Senate Health Care Bill Talking Points

Overall Impact:

The Better Care Reconciliation Act released by Majority Leader Mitch McConnell significantly cuts Medicaid services for people with disabilities:

  • Directly removes $19 billion from Medicaid home and community-based services for individuals with disabilities (Sec. 125);
  • Ends the federal government’s guarantee to cover a state’s actual cost to provide care and supports for a person with a disability (Sec. 133);
  • Calculates annual adjustments to states with a formula that does not reflect the actual costs of medical commodities and services (Sec. 133).

Directly cuts home and community-based services (Sec. 125)

The Better Care Reconciliation Act ends the Community First Choice Program, which will directly cut funding currently used to provide Medicaid services for people with disabilities.

  • Ending the Community First Choice program in 2020 represents a $19 billion cut in currently available services for people with disabilities, according to the Congressional Budget Office. In total, the Senate bill removes $772 billion from Medicaid over the next decade. 

Ends Federal Government Guarantee to Meet State's Actual Medicaid Costs for Disability Services: (Sec. 133)

The Better Care Reconciliation Act ends the federal government commitment to match a state’s actual costs to care for and provide support for people with disabilities who are enrolled in Medicaid.

The Better Care Reconciliation Act replaces this federal matching guarantee with a lump sum, based on a per capita cap formula using past costs times the number of individuals with disabilities enrolled in the state Medicaid program.

The capped federal lump amount does not increase if an individual’s cost of care goes up—due to deteriorating health or changes in a chronic condition.

  • The state is on the hook for an individual’s cost increases—an additional expense the state will have to address by finding new state funds or cutting or limiting services elsewhere.

The capped federal lump amount does not increase if a new, promising—but more costly—drug treatment is discovered to better address a disease or chronic condition.

  • The state is on the hook for these drug treatment increases—an additional expense the state will have to address by finding new state funds or cutting or limiting services elsewhere.

A capped funding structure uses a one-size-fits-all approach to financing health care. It does not account for changes to a person’s health or disability.

  • Per capita caps limit states ability to manage the surge in long-term care costs associated with 10,000 baby-boomers turning 65 every day.
    • For example, Medicaid costs for seniors 85 years old and older are 250% higher than seniors between 65 and 74.

This massive Medicaid cost-shift to states will, according to the Congressional Budget Office, force states to:

  • Eliminate optional home and community-based services;
  • Restrict eligibility for essential Medicaid services;
  • Cut reimbursement rates for Medicaid providers; or
  • Find new resources or delivery efficiencies.

Medicaid Adjustments Won't Meet Annual Health Care Costs: (Sec. 133)

The annual Medicaid growth rate adjustments in the Better Care Reconciliation Act fail to keep up with actual costs to provide Medicaid care and services for individuals with disabilities.

The annual adjustments are not based on individual need or even state cost to provide care and supports for individuals with disabilities.

Rather, the Better Care Reconciliation Act uses two formulas—both of which severely undercut the true, annual cost of delivering health care and community supports for people with disabilities. The Senate bill’s failure to meet Medicaid’s actual growth rates will result in real state funding cuts for disability services.

  • Medicaid costs are expected to grow by 5 percent each year for the next decade. Yet, the Senate bill would only provide states with up to 3.7 percent extra each year—leaving states with an annual Medicaid deficit.

      For example, if physical therapy for a child with cerebral palsy costs $100 in 2017, the cost to the state for the same service is expected to rise to $105 an hour in 2018. Yet, the state will only receive $3.70 more under the Senate formula toward the $5.00 increase. To make up the $1.30 shortfall, the state will be forced to find new resources or cut services.

    Under current Medicaid law, the federal government reimburses based on the full cost (ie: $105) rather than a capped adjustment (ie: $103.70), as proposed in the Senate bill.

States will be forced to add new resources or—more likely—cut, restrict or eliminate Medicaid services in order to make up for the difference between true health care costs and the federal reimbursement adjustment.

Easterseals Position:

Easterseals urges the U.S. Senate to oppose the Better Care Reconciliation Act for its real cuts to Medicaid services for children and adults with disabilities.

Medicaid is already underfunded, which has resulted in cuts to essential services and longer wait lists for children and adults with disabilities.

The Senate health care bill will accelerate this problem by instituting restrictive caps on federal Medicaid funding.

The legislation fails to meet Easterseals’ basic do-no-harm standard for health care reform.

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