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Tuesday, June 27, 2017

Senate Trumpcare Update

Mitch McConnell has postponed the Senate vote on Trumpcare.  One reason for the bill's extreme unpopularity is its impact on people with disabilities.

Darla Mercado at CNBC:
If you depend on Medicaid to supplement the cost of care for your special needs child, now is the time to reassess your long-term plans.
Some 11.2 million children in the U.S. have special needs — and of these, nearly 5 million rely on coverage from Medicaid and its Children's Health Insurance Program, according to the Kaiser Family Foundation.
Now, funding to those programs is imperiled as the House and Senate debate their health-care bills. The House proposal, the American Health Care Act, would reduce Medicaid spending by $834 billion from 2017 to 2026, according to the Congressional Budget Office.

Meanwhile, under the Senate bill, known as the Better Care Reconciliation Act, federal spending on Medicaid would decrease by $772 billion from 2017 to 2026, according to the Congressional Budget Office. The bill phases out Obamacare's Medicaid expansion program.
Dr. Lynne Williams at The Pittsburgh Post-Gazette:
While Medicaid is the sole health insurance for low-income families, it also serves as secondary insurance for families of all income levels whose children have “medically complex conditions” that require life long specialized health care. Medicaid supports children with cancer, cystic fibrosis, diabetes and autism, among a long list of serious conditions.
With Medicaid funding, children receive ventilators so they breathe, insulin to regulate their blood-sugar levels and behavioral health counseling to help them learn to engage with their families. Medicaid supports kids in school, too, providing additional learning support and therapists.
Thanks to Medicaid, these children receive comprehensive and preventive health care services to keep them healthy and out of the hospital. Without it, many families would face bankruptcy. Or worse, children would suffer and not get the care they need.

The proposed U.S. Senate version of the House’s American Health Care Act has been clear about one thing: Medicaid will be capped and cut. The legislation effectively would transfer all the financial risk to our state government — already running a budget deficit of more than $1 billion — which would be left to its own devices to figure out who gets help and who gets hurt.
Harold Pollack at Slate:
Within the disability community, block grants establish a poisonous zero-sum dynamic across different constituencies that have wildly varying needs and that command very different levels of resources. My own family receives intellectual disability services within Medicaid’s Home and Community Based Services program. Many medically fragile kids do the same, as articulated by Natalie Weaver in this poignant video. Such programs serve many middle-class families with politically potent connections and family stories. Less influential, cute, or cuddly constituencies may be elbowed aside within the Darwinian politics that block grants promote.

These dangers are compounded because BCRA weakens federal oversights. BCRA does require states to offer a basic package of Medicaid services. Yet its 142 pages are notably silent regarding granular details that give these requirements real meaning. These details include how states managed eligibility requirements and waiting lists, how often Medicaid will allow a growing child with cerebral palsy to replace her wheelchair, Medicaid reimbursement levels to specialty physicians, and more. Block grants pressure states to nickel-and-dime patients and providers on each of these matters.

Legal scholar Nicholas Bagley notes that BCRA gives governors breathtaking powers to demand essentially nonrevocable eight-year waivers to alter insurance provision and regulation in their states. The ACA imposes a reasonably stringent process through which the Department of Health and Human Services oversees state waivers. BCRA instead requires the HHS secretary to grant a waiver as long it does not “increase the federal deficit.”