Health Care is Under Attack What are the plans to repeal the Affordable Care Act and gut Medicaid (Medi-Cal) and what can we do... Senior and Disability Action

Medicaid / Medi-Cal Medicaid and Medicare started in 1965 Serves more than 13 million low-income Californians Funded with state and federal $ Covers low-income people with disabilities, low-income seniors, now other low-income adults and children Of the 73 million Americans covered by Medicaid, 15 million (21%) are children and adults with disabilities and seniors. People with disabilities account for 48% of total Medicaid dollars due to higher acute care costs and costs of long-term services and supports. Efficient program: costs less per beneficiary than private insurance, growing more slowly

People with Disabilities Benefit from the Affordable Care Act Medicaid expansion has allowed millions of people with disabilities to get health care! 10 million people are covered by Medicaid expansion; about 20% of those are people with disabilities. The ACA improved data collection about people with disabilities and recognized disability in health care disparity work. (more on next page)

People with Disabilities Benefit from the Affordable Care Act (continued) Private sector reforms have allowed people with disabilities and chronic conditions to afford private health insurance, many for the first time. Key provisions include: Strong nondiscrimination provisions and health insurance reforms such as  Banning the exclusion of people based on pre-existing conditions  Modifying community rating (insurance pricing)  Eliminating annual and lifetime caps, Improving health insurance affordability through tax credits and subsidies Requiring a more comprehensive benefit package including preventative care, mental health and substance abuse services, and prescription drug coverage Expanding access to health insurance in other ways including:  Medicaid expansion to childless adults  Allowing coverage for dependents until age 26  Improving accessibility of medical diagnostic equipment Expanding access to long term supports and services through Community First Choice Option, Money Follows the Person, and other state waiver options

Republican Plans to Repeal ACA “American Health Care Act” Repeal Medicaid expansion in 2020 (11 million people at risk) Gets rid of individual mandate and employer mandate (resulting in higher premium costs) Age-based tax credits replace subsidies. Not income-based except for individuals making more than $75K. $2000 for a 20-year old, $4000 for 60+ (poor people & older people get hurt). (Tax credits are useless for workers and others with low incomes who can’t come up with the up-front costs.) Rolls back ACA requirement to cover “essential” benefits like mental health services or preventative care Eliminates 6% FMAP (federal match) for Community First Choice Option

Republican Plans to Repeal ACA “American Health Care Act” Insurers can charge older customers five times as much as young adults (this was 3 to 1 under the ACA) Keeps requirement to cover people with pre-existing conditions but allows 30% charge for lack of continuous coverage Keeps coverage for kids to age 26 Repeals taxes on high-income health care payers Defund Planned Parenthood Fund for state “high-risk” pools Medicaid to change to “per capita caps” in 2020

Per capita caps “Medicaid Per Capita Cap Has Same Damaging Effects as Block Grant” – Center for Budget & Policy Priorities Provides fixed funding per person, regardless of need Essentially caps federal funding, using 2016 as a base year. Over the next 10 years federal support is projected to be cut by $1 trillion; states and/or counties will have to come up with the replacement revenue or make major cuts. Cuts federal/state investments in innovative plans such as coordinating care for people with chronic conditions, or programs for long-term services & supports.

Per capita caps Cuts would grow each year. As health care costs rise, or if there is a public health crisis, states must absorb costs. States will likely impose Medicaid cuts in eligibility, benefits, and provider payments. Medicaid is states’ biggest source of federal funding, so cuts under per capita caps will squeeze state budgets overall. Will not control health care costs. Hits seniors and people with disabilities the hardest, because the majority of Medicaid spending covers their health care & home care.

Home Care Medicaid covers 62% of all long-term care services - includes IHSS and nursing homes. When states lose Medicaid dollars, these services are likely to be on chopping block. End of federal funding for Money Follows the Person (MFP); extension needed. This program funds long-term services and supports and has allowed over 63,000 people to get out of nursing homes. Will make it far more difficult for people to leave or avoid institutions, which are 2-3 times more expensive and allow a poorer quality of life than community services and supports. In 2020, will eliminate the 6% extra federal match for the Community First Choice Option. California and other states will be expected to absorb that cost. People with disabilities who are employed may have to quit their jobs due to loss of funds for Personal Care Attendants (PCAs) or access to state optional Medicaid buy-in plans.

Who would hurt the most? Poor older adults People with disabilities They lose the subsidy. The tax credit is smaller – and requires money up-front. Insurers can charge older people much more than they could before. May lose drug discounts, free wellness visits and preventative care People with disabilities Cuts will be made to prescription drugs, physical, occupational and speech therapies, home care programs, etc. These so called “optional” services often mean the difference between life and death for people with disabilities.

Impact on Medicare “Repealing the ACA’s tax on high income households and hospitals would exhaust the Medicare Trust Fund by 2024.” – Brookings (higher Medicare premiums for wealthy folks) Unclear impact on Medicare benefits in ACA, such as free coverage for some preventative care, closing Rx drug doughnut hole, etc. May increase some costs for Medicare beneficiaries. May renew Republicans’ push for vouchers, higher eligibility age, etc.

What’s Next Bills go through Energy & Commerce Committee and Ways & Means Congressional Budget Office will do a report on the bills (unless Ryan prevents it) Then to Budget Committee Full House vote Then Senate & Trump Republicans are trying to get this passed before the April 7 Congressional recess

What do we do? Call your Member of Congress! Even if we’re in a Democratic district, we need to urge them to fight fight fight. Write a postcard! We’ll send these to Rep. Paul Ryan and Rep. Kevin McCarthy, head of the Budget Committee Come out on March 18 to knock on doors in districts of Republican Congressmembers Call friends and family in Republican Congressional districts. Urge them to call immediately. Research shows most people are unaware of the proposed changes to health care, but when people do hear, more than 67% are opposed! Go to Congressional town halls!

Key CA Reps The following Republican CA US Reps represent districts where Clinton won, and need to be held accountable to our needs: Denham, Issa, Knight, Rohrabacher, Royce, Valadao, Walters Also important: McClintock Got friends and family that live in these districts?

YOU can get involved and help Every conversation with a new person, call, or signature, helps make your voice heard Bring this presentation to your community organization, your apartment building, your senior center, your congregation, your union, your neighborhood group Republicans are beginning to feel the heat in their districts! Moderates are speaking up about protecting people on Medicaid, and conservatives don’t like the new plan proposed. There is hope! You can do a lot, or a little, but DO SOMETHING

Thanks Information from: Disability Power for Community Integration California Alliance of Retired Americans Consortium for Citizens with Disabilities Justice in Aging Kaiser Family Foundation Many others