supports. It essentially ends Medicaid as we know it.
Medicaid has long operated as an entitlement program. The federal government provides matching grants to states to cover the cost of caring for those who are eligible. The grants aren’t capped.
The House and Senate wish to make Medicaid into a per-capita cap system. Republican leaders promote the approach as providing more flexibility for states. Foes of the changes contend that services would be placed at risk as more pressure is put on state coffers.
Under the proposed changes states would receive set dollar amounts per person. That capped amount wouldn’t take into account the varying costs ofcare needed, especially for people with chronic health conditions, elders and people with disabilities. Each state would have to make up its actual costs of care under the proposed changes.
That has raised fears nationwide.
Minnesota’s senators, Amy Klobuchar and Al Franken have announced they will vote against the bill. Much of the lobbying effort in Minnesota has focused in asking people to contact senators from other states.
News reports indicated that the Senate would be looking at two versions of the bill. The Congressional Budget Office was to review the bills over the holiday break, which ends July 10. The Senate’s health care overhaul has severe Medicaid cuts similar to those approved by the U.S. House in May. The House bill cut Medicaid spending by $834 billion in the next decade.
According to the Congressional Budget office, the Senate health care proposal would slash $772 billion from Medicaid in the next decade. The nonpartisan budget office also said the Senate bill will trigger continuing disparities in federal support for Medicaid. “Despite the uncertainty, the direction of certain effects of this legislation is clear. For example, the amount of federal revenues collected and the amount of spending on Medicaid would almost surely both be lower than under current law,” the Congressional Budget Office stated.
“With less federal reimbursement for Medicaid, states would need to decide whether to commit more of their own resources to finance the program at current-law levels or to reduce spending by cutting payments to health care providers and health plans, eliminating optional services, restricting eligibility for enrollment through work requirements and other changes or (to the extent feasible) arriving at more efficient methods for delivering services,” the office stated.
The Medicaid cuts proposed have led to protests nationwide. Members of the national disability rights group ADAPT in June were arrested during protests in the Senate Office Building. They staged a “die-in” outside of Senate Majority Leader Mitch McConnell’s office.
ADAPT members rallied to protest the possible loss of community-based services and supports. News accounts indicated that many ADAPT members got out of their wheelchairs and laid on the floor in front of McConnell’s office. The Kentucky Republican is a lead author of the controversial bill. Pictures of the arrests of people with disabilities were seen around the world. More than 40 people were arrested.
ADAPT leaders said that if the changes are enacted, the consequences are dire. “To say people will die under this law is not an exaggeration,” said Mike Oxford, an ADAPT organizer from Kansas. He was quoted by the online news site Disability Scoop. “Home and community-based services are what allow us to do our jobs, live our lives and raise our families. Without these services many disabled and elderly Americans will die. We won’t let that happen.”
Nine ADAPT members were recently arrested and taken into custody after protesting at a Colorado senator’s Congressional office. More actions around the nation are planned.
Disability advocates from around the country are weighing in. “The bottom line is that under this legislation, Medicaid will be decimated. People will lose vital benefits and services that support their basic human right to a life in the community. It will turn back the clock on the progress we have made as a society over the last 65 years. It’s morally reprehensible, and our nation cannot let this happen,” said Peter Berns, CEO of The Arc.
“Thanks to the Medicaid expansion under the Affordable Care Act, millions of people, including people with disabilities, their family members, and their support professionals, have gained access to health coverage. Lives have been saved because people have had access to affordable, comprehensive health coverage. The tax credits and changes to health savings accounts proposed in this bill are not adequate to meet needs of people with intellectual and developmental disabilities or those with chronic health conditions,” said Berns.