The Battle to Save Medicaid and Disability Community Living Programs

Trump/House Passed Bill Ends Medicaid As We Know It
You wouldn’t know it from the press coverage or the House debate over the Trump/Ryan American Health Care Act (AHCA), but the biggest casualty of the GOP healthcare plan is the fundamental ending of Medicaid as an entitlement program and cutting $880 Billion from the program that funds community services and supports for people with I/DD, elders, poor people and their health care, women’s health care, mental health programs, substance abuse programs and hundreds of other required and optional programs that have been funded from 50% to 90% by the federal government.

Enacted in 1965, when Medicare was passed, Medicaid is the backbone of every state’s disability community program.  Cutting $880 Billion over ten years from this program has been the dream goal of House Speaker Paul Ryan for nearly a decade, before the Affordable Care Act was enacted.

If the AHCA is passed by the Senate, as recommended by the House, states will lose billions in federal matching funds forcing states with already troubled budgets to cut services or dramatically raise taxes to make up for the loss of billions of dollars.  Most governors and legislators will balk at steep tax increases, thus people with intellectual and developmental disabilities will have to contend with fighting for limited fiscal scraps with other worthy causes like elder services, children’s issues, mental health services, maternal health care, substance abuse services, education, etc in a Trump inspired Social Darwinism to see which of the poorest and weakest survive or die.

Though we live in a progressive state, much is at risk with the AHCA, as pointed out by Governor Charlie Baker in a press release yesterday.  The Governor warns of a potential loss of $1.3 to $1.5 Billion in the first years and more over the next few years; however what has not been mentioned is the threat to the Baker Administration’s Accountable Care Organization plans, dependent upon $5 Billion in the next five years from discretionary Medicaid waiver funds.

With a $880 Billion cut at Medicaid on the horizon, former U.S. HHS Secretary Kathleen Sebelius warned ADDP Members yesterday at the ADDP Annual conference that any and all waiver programs will be on the chopping block and can be ended at any time by the federal government if deep budget reductions are enacted. 

Gutting Medicaid by $880 Billion is a tremendous cut for Medicaid and likely to result in the termination of hundreds in not thousands of programs, and millions of people losing life sustaining services and supports.

To think that the Massachusetts ACO would exempt from any of these cuts would be optimistic thinking at best.  For members planning for the ACO and Community Partner programs with the Commonwealth, this news is unsettling.

Will the Senate step up and reject Trump/Ryan Care?  Making political predictions since the 2016 election seems to be a fool’s errand, thus we must be vigilant in our advocacy to protect Medicaid from the AHCA House provisions.

ADDP and our national trade association, Ancor will be in the forefront of this fight.  To succeed, we will need every member, every self-advocate, every parent and friend to be by our side and to convince the American public and the U.S. Senate that there is too much to lose by enacting the AHCA/Trump Ryan Care.