Fighting Trumpcare

In The Politics of Autism, I discuss Medicaid services for people with intellectual and developmental disabilities, as well as other government programs at the federal and state levels.

People with disabilities and their families have pushed back against Trumpcare.  Their protests have impact because the public tends to have more sympathy for the disabled than for able-bodied program recipients.

Jeff Stein at Vox:

“I think the concern of citizens generally has made an impact on me, yeah. Obviously, I get it a lot of feedback from the other side, too, in editorials and newspapers like the Wall Street Journal attacking me,” said Sen. Rob Portman (R-OH), one of the crucial swing votes on the bill. “And then you have the protesters on the other side ... those voices are heard, absolutely.”

It’s hard to keep an exact tally of the flurry of health care activism since Republicans took control of Congress. Daily Action, one progressive group, reported 200,000 calls — which, when added together, would stretch to a combined 495 days of call times — to Senate GOP offices over the health bill. Dozens of activists with disabilities have been arrested at sit-insprotesting Medicaid cuts throughout the country.

More than 400 protesters have been arrested in the Capitol alone over the past three weeks, including the NAACP’s William Barber. Activists have chartered planes to fly anti-TrumpCare banners in West Virginia and Ohio; others have driven anti-TrumpCare tractors or launched cross-state bus tours.

In Fort Wayne, Brian Francisco reports at The Journal-Gazette:

About 40 people played dead for one minute Tuesday outside the E. Ross Adair Federal Building and U.S. Courthouse downtown.

Holding paper replicas of tombstones, they lay down on the plaza in front of the building to silently protest Republican efforts in Congress to repeal and replace the Affordable Care Act. Rowan Greene, dressed as the Grim Reaper, walked among the reposing crowd.

Their demonstration – organized by Indivisible, Fort Wayne Liberation Movement and United Activists of Fort Wayne – was aimed at a tenant of the federal building: Sen. Todd Young, R-Ind., who has not said how he will vote on the Better Care Reconciliation Act.
...

Susan Catterall of Hamilton, a mother of two adult children with autism, said people with disabilities are at risk of losing medical care if Congress curbs state Medicaid expansions created by the Affordable Care Act. She said Indiana's expanded Medicaid program, known as Healthy Indiana Plan 2.0, has drastically cut the waiting time for people enrolling in home services for autism and developmental disabilities.

“This is the United States of America. We are capable of taking care of the disabled, the poor and the elderly,” Catterall shouted to the crowd.

AMA Opposes Vaccine Commission

In The Politics of Autism, I look at the discredited notion that vaccines cause autism

Sara Berg writes at AMA Wire:

At the 2017 AMA Annual Meeting in Chicago, the AMA House of Delegates (HOD) adopted policies aimed at protecting children’s health by addressing vaccine policy...
It remains clear that the use of vaccines benefits public and individual health. Yet the authors of a resolution on the topic said that “physicians remain concerned the current federal administration may attempt to establish new vaccine policy based on unfounded and unscientific facts.”

In recognition that vaccinations are safe and effective, and that their benefits far outweigh any risks, the AMA adopted policy that:

• Supports the rigorous scientific process of the Advisory Committee on Immunization Practices as well as its development of recommended immunization schedules for the nation.
• Recognizes the substantial body of scientific evidence that has disproven a link between vaccines and autism.
• Opposes the creation of a new federal commission on vaccine safety whose task is to study an association between autism and vaccines.

“The AMA fully supports the overwhelming body of evidence and rigorous scientific process used by the Advisory Committee on Immunization Practices which demonstrate vaccines are among the most effective and safest interventions to both prevent individual illness and protect the health of the public,” William E. Kobler, MD said in a statement. Dr. Kobler is a member of the AMA Board of Trustees.

“We are deeply concerned that creating a new federal commission on vaccine safety to study the already disproven association between autism and vaccines would cause unnecessary confusion and adversely impact parental decision-making and immunization practices,” Dr. Kobler added. “The United States has a long-standing system for ensuring the ongoing development, safety, and efficacy of vaccines.”

“The AMA will continue its work to promote public understanding and confidence in the use of vaccines in order to prevent resurgence in vaccine-preventable illnesses and deaths,” concluded Dr. Kobler.

Crime Against People with Disabilities

In The Politics of Autism, I write that people with disabilities are victims of violent crime much more often than people without disabilities. The Bureau of Justice Statistics does not report separately on autistic victims, but it does note that the victimization rate is especially high among those whose disabilities are cognitive. 

Erika Harrell has a report at the Bureau of Justice Statistics titled "Crime Against Persons with Disabilities, 2009-2015 - Statistical Tables."

In 2015, the rate of violent victimization against persons with disabilities (29.5 victimizations per 1,000 persons age 12 or older) was 2.5 times higher than the rate for persons without disabilities (11.8 per 1,000), which was adjusted to account for the differences between the age distributions for persons with and without disabilities (see Methodology) (figure 1). 1 In every year from 2009 to 2015, the rate of violent victimization against persons with disabilities was at least twice the age-adjusted rate for persons without disabilities. The rate of violent victimization increased from 2011 to 2012 for both persons with and without disabilities. From 2012 to 2015, the rate  emained steady for persons with disabilities and decreased for persons without disabilities.

...
During 2011-15, persons with cognitive disabilities had the highest rates of total violent crime (57.9 per 1,000), serious violent crime (22.3 per 1,000), and simple assault (35.6 per 1,000) among the disability types measured [emphasis added]

Conservative Case for Medicaid

In The Politics of Autism, I discuss Medicaid services for people with intellectual and developmental disabilities, as well as other government programs at the federal and state levels.

Since the 1960s, when California Governor Ronald Reagan signed the Lanterman Act, conservative Republicans have often supported legislation to help people with disabilities. (Rick Santorum, for instance, was prime Senate sponsor of the Combating Autism Act of 2006.)  One persuasive argument for conservative support is that it is more efficient and effective to help people with disabilities achieve independence than to pay for their institutionalization. Pay now, or pay later.

A couple of recent articles explain why conservatives should oppose the Medicaid cuts in BCRA.

Matthew Herr at The Hill:

HCBS keep people with mental illness, Intellectual & Developmental Disabilities (I/DD), and traumatic brain injury (TBI) — including members of our state’s sizable veteran population — in their communities and out of institutions. The data has shown over, and over, and over again that HCBS are one of the most fiscally effective parts of Medicaid. They are two to 30 times less expensive than comparable institutional placement. And they produce better results.

By keeping people in their communities, HCBS also promote independence and self-reliance. People who stay in their communities contribute to their communities. They live fuller, freer, more productive lives. They are more likely to get and maintain employment, and pay taxes as a result. Without access to HCBS, more Americans will face a life of purgatory in costly state-managed institutions — where the government can decide where you will live, when you eat, and what you do in your spare time.

With soaring healthcare costs, we absolutely need to rein in spending where it is wasteful. But why are we trying to pass healthcare legislation that would gut the most fiscally effective parts of Medicaid?

Jason Sattler at USA Today:

The 50 unique state programs cover 60% of all children with disabilities, affirming the “pro-life” decisions of parents to have children regardless of the potential complications. The expenses incurred by parents of kids with severe special needs are so immense that even affluent families could be bankrupted without the supplemental support of Medicaid.

The Senate GOP argues its proposed Medicaid cuts of up to 39%, which survived the bill’s second draft intact, won’t hit families caring for children with disabilities.
But don’t believe the spin.

Yes, there is a “carve out” to protect “blind and disabled” children, but that will only protect a “fraction of kids” with severe special needs, according to Janis Guerney, co-public policy director at Family Voices. Additionally, kids with “complex conditions — such as cystic fibrosis, autism and Down syndrome — would be vulnerable to whatever cuts their states make,” according to Kaiser Health News’ Jordan Rau.

States, which have to balance their budgets by law, will be forced into constant “Sophie’s Choices” requiring them to decide who is most deserving of care — the elderly, poor kids or people with disabilities.

IDEA Performance

In The Politics of Autism, I write about special education and the Individuals with Disabilities Education Act.

From the US Department of Education:

Following is a list of each State’s performance in meeting the requirements of IDEA Part B, which serves students with disabilities, ages 3 through 21:

 MEETS REQUIREMENTS
Alabama, Connecticut, Delaware, Federated States of Micronesia, Iowa, Kansas, Kentucky, Massachusetts, Minnesota, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Carolina, North Dakota, Oklahoma, Pennsylvania, Republic of Palau, Republic of the Marshall Islands, South Dakota, Tennessee, Virginia, Wisconsin, Wyoming

 NEEDS ASSISTANCE (one year)
District of Columbia, Florida, Illinois, Indiana, Nevada, West Virginia

 NEEDS ASSISTANCE (two or more consecutive years)
Alaska, American Samoa, Arkansas, Arizona, California, Colorado, Commonwealth of the Northern Mariana Islands, Georgia, Guam, Hawaii, Idaho, Louisiana, Maine, Maryland, Michigan, Mississippi, New Mexico, New York, Ohio, Oregon, Puerto Rico, Rhode Island, South Carolina, Texas, Utah, Vermont, Virgin Islands, Washington

 NEEDS INTERVENTION (six consecutive years)
Bureau of Indian Education

IDEA PART C DETERMINATIONS:

Following is a list of each State’s performance in meeting the requirements of IDEA Part C, which serves infants and toddlers birth through age 2:

 MEETS REQUIREMENTS

Alabama, Connecticut, District of Columbia, Georgia, Indiana, Iowa, Kentucky, Maryland, Michigan, Minnesota, Mississippi, Missouri, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Puerto Rico, Rhode Island, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, Wyoming

 NEEDS ASSISTANCE (one year)

Arkansas, Colorado, Idaho, Kansas, Montana, Nebraska, South Carolina

 NEEDS ASSISTANCE (two or more consecutive years)

Alaska, American Samoa, Arizona, Commonwealth of the Northern Mariana Islands, Delaware, Florida, Guam, Hawaii, Illinois, Louisiana, Maine, Massachusetts, New Jersey, Oklahoma, South Dakota, Tennessee, Vermont, Virgin Islands

 NEEDS INTERVENTION (one year)

California

Trump's Fake Appeal on Health Care

In The Politics of Autism, I discuss Medicaid services for people with intellectual and developmental disabilities, as well as other government programs at the federal and state levels.

In his weekly radio address, Trump attacked the Affordable Care Act and mentioned an autism family whose premiums had gone up.  What he did not mention is that Trumpcare would hurt people with autism.

• The Medicaid cuts would hit millions of kids with disabilities such as autism.
• The cuts would cause states to scrap home and community-based services, notwithstanding a sham "demonstration project" in the bill.
• A new provision would cause premiums to soar for people in the individual market with preexisting conditions such as autism.  A letter from America's Health Insurance Plans and the Blue Cross/Blue Shield Association explains:

The Consumer Freedom Option allows insurers to sell products that must comply with all rules in current law alongside plans that do not comply with current insurance reforms – meaning they are allowed to refuse offering coverage to certain people, charge different rates based on age and gender, and not provide comprehensive health benefits. This would allow the new plans to “cherry pick” only healthy people from the existing market making coverage unaffordable for the millions of people who need or want
comprehensive coverage, including, for example, coverage for prescription drugs and
mental health services.

...
As healthy people move to the less-regulated plans, those with significant medical needs
will have no choice but to stay in the comprehensive plans, and premiums will skyrocket
for people with preexisting conditions. This would especially impact middle-income families that that are not eligible for a tax credit. Taxpayers will pay more to finance
federal tax credits for the individuals in comprehensive plans and these costs will continue to increase, even with dedicated funding. Risk adjustment is also critical to making the individual market sustainable, but can only work when there are uniform
benefit requirements across the market.

HCBS Provision

In The Politics of Autism, I discuss Medicaid services for people with intellectual and developmental disabilities, as well as other government programs at the federal and state levels.

Michelle Diament reports at Disability Scoop:

Tucked inside the latest version of the Senate bill, unveiled Thursday, is a proposal for a new waiver that states could apply to “for the purpose of continuing and/or improving home and community-based services.”

However, the waiver proposal, which would allow states to receive full federal funding for home and community-based services, is limited in scope. It would be available as a four-year demonstration project for just a handful of states and overall funding for the initiative would be capped at $8 billion total.

As NAACP leader Roy Wilkins once said of a weak civil right bill: the provision is a "soup made from the shadow of a thin chicken that had starved to death."