This afternoon, House Republicans voted to roll back the Affordable Care Act’s protections for people with pre-existing conditions, slash hundreds of billions of dollars from Medicaid, and otherwise harm the health care of seniors, people with disabilities, veterans, and the vast majority of Americans. The American Health Care Act (AHCA), or Trumpcare, is an extraordinary statement of contempt towards any member of the public who might actually need health care in the coming years (hint: that’s all of us).
Though some of the damage that this bill does has been well publicized, there is a particularly odious impact of Trumpcare getting very little attention: It threatens to force seniors and people with disabilities into nursing homes and institutions.
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For the last several decades, disability rights advocates have fought to expand funding for Medicaid-funded home and community-based services, so that seniors and people with disabilities can live in their own homes, control their own lives, and be fully included in society. Thanks to generations of advocacy, millions of Americans with disabilities receive Medicaid-funded home care today.
When the Affordable Care Act was passed, legislators started to prioritize funding for programs that provide people with disabilities with services in their homes, rather than relegating those who require additional support to institutions and nursing homes. Through the ACA, Congress created several programs designed to reward states with additional Medicaid funds if they expanded in-home care for seniors and people with disabilities.
One of the most successful of these programs is the Community First Choice State Option (CFC), which provides funding for services that help seniors and people with disabilities get out of bed, dress, and perform other activities necessary for daily life. A 2015 review of the four states that have been using the CFC the longest found that the program was serving over 500,000 people—today, that number is likely much larger. But the AHCA sunsets this program in 2020, cutting about $12 billion in funding from in-home care from seniors and people with disabilities over the next decade.
That is only a small part of the $839 billion in Medicaid cuts AHCA imposes overall, which themselves will devastate Medicaid-funded services to seniors and people with disabilities across the country. AHCA also sets “caps” on each states’ Medicaid funding that will grow at a much slower rate than the existing Medicaid funding system, cutting hundreds of billions of funding over the next decade relative to current law. In addition, the caps also freeze in place state funding decisions at the time they’re made—so a state that offered relatively stingy benefits to people with disabilities or children in 2017 would no longer be able to access additional federal funds to expand those services in the future.
Some Republican House members realized the harm AHCA will cause to their constituents with disabilities. Rep. Daniel Webster (FL-10) bemoaned the likely impact AHCA’s Medicaid cuts would have on seniors living in his district, so he introduced an amendment to exempt nursing homes from AHCA’s caps on Medicaid funding during the March push to pass the bill. The amendment did not offer protections for home care, so it actually would have worsened Medicaid’s longstanding bias in favor of institutional care.
The GOP leadership still refused to adopt Webster’s amendment. For them, even weak protections for seniors and people with disabilities go too far.
Despite stating clearly on Tuesday that his “concern that Florida will be penalized under the American Health Care Act because demand for Medicaid-funded nursing home beds has not been fixed,” Webster voted in favor of the American Health Care Act today—in exchange for “assurances” from the Trump White House that his concerns will be addressed in the future.
Republicans in the House continue to put their faith in Donald Trump, instead of insisting on meager protections of their own constituents’ needs. For too many members of Congress, the needs of seniors and people with disabilities are taking a backseat to trusting Donald Trump —and advancing his health care bill—at all costs.