With the election over, and Congress scheduled to return next week, Washington’s attention will quickly shift to proposals to reduce the federal deficit.
It has been widely reported that during the last few months there have been extensive behind the scenes discussions, particularly by Senators, of “grand bargains” to reduce spending and increase revenues to make major reductions in the deficit. Now these discussions will move to the public arena. They will be dominated by a sense of urgency created by the so-called fiscal cliff across the board spending cuts and tax increases which will occur on January 1, unless Congress passes legislation to undo them.
Reports of the behind-the scenes discussions indicate that they include considering proposals to make significant reductions in the federal Medicaid program. This is an issue of great concern to people with disabilities; 8 million of whom rely on Medicaid for health care and long term supports which is critical to their ability to live healthy productive lives as independent members of their communities.
AAPD and other advocates have made it clear that we are willing to work with Congress and the Administration to develop proposals which reduce the costs of Medicaid, by reforms that will make the program more efficient without reducing the services provided. We will oppose proposals that only reduce funding and lead to cuts in the number of beneficiaries or the services they receive.
Two general approaches for reducing annual spending for Medicaid have gained significant support.
The first, incorporated in the budget passed by the House earlier this year is known as the block grant approach. It specifically sets funding levels for Medicaid for the next ten years. The ten-year budget would reduce Medicaid spending by $800 billion compared to the current program.
The second approach, one that reportedly has been seriously considered in the recent behind the scenes discussions, is a “per capita” approach. It would limit funding by establishing an allowable cost for each beneficiary under the program. This would permit increased funding if more persons were added to the program.
In evaluating any specific proposals to reduce funding with these approaches, it is important to bear in mind that there are two separate issues; how much is funding reduced, and what problems are created by the method used to set the caps.
