July 6 Washington Update
Greetings from Washington. Congress has been in recess this week, so the health policy community has been intensely focused on analyzing last week's Supreme Court decision about the Affordable Care Act (ACA).
The ACA after the Supreme Court decision. It was hoped by many that the Supreme Court would clear up uncertainty about the future of the ACA. While its decision last week upheld most of the law, including the requirement that individuals be covered by insurance or pay a penalty, the Court's ruling on Medicaid actually created new a new set of questions.
The Court effectively converted, into a state option, the ACA's state "mandate" to expand Medicaid eligibility to all individuals with incomes below 133% of the Federal Poverty Level (FPL). The population affected is primarily low-income, childless adults, and may include some people with disabilities who do not get Medicaid on some other basis, such as those who can work but have jobs that do not offer insurance coverage. The Medicaid expansion was supposed to provide insurance coverage to more than half of the 30+ million expected to gain coverage under the ACA.
The Governors of at least two states (Florida and Louisiana) have stated that their states will not implement the Medicaid expansion intended by the ACA. Other governors have also expressed reluctance to do so. Although the federal government picks up 100% of the cost of the expansion for the first three years, the state share will gradually increase to ten percent in 2020. Governors have voiced concern about their states' ability to afford the ten percent matching rate down the road, and concern that the federal share could become less generous in the future.
In addition, states have an incentive not to cover individuals with incomes between 100 and 133 percent of poverty. If these people are on Medicaid, the states must (eventually) pay for a portion of their coverage. But, if these individuals are not on Medicaid, they will be eligible for federal subsidies to purchase private health insurance on the Exchanges.
Notably, citizens with incomes of less than 100% are not eligible for any subsidies (since the ACA assumed they would be covered by Medicaid). On the other hand, legal immigrants with incomes below 100% of FPL are eligible for premium subsidies if they are ineligible for Medicaid due to a waiting period imposed on immigrants.
States have until 2014 to make their decisions on the Medicaid expansion, and many observers think that most states ultimately will take up the option. After all, the federal match is much more generous than the match provided for covering other Medicaid-eligible individuals. In addition, it is expected that public hospitals and other health care providers serving many uninsured individuals will pressure state governments to expand Medicaid eligibility.
It is also possible that the Department of Health and Human Services can figure out ways to encourage states to adopt the expansion. On the other hand, states now have negotiating power with the administration. They could propose covering only part of the population with incomes below 133% of poverty - such as those with incomes under 100 percent. States might also decide to adopt the expansion only for the three years that the federal government covers all of the cost, and cut back eligibility thereafter.
An Urban Institute paper issued yesterday provides a detailed estimate, with state breakdowns, of those likely to be left uninsured if states choose not to expand Medicaid. According to this study, the ACA would have expanded eligibility to 15.1 million adults. Of these, 11.5 million people would not be eligible for premium assistance. Of those, approximately 1.4 million live in California, 1.0 million live in Florida, and 1.3 million live in Texas.
It should also be noted that states could not only decline to expand Medicaid eligibility but, as of 2014, when the maintenance-of-effort (MOE) provision expires, they could actually restrict eligibility in relation to pre-ACA levels. See http://www.kaiserhealthnews.org/Stories/2012/July/03/states-could-cut-medicaid-rolls-after-ruling.aspx?utm_source=medicaidtop&utm_medium=email&utm_campaign=070512.
All this means that state-level advocates will have a big job ahead of them in trying to get states to expand (or even maintain) Medicaid eligibility.
A Kaiser Family Foundation brief regarding the Supreme Court's decision can be found at http://www.kff.org/healthreform/upload/8332.pdf. The first three pages provide a nice summary of the ACA. The next seven pages explain the Court's decision and some of its implications for the future. For an interesting discussion among health care journalists about political factors that will influence ACA implementation, you can listen to, or read the transcript of, a Kaiser Health News webcast at http://www.kaiserhealthnews.org/stories/2012/july/03/health-law-questions-webcast.aspx?utm_source=medicaidtop&utm_medium=email&utm_campaign=070512.
F2F funding bills (S. 2123 and H.R. 4083). There are no new cosponsors this week, so the tally stands at nine Senate cosponsors, in addition to Senator Menendez, and 10 House cosponsors, in addition to sponsor Representative Pallone (D-NJ). The policy team continues efforts to garner congressional support for the legislation by meeting with additional Hill staffers.
If we hope to get the F2Fs re-funded, Members of Congress will need to hear from F2Fs about how effectively they are spending their federal grant funds, and from families about how important F2F services have been in their lives.
If your Members of Congress have not yet cosponsored the legislation, please contact them to ask that they do so. See the guidance at the end of this update or click here now to send a pre-drafted letter to your Representative.
Also, please forward this information to your family, friends, and health care providers, and ask them to contact their Members of Congress as well. And, if you haven't done so already, please thank your Senator(s) and Representative who have cosponsored the legislation. You can find their contact information by clicking on their names on the list of cosponsors at the end of this update.
UN Convention on the Rights of Persons with Disabilities. Partly in response to pressure from a large number of disabilities groups, the Senate Foreign Relations Committee, chaired by Sen. John Kerry (D-MA), will hold a hearing on the Convention on the Rights of Persons with Disabilities (CRPD) on Thursday, July 12th. Family Voices joined in the call for a hearing by signing onto a letter sent to the leaders of the Foreign Relations Committee last week.
Florida case regarding children in nursing homes. The U.S. Justice Department has filed a pleading in federal court seeking to intervene in a Florida ADA case in which children's advocates are suing the state about placement of children with complex medical conditions into nursing homes designed for the elderly. For more information, see http://www.miamiherald.com/2012/06/29/2875181/feds-join-suit-over-treatment.html.
Webinars on the ACA. The HHS Center for Faith-Based and Neighborhood Partnerships is hosting a series of interactive webinars - in English and Spanish -- on the ACA. To RSVP, or for more information, go to http://www.hhs.gov/partnerships/resources/aca_101-invite.html.
July 19, 12:30 pm ET - The Health Care Law 101 (in English)
July 24, 2:00 pm ET - The Health Care Law 101 (in Spanish)
July 12, 3:00 pm ET - Region 3 (Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia)
July 12, 3:00 pm MT/4:00 pm CT - Region 8 (Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming)
July 17, 10:30 am CT - Region 7 (Iowa, Kansas, Missouri, Nebraska)
August 8, 11:00 am ET- Region 1 (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont)
As always, please feel free to contact us with any questions.
NOTE: Past issues of the Washington update can be found on the Family Voices home page by scrolling down in the "News Feed" section.
Cosponsors of House F2F funding bill, H.R. 4083, sponsored by Rep. Frank Pallone (D-NJ):
Rep Langevin, James R. [RI-2] - 2/17/2012
Rep Norton, Eleanor Holmes [DC] - 2/17/2012
Rep Pingree, Chellie [ME-1] - 2/17/2012
Rep Cicilline, David N. [RI-1] - 2/17/2012
Rep Michaud, Michael H. [ME-2] - 2/17/2012
Rep Engel, Eliot L. [NY-17] - 2/17/2012
Rep Green, Gene [TX-29] - 3/5/2012
Rep Rangel, Charles B. [NY-15] - 3/8/2012
Rep Roybal-Allard, Lucille [CA-34] - 3/20/2012
Rep Carson, Andre [IN-7] - 4/26/2012
Cosponsors of Senate F2F funding bill, S. 2123, sponsored by Senator Robert Menendez:
Sen Bingaman, Jeff [NM] - 2/17/2012
Sen Conrad, Kent [ND] - 2/17/2012
Sen Snowe, Olympia J. [ME] - 2/17/2012
Sen Whitehouse, Sheldon [RI] - 2/17/2012
Sen Lautenberg, Frank R. [NJ] - 2/17/2012
Sen Kerry, John F. [MA] - 3/13/2012
Sen Klobuchar, Amy [MN] - 5/8/2012
Sen Akaka, Daniel K. [HI] - 6/4/2012
Sen Franken, Al [MN] - 6/5/2012
Contacting your Members of Congress about F2F funding bills
All of you who are concerned about the future of F2Fs should contact your Members of Congress to urge that they cosponsor the Menendez or Pallone bill. You can call them through the Capitol switchboard at 202-224-3121. (To find the names of your Members of Congress, go to http://www.congressmerge.com/onlinedb/index.htm.) When you speak to the receptionist, state that you are a constituent and ask to speak to the staff person who handles health issues. If that person is not available to talk, you can leave a BRIEF message identifying yourself as a constituent who has a child with special health care needs (if applicable) and asking that the Representative/Senator cosponsor a bill that would extend funding for Family-to-Family Health Information Centers. Refer to the appropriate bill number and sponsor - in the Senate, S. 2123, sponsored by Senator Menendez; in the House, H.R. 4083, sponsored by Rep. Pallone. Leave your home phone number and email address.
You can also write to your Representative (even if you call) via the "Advocacy" section of the Family Voices website, where you will find a pre-written letter that you fill in with your personal information. (You do not need to know the name of your Representative.) Please ask families you have worked with, friends, and relatives to write their Representatives through the Family Voices website also. The URL is http://www.familyvoices.org/action/advocate. At this time, the website is not configured to automatically send the letter to Senators, but simple instructions about how to contact your Senators, and text to copy and paste, can also be found on that page. (You do not need to know the names of your Senators.)
Remember: Federal resources may not be used for lobbying activities.
Please feel free to call Brooke or Janis (contact information above) if you have any questions.