Healthcare Reform and People with Disabilities: What You Should Know
April 26, 2020
By Ellice Switzer
As a result of the November elections, the Republican Party has taken control of the legislative and executive branches of the federal government, as well as most of the governorships and state legislative bodies throughout the country. In practical terms, this means that the Republican Party platform is free from the policy action “gridlock” that stymied conservative political action over the last 8 years. As a community, people with disabilities, their families, and other stakeholders need to be informed about Republican ideals of distributive justice, social welfare, and government oversight. Changes to these policies will impact the lives of millions.
The Republican Party platform states that:
Our society is at a crossroads. For several generations, an expansive federal regime has marginalized and supplanted the institutions holding our society together. No wonder, then, that so much seems to be coming apart now. The question is whether we are going to reinvigorate the private-sector institutions under citizen control or allow their continued erosion by the forces of centralized social planning.[i]
This view is represented by policy actions that seek to shrink bureaucracies in favor of private sector activities, including government spending on social programs, and to devolve responsibility for social welfare to states and individual communities. By “centralized social planning” the Republican platform refers in part to what is commonly known as “the social safety net” and encompasses programs like Medicaid and Social Security, which are designed to protect the welfare of vulnerable citizens. This worldview was distinctly evident in President Trump’s recommendations for discretionary spending, which called for an overall reduction in funding to the departments of Labor (-20%), Health & Human Services (-16%), and Education (-14%), all of which fund a variety of programs and services for people with disabilities.[ii] Although Trump’s recommendations did not address the larger social welfare entitlement programs (Medicaid, Medicare, and Social Security), recent efforts at overall healthcare reform indicate a willingness to implement changes and cuts to those programs as well.
Major changes to Medicaid spending could have a swift and direct impact, as 42% of all Medicaid dollars are used to pay for services and supports for people with disabilities.[iii] Those supports include residential programs, supported employment services, transportation, personal assistance services, and day habilitation programs designed to increase independence and community inclusion. However, the connection between long-term supports and services for people with disabilities and Medicaid has long been misunderstood by many legislators on both sides of the aisle. The failed republican healthcare bill included changes to Medicaid that would impose ‘per capita’ or per-enrollee caps on Medicaid spending, and other healthcare reform ideas have proposed turning Medicaid into a block grant program. In either scenario, these types of reforms shift the financial burden to states and likely result in a loss of supports and services and narrower eligibility criteria.[iv]
Even though the Patient Protection and Affordable Care Act (ACA or “Obamacare”) passed as an amalgam of previous attempts at bipartisan healthcare reform throughout the administrations of multiple presidencies,[v] the contentious nature of the debate surrounding this legislation is no surprise given the diffuse costs associated with the ACA, in comparison to the relatively concentrated benefits of the major aspects of the plan; i.e., insuring the uninsured, and those with more costly medical expenses. But for people with disabilities, many aspects of the ACA represent a lifeline to good health, community engagement, and economic security. In the newest revisions to the now defunct healthcare bill, Republicans propose to reverse the trend of concentrated benefits and diffuse costs by eliminating the requirements to charge the same price for insurance regardless of the health status of the insured. It threatens protections for people with pre-existing conditions by allowing states an opt-out provision, and would no longer require that insurers cover a minimum of essential health benefits. The new revisions would also allow the Community First Choice Option in the ACA to expire—a Medicaid provision that allows states to provide more home- and community-based options to beneficiaries.
Regardless of personal political ideologies, the shift in policy action within the executive and legislative branches will undoubtedly result in real-world impact on the everyday lives of Americans with disabilities. Now more than ever, it is important to pay attention to changes as they are proposed, in order to effectively prepare and plan for the future. A better informed electorate can help to direct the dialogue around healthcare reform, to ensure that people with disabilities are not left behind.
[i] The Republican National Committee. (2017). Republican platform: great American families, education, healthcare, and criminal justice. Retrieved on April 5, 2017 from https://www.gop.com/platform/renewing-american-values/
[ii] Parlapiano, A. Aisch, G. (March 16, 2016). Who wins and loses in trump’s proposed budget. Nytimes.com. Retrieved on April 4, 2017 from https://www.nytimes.com/interactive/2017/03/15/us/politics/trump-budget-proposal.html
[iv] Rudowitz, R. (2017). 5 Key Questions: Medicaid Block Grants & Per Capita Caps. The Henry J. Kaiser Family Foundation. Kff.org. Retrieved on April 4, 2017 from http://kff.org/medicaid/issue-brief/5-key-questions-medicaid-block-grants-per-capita-caps/
[v] Quadagno, J. (2014). Right-Wing Conspiracy? Socialist Plot? The Origins of the Patient Protection and Affordable Care Act. Journal of Health Politics, Policy & Law, 39(1), 35-56. doi:10.1215/03616878-2395172
Ellice Switzer has nearly 20 years of university and nonprofit experience in the field of disability. She provides national level technical assistance and training on topics related to disability and employment, and US disability policy.