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House GOP Passes Bill to Gut ACA, APSE is Taking the Fight to the Senate (May 4, 2017)

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My son has Down syndrome. The GOP’s health-care bill scares me to death. (May 18, 2017)

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Medicaid Action Center:

Stay Informed, Set Your Strategy, Take Action!

At APSE, we believe that work is a meaningful part of living a healthy, productive, and full life. For millions of Americans with disabilities, having access to healthcare and employment services through Medicaid long-term services and supports is what makes their jobs and their inclusion in their communities possible.


The 2010 Affordable Care Act (sometimes called Obamacare) provided for a Medicaid expansion which has enabled people with disabilities to lead more productive lives by giving millions more Americans healthcare coverage. For Americans with disabilities in particular, the ACA allowed them to get health insurance without discrimination of their pre-existing conditions. It has also provided them with the healthcare benefits essential to managing their disabilities. Now, the future of that expansion is uncertain. This month, after many fits and starts, the House passed a version of the American Health Care Act (AHCA). Although it lacked many specifics and an assessment of its cost and impacts from the Congressional Budget Office (CBO), it did include a rollback of the Medicaid expansion that has been so important to our community. In addition to the rollback of the Medicaid expansion, this bill contains $839B in cuts to Medicaid. These cuts, if enacted, would decimate the system of services and supports that Americans with disabilities rely on for their independence and community participation. Because these Medicaid services are considered “optional”, states would have to forgo these services to pay for services considered mandatory within Medicaid law. Such funding cuts would decimate the system of services and supports that keep Americans with disabilities out of nursing homes. The House bill has these goals:


REPEAL. The current House bill repeals portions of the ACA, including Medicaid expansion. This rollback will have severe impacts on our community: A full 42% of Medicaid funding currently pays for services and supports for individuals with disabilities. Medicaid is also the primary funder of employment services and supports for these individuals. 


CHANGE. The current House bill also changes the way federal Medicaid funding flows to states. Currently, federal funds are allotted to individual Medicaid programs in each state. The House bill replaces this with “per capita caps.” This means that the federal government would set a limit on how much it contributes for each Medicaid enrollee. With a cap in place, states will lose flexibility to meet the needs of many people with disabilities. Further, all Medicaid Home and Community-Based Services (HCBS) are optional services – meaning they will be cut first to maintain mandatory programs when funds are scarce.


REDUCE. The House bill slashes the overall amount of Medicaid funding by nearly a trillion dollars – an amount no state will be able to compensate for.


Now that the bill has passed out of the House, it has moved to the Senate, where a small group of senators is working behind closed doors on a bill they hope the Republican majority will support. Senators have indicated they may use the House bill as a template, or may start from scratch on their own proposal. 


As such, there is very little information on what the final bill will look like. The situation is complicated: The majority is hoping to use a specific budget process to pass the bill, which will require fewer votes for passage, but that means the bill must conform to certain rules and cost-savings. An analysis by the non-partisan Congressional Budget Office (CBO) has estimated that 23 million Americans will lose healthcare coverage with the House bill and that it will save over $100B to the budget over a ten-year period. Once the Senate passes a bill, both chambers must work together to combine their efforts in a process known as reconciliation. It’s not clear how long that process will take.


What is clear? The gains we’ve made are in grave jeopardy. Furthermore, administration officials have suggested that states begin to prepare their Medicaid recipients for transitioning to commercial health insurance. 


The key takeaway: We don’t know much, but what we do know is worrying. The best way to make sure your local representatives are hearing your concerns is to speak up.  

You can make your voice heard.

Updates from APSE

My Medicaid, My Life (May 3, 2017)

The first step is to stay informed. ACA and Medicaid provisions that have been most important to the APSE Community include: the Medicaid expansion, dependent coverage, long term services and support (LTSS), Community First Choice (CFC), Home and Community-Based Services (HCBS), and intellectual disabilities/developmental disabilities waivers. Check back to this page for the latest on what’s happening. And you can always reach out to APSE with questions.


Armed with what you know, you can:


Talk to your neighbors about Medicaid: You are informed about Medicaid because it directly affects you and your loved ones. Remember that many of your friends and neighbors may be less informed. Find gentle ways to show them what Medicaid means to you. 


Attend Town Halls: Express your concerns in person to your representatives and local politicians. Encourage friends to go with you. A full calendar of Congressional Recesses can be found here.


Submit an Op-Ed to your Local Paper: Detail your personal story and how proposed reforms would impact you or someone close to you. (For an example of a powerful op-ed, see APSE director Allison Wohl’s recent piece, here). 


Approach Your Legislator (state or federal): Attend local events and tell your story. If possible, get a picture with your legislator and post on social media.   


Request meetings with your state governor’s office: Your governor’s office is being told to prepare Medicaid recipients to transition to private insurance. Tell him or her what that means for you or for the individual with disabilities in your life. 


Build a coalition: Groups who work on aging, poverty, and healthcare share our values. Work together for a common cause. 


Use social media: Put a human face on the issue by creating videos to post on social media channels. Send your videos to local TV and radio stations. 


Show, don’t just tell: Plan a Take Your Legislator to Work day event with your APSE Chapter and/or within your organization to show your policy makers the importance of employment in your community. 

APSE is here to be your strong voice for federal programs and legislation that support Employment First. We also provides tools— including APSE Action Alerts and our upcoming members-only webinar series—to guide you when you contact members of Congress to discuss issues that matter to people with disabilities. We urge you to take advantage of these tools. And let us know how we can help!

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