Core to the mission of Independent Living Centers is advocacy! The members of CFILC develop positions regarding issues that impact people with disabilities, and we join our allies in advocating for access and equal opportunities for people with disabilities. To learn about the current issues see below, please contact Henry Contreras, CFILC's Public Policy Director.
CFILC Letter of Opposition: American Health Care Act (AHCA) March 10th, 2017
The California Foundation for Independent Living Centers and the disability community as a whole are carefully monitoring congressional legislation to block grant or cap Medicaid and to repeal and replace the Affordable Care Act (ACA). We are also concerned that these proposals are being fast-tracked without careful and deliberate consideration about the extreme negative effects most of proposals would have on the health and lives of people with disabilities.
CFILC is a membership association representing 21 Independent Living Centers (ILCs) in California that provide programs and services to over 100,000 people with disabilities annually.
We strongly oppose the AHCA proposals that repeal or phase-out many of the ACA's essential provisions, including the individual and employer mandates, the 10 Essential Health Benefits, Medicaid expansion, and most importantly, the Community First Choice Option (CFCO).
We oppose the AHCA proposals that would repeal the ACA's subsidies and replace them with age-based tax credits. There are proposals to introduce continuous coverage requirements and create a Patient and State Stability fund that states can use for a variety of activities, including the creation of high-risk pools. The legislation essentially pays for these changes, plus millions in tax cuts, by restructuring Medicaid into a per-capita cap system, which will result in drastic cuts that will increase exponentially over time.
Proposals to Cut and Place Caps on Medicaid: Funding caps on the Medicaid program would be devastating to people with disabilities. We ask that you carefully evaluate how this would impact your constituents and people throughout the nation.
Medicaid is a program that provides health care services and long-term services and supports (LTSS) that maintain the health, function, independence and well-being of 10 million enrollees living with disabilities and their families. The ability to access essential and timely health care can be a matter of life or death.
Block granting, per capita caps, or significant cuts to the Medicaid program would shift huge costs onto states and consumers. They would inevitably lead to drastic reductions of Federal support for Medicaid and a projected 25 to 40 percent cut over 10 years. States that are currently in fiscal crisis would be unable to absorb additional expenses to sustain their Medicaid program. Instead, they would be forced to shift costs to consumer or cut services and eligibility for their growing and aging population.
We are equally concerned that state funding shortages would worsen over time. The gap between actual costs and available Federal funding would also steadily increase and put states in an ever-increasing bind to cover these differences. It is critically important to understand that people with disabilities and older adults typically have the most extensive health care needs and rely upon important coverage for optional Medicaid services. They are the most likely candidates for cuts in services and eligibility.
People with disabilities would also be at-risk of losing access to Assistive Technology. Medicaid is one of the largest providers for a wide range of Assistive Technology devices and technology to live independently and work in their communities as a viable alternative to significantly more costs institutionalization in nursing homes and other institutions.
Opposition to the Repeal of the ACA's Protections for People with Disabilities: CFILC urges you to carefully analyze proposed health care reforms from the disability community's perspective. The ACA's health care reforms made significant progress in expanding access to health care for people with disabilities. They incorporated consistency with long-standing core principles that include:
Non-Discrimination: People with disabilities of all ages and their families must be able to fully participate in the nation's health care system;
Comprehensiveness: People with disabilities and their families must have access to benefits that provide a comprehensive array of health services, including behavioral health, rehabilitation and habilitation, assistive devices, LTSS, and services across all service categories and sites of service delivery;
Continuity: People with disabilities of all ages and their families must have access to health care that responds to their needs over their lifetimes, and provides continuity of care that helps treat and prevent chronic conditions;
Appropriateness: People with disabilities and their families must be assured that comprehensive health, rehabilitation, and LTSS are provided on the basis of individual need, preference, and choice;
Equity: People with disabilities and their families must have equitable access to health coverage programs and not be burdened with disproportionate costs; and
Efficiency: People with disabilities and their families must have access to health care that is effective and high quality with a minimum of administrative waste.
The ACA made significant progress in expanding access to health care in ways that were aligned with these principles. States were given flexibility to expand their Medicaid program to childless adults earning up to 138% of poverty that has helped millions of Americans, including people with disabilities and chronic health conditions. These Federal contributions expanded Medicaid's ability to help additional enrollees without harming existing programs that provide supports and services to people with disabilities.
In addition, the ACA's reforms in the private sector enabled people with disabilities and chronic conditions to obtain affordable access to private health insurance which was the first opportunity to do so for many. Among other things, the ACA expanded mental health parity provisions, created health insurance market places, and improved accessibility to medical diagnosis equipment.
The ACA also expanded access to LTSS by creating the Community First Choice Option that allowed states to provide participant-directed home and community-based attendant services and support as part of their state Medicaid program. It also provided enhancements to the state plan home and community-based services option, extended Money Follows the Person Rebalancing Demonstration, and created the Balancing Incentive Program to give incentives for states to increase access to non-institutional LTSS.
There are numerous provisions in the ACA that are important for people with disabilities. It has unquestionably improved access to care for people with disabilities and chronic conditions to help them live healthy, independent, and full lives.
For all of these reasons, we ask you to oppose the American Health Care Act which eliminates protections for people with disabilities and puts at risk existing access to comprehensive and affordable coverage.
Teresa Favuzzi, MSW
Ana Acton, Chair, CFILC Board of Directors
Sheri Burns, Chair, CFILC Public Policy Committee
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