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.

Canada bars a family immigrating because their daughter has Down syndrome

from CTV.ca and the Canadian Press:
A New Democrat MP is demanding the federal government reverse a decision to bar a family from India from immigrating to Canada to join their son in B.C. because their adult daughter has Down Syndrome.

The son, Kevin Patel of Vancouver, wanted to sponsor his parents and sister to come to Canada to become permanent residents.

But Immigration Canada rejected the request because it says his sister's condition could pose an excessive burden on Canada's health and social services.

"Are we looking at immigration as a nation-building exercise?" Patel said at a news conference as he questioned the government's priorities.

"Or are we looking at immigration as a commercial project where we only bring in young people, only smart people, so that they can fund our economy? Should we treat immigrants as a commodity and not as person or as a family?"

NDP citizenship critic Don Davies said the government's conclusion is not supported by any facts and is instead based on stereotypes of people with Down Syndrome.

Davies, who outlined his concerns in a letter to Canadian immigration officials based in India, described the daughter's condition as "mild Down Syndrome."

"Your officer has come to the disturbing and baseless decision that, while she would not be an undue burden on Canada's medical system, the mere fact she has Down Syndrome means she would be an undue burden on Canada's social security system," Davies writes in the letter, issued to the media on Friday.

"This conclusion is not supported by any facts, is contradicted by the evidence submitted in this case and, with all due respect, represents an outdated stereotype of a person with Down Syndrome that is not in keeping with modern understanding of people with this condition. Frankly, it represents a bigoted and discriminatory view that is unacceptable in 2012."

Davies said Patel, whose legal given name is Kaivalya, has been living in North American since 2000. He is currently working as a certified general accountant.

He applied in 2006 to sponsor his mother, father and sister to come to Canada, and that application was granted in 2008, according to Davies. The family submitted an application for permanent residency in 2009, and have since undergone medical exams and submitted financial information.

"The family has complied with all the requests your office has placed on them and they have also affirmed repeatedly that Aditi (the daughter) does not have any special medical, para-medical or respite care needs," Davies writes.

"Aditi has been extremely self-reliant, physically independent and healthy as an individual. On the contrary, Aditi has demonstrated great skill in knitting, candle and incense making as well as outdoor sports, for which her medals and certificates as well as inter-state trips for badminton competition are a testament."

Davies said if immigration officials refuse to grant the Patel family entry into Canada, the country will have failed Kevin Patel and denied him the opportunity to have his family live in this country with him.

Immigration Minister Jason Kenney was unavailable to comment on the story Friday, though his communications director, Ana Curic, responded on his behalf.

Curic wrote in an email that she couldn't discuss the Patels in detail because of privacy laws, but she said Kenney's office contacted Davies on Friday for more information and staff are looking into the case.

"Generally speaking, decision makers at (Citizenship and Immigration Canada) must apply the Immigration and Refugee Protection Act as it is written," wrote Curic.

"Under (the act,) which came into effect in 2002, permanent resident applicants and their immediate family members must be medically assessed to determine if they pose a danger to public health or public safety, and whether their presence would pose an excessive demand on Canada's health and social services systems."
She continued: "Excessive demand is based on anticipated health and social service costs over a five- to 10-year period and/or the potential impact on waiting lists.

"Canada's immigration law does not discriminate against those with illness or disability. It does strive, however, to find the appropriate balance between those wanting to immigrate to Canada, and the limited medical resources that are paid for by Canadian taxpayers."