What Will Sequestration Mean for People with Disabilities?

from the National Council on Disability:

A series of automatic, across-the-board cuts to federal government spending totaling $1.2 trillion over the course of 10 years are set to take effect this Friday, March 1. Dubbed “sequestration” these cuts, if implemented, will be split between defense and domestic discretionary spending. 

The National Council on Disability (NCD) urges the Executive Branch and Congress to find a responsible alternative to sequestration to prevent potential harm to Americans with disabilities and their families.

Background

Originally passed as part of the Budget Control Act of 2011 on the heels of the debt ceiling compromise, the sequester was intended to pressure the Joint Select Committee on Deficit Reduction (the “Supercommittee”) to agree on a budget of $1.5 trillion by way of spending cuts and revenue increases over the next decade.

Congress stopped mandatory budget cuts from taking effect by passing the American Taxpayer Relief Act January 2 when the deadline was pushed back to March 1, 2013.  If Congress fails to agree on a budget to reduce the federal deficit by then $85 billion in spending cuts – split evenly between domestic and defense discretionary programs – will go into effect.

For Americans with disabilities, this means everything from special education to transportation, to housing and health care programs will “feel the pinch” due to the precarious collision of across-the-board cuts and unforeseen circumstances. 

Spending reductions break down into three broad categories:

1. Defense spending. Amounts to half the sequester cuts.
2. Non-defense. Includes housing, education, and employment programs.
3. Medicare. Limited to a 2% cut in payments to Medicare providers, specifically hospitals and doctors.

Mandatory programs

• Assistance to individuals with low-incomes and their families like Temporary Assistance for Needy Families (TANF, or welfare), the Supplemental Nutritional Assistance Program (SNAP, or food stamps), unemployment benefits and provider payments made through Medicare will not be cut, although staff time and resources are likely to be compromised. 

Medicare

• While other non-defense programs are facing a 8.4 percent cut, Medicare cuts are limited to 2 percent per fiscal year. The Congressional Budget Office (CBO) estimates that in 2013 a 2 percent cut totals $123 billion dollars.

Social Security

Harkin: Leave Medicare, Medicaid out of fiscal-cliff talks

By Elise Viebeck from the Hill:

Senate Health Committee Chairman Tom Harkin (D-Iowa) said Thursday that Medicare and Medicaid should be off the table during talks on the fiscal cliff.

Harkin spoke alongside other liberal lawmakers at an event to highlight opposition to cutting social programs for deficit reduction.

He touted the results of the Nov. 6 election as evidence that Americans support raising taxes instead of cutting spending. 

When it comes to Social Security, Medicare and Medicaid, the American people told us to protect and strengthen these programs, not cut them," Harkin said.

"The American people want a change in the structure of who pays and making sure that we keep the programs that protect the poor, the disabled and the elderly," he told The Hill.

President Obama will meet Friday with lawmakers to open negotiations on how to avoid the "fiscal cliff," a combination of tax increases and automatic spending cuts that will hurt the U.S. economy unless lawmakers act.

In earlier talks, Obama backed roughly $100 billion in cuts to Medicaid, including a streamlined system for federal payments that would result in state governments shouldering more of the funding burden.

At Thursday's event, Sen. Bernie Sanders (I-Vt.) said he wanted to "send a very loud and very clear message to the leadership … in the White House" not to cut Social Security, Medicare or Medicaid.

Sanders added, "There are fair ways to reduce the $1 trillion federal deficit and $16 trillion national debt, but balancing the budget on the backs of the elderly, the sick, the children and the poor is not among them."
 Republicans have said they won't accept new tax revenues unless Democrats agree to reform entitlements.

Medicaid, The Frail Elderly, And Federal Budget Cuts

by Howard Gleckman from Forbes:
Medicaid is in the budget bull’s eye. But many lawmakers aiming to cut the program have no idea what it does, and how important it is to frail seniors who need help with daily living. The popular image of Medicaid: health care for a poor mother and her child. The all-too-often reality: long-term supports and services for an 85-year old widow with dementia.
With Congress and President Obama looking for both a short-term way to avoid the dreaded fiscal cliff and a long-term deficit reduction deal, Medicaid and Medicare are at the top of the hit list—in large part because they are so costly.
Let’s leave the debate over Medicare for another time. But Medicaid, frequently lumped in with Medicare and Social Security as one of those vaguely threatening “entitlements,” is another matter.
Medicaid, jointly run by the federal government and the states, does two jobs. It provides health care for those poor mothers and their kids—who represent about three-quarters of enrollees. But two-thirds of the Medicaid budget is spent on the frail elderly and younger adults with disabilities. And one-third of all Medicaid spending—about $120 billion– is for their long-term care alone.
In recent months, conservatives have taken up the cry that the U.S. has become a “Nation of Takers,” to borrow the title of a recent book by American Enterprise Institute scholar Nick Eberstadt. It became a common campaign theme of GOP presidential candidate Mitt Romney. A recent column by Washington Post columnist Bob Samuelson nicely summarizes this view. And too often Medicaid is casually tossed into the conversation.
So who are the Medicaid takers? Among the elderly, they are among the nation’s most vulnerable. They are frail, often suffer from multiple chronic diseases (such as heart failure, dementia, or diabetes), and are impoverished. Many were once middle class but, due to illness, are without financial resources in old age.
Look at the roughly 9 million people who are sick enough and poor enough to be eligible for both Medicare and Medicaid (often called the dual eligibles, or just the “duals”). Some are poor, but relatively healthy. Many others are not.
Two-thirds of the duals are aged 65 or older. According to MedPAC, the independent commission that advises Congress on Medicare, 38 percent have cognitive or mental impairments, 22 percent have multiple physical impairments, and 23 percent live in nursing homes or other institutions.
Sixty percent of those duals who live in nursing homes or other institutions have dementia or some other cognitive impairment. According to the Kaiser Family Foundation, one-quarter of elderly who are eligible for both programs need assistance with at least three activities of daily living (such as bathing, going to the bathroom, eating, or dressing). Many are, in other words, helpless.
Among the 1 million dual eligibles who are the most costly Medicaid patients, nearly half are aged 80 or older, three-quarters need help with 3 or more activities of daily living, three-quarters live in institutions, and one out of every six has Alzheimer’s.
Ninety percent are poor or near-poor. More than half have incomes of less than $10,000. And 90 percent have no other insurance. According to Kaiser, 70 percent are women and only about 20 percent are married. Some have adult children to care for them. Many others do not.
There is no doubt the U.S. has a long-run budget problem, and that we need to do a better job caring for the frail elderly who are chronically ill and need both medical care and long-term services. Maybe we can find a way to provide these people with better care and save money. Maybe we can find an alternative to Medicaid, at least for people who were once middle-class. But taking a meat axe to Medicaid in a frantic attempt to hit a politically-motivated budget target is not the way to do it.

Fiscal Cliff: What Is At Stake For Medicare And Medicaid?

from Kaiser Health News:
Jackie Judd talks to KHN's Mary Agnes Carey about the budget negotiation scenarios for Medicare, where the "doc fix" fits into the budget picture, and whether Medicaid cuts are possible.
>>Listen to the audio or read a transcript below:
JACKIE JUDD:  Good day, this is Health on the Hill. I’m Jackie Judd. A year ago this month, negotiations on Capitol Hill to reduce the federal deficit collapsed. A year later, have the political dynamics shifted enough so that there is an opportunity for a deal? And if so, how might that affect Medicare and Medicaid? Here to sort through that question is Mary Agnes Carey, senior correspondent for Kaiser Health News.
Mary Agnes, you’ve spent a lot of time this week listening to what people were saying on Capitol Hill. Are you hearing anything different?  Is the tone different? Could there be a deal?
MARY AGNES CAREY: Everyone seems to be talking about a “balanced approach.” We hear this from the president. We hear it from Democrats. We hear it from Republicans. The president and Democrats are saying to Republicans, “If you move on taxes, if you ask some high-income individuals to pay more on taxes, we’ll move on entitlements, on Medicare and Medicaid.”  People seem very, very open to this idea of avoiding the fiscal cliff, of avoiding these automatic spending cuts that are set to kick in in January.  But the thing we have to remember from watching Capitol Hill for a long time is that this is where folks always are at the beginning of a negotiation.