The Affordable Care Act: Where Are We?

By now, you have probably heard a great deal about the Patient Protection and Affordable Care Act (ACA), or “Obamacare,” and what lies ahead for the law. As an individual with a disability, a family member, or a provider of disability services and supports, you may wonder how the law impacts Americans with disabilities and what could happen if it is repealed, as Congress is poised to do.

How Does the ACA Benefit Americans with Disabilities?

To begin with, the ACA allows states to choose to receive a higher rate of federal Medicaid support.  As a result, more Americans can now use the Medicaid program. This expansion benefits those with disabilities and other chronic health conditions through:

  • Strong nondiscrimination provisions and health insurance reforms:
    • A ban on the exclusion of people based on pre-existing conditions.
    • Modification of community ratings.
    • Elimination of annual and lifetime dollar caps.
  • Improved affordability of private health insurance through premium tax credits, cost-sharing assistance for low and moderate income individuals, and elimination of medical underwriting.
  • More comprehensive mandatory benefit packages that include rehabilitative and habilitative services and devices, mental health and substance abuse disorder services that include behavioral health treatment, and critical prescription drug coverage.
  • Expanded access to health insurance:
    • Medicaid expansion to childless adults.
    • Expanded mental health parity provisions.
    • Required coverage for dependents until age 26.
    • Health insurance market places.
    • Improved accessibility to medical diagnostic equipment.
  • Expanded access to long-term supports and services:
    • The newly-created Community First Choice Option that allows states to provide participant-directed home and community based attendant services and supports as part of their state Medicaid plan.
    • Enhancements to the state plan home and community based services option.
    • Extension of the Money Follows the Person Rebalancing Demonstration.
    • Creation of the Balancing Incentive Program to encourage states to increase access to non-institutional LTSS[1].

What’s Happening in Congress with the ACA?

One of the first orders of business for the 115th Congress was to lay the procedural groundwork for repeal of the ACA:

  • The Senate passed a measure that allows Republicans on Capitol Hill to use a process known as “budget reconciliation” to roll back major parts of the health care law.
  • The House passed its own version of this measure.
  • President Trump signed an Executive Order on January 21 that will enable federal agencies to take steps toward the repeal and replacement of the ACA. Potential plans to replace the ACA may be introduced before the end of January. Trump adviser Kellyanne Conway said that the replacement bill will include Medicaid block grants. Under a block grant, the federal government would control how much federal money is spent on Medicaid on an annual basis and provide a set amount to each state based on a funding formula. In order for states to manage their Medicaid programs with a fixed amount of federal funding, the entitlement to Medicaid would need to be eliminated. Block grants would amount to drastic cuts to Medicaid spending over time. This would limit both the number of people who can be covered under Medicaid and the level of services they can receive.

Medicaid block grants would decimate the services and supports that individuals with disabilities rely on in their day-to-day lives. Much of the increased burden would fall on individuals and families to piece together supports and services – even more so than is currently the case. Americans with disabilities rely on Medicaid for both health care and long-term services and supports. This loss of funding would have a devastating impact not only on the health of individuals, but also on their ability to live independent lives integrated in the community.

What Can You Do?

Educate yourself on Medicaid and how it impacts you and your community through APSE’s Medicaid Action Center.

  • Call your members of Congress and ask them to make sure that the provisions listed above are included in any ACA replacement bill.
  • Take Action when APSE sends out Action Alerts. Your voice makes a difference. Remember that the mid-term elections are less than two years away. The impact that the ACA repeal has on individuals and their families will be a major campaign issue in both parties.

Repealing and replacing the ACA may move quickly in Congress, so please make sure to refer often to APSE social media and the Medicaid Action Center to keep yourself up to date.

[1] Consortium of Citizens with Disabilities Fact Sheet on the ACA, 2017

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