The election of 2016 is old news and the new administration is moving forward at lightning speed. Recently asked to predict the Trump Administration’s impact on services to people with disabilities I pondered the impossible. Then I started looking for my old Magic Eight Ball.
It’s no secret the country took a giant slide to the right in this election. In addition to controlling the White House, Senate, and House 32 states elected republican governors. Of those 32, 25 are states with republican governors and both legislative houses. Of the multitude of issues facing our members, a couple stand out.
On immigration – President Trump’s positions of immigration will likely impact disability agencies across the country given the high percentage of immigrants working in various positions in our agencies. While we don’t have current numbers, we know our workforce has large numbers of legal immigrants in DSP and other roles performing their jobs with excellence.
On education – Watch the debate on the use of vouchers. Vouchers could potentially undermine IDEA and the requirement for schools to provide a free and appropriate education to all children with disabilities.
On healthcare – The repeal of the Affordable Care Act is potentially a huge setback for people with disabilities. Without seeing a replacement alternative under discussion, it’s hard to know the full impact, but important to understand the benefits people with disabilities receive under the current ACA. These include the following:
- Community First Choice Act is incorporated into the ACA. Over 600,000 PWDs receive supports through CFC nationwide; with several hundred thousand more projected in future implementations.
- State plan 1915(i) personal supports were expanded and enabled by the ACA as an entitlement.
- Potential loss of $1,000,000 lifetime insurance benefit cap
- Potential loss of pre-existing condition exclusion
- Potential loss of requirement for person centered planning and self-direction included in HCBS services
- Potential loss of Rebalancing language incentivizing states to move away from nursing facilities and ICFs
- Elimination of requirement for essential benefits package
- Loss of Money Follows the Person (now expiring anyway)
- Potential loss of requirement for medical loss ratio of 80% in insurance companies
- Potential loss of capped out-of-pocket expenses
- Potential loss of provision requiring prevention care
- Potential loss of premium parity
- Potential loss of Medicaid expansion provision
The loss of any of these provisions can dramatically impact the quality of life a person with a disability enjoys. We must be prepared to fight for these provisions both federally and within each of our states. In some states, we know our DSPs are only insured through Medicaid expansion. Much is at stake.
At the same time block grants and per capita caps are on the table and very likely to move forward. Our advocacy must embrace ways forward regardless of the outcome. What are the provisions that must be present in a block grant configuration? (Think automatic inflationary adjustments, rates adequate to meet all requirements, etc.) What are the benefits of greater flexibility? (Think fewer regulations, easier billing methodologies, etc.) Now is the time to prepare for these discussions.
One action that does not bode well for the future is putting your head in the sand. While some of us are tempted to say, “Wake us up when it’s over,” we know that’s a bad idea. Things will be different going forward and we must be at the table in our states as well as at the federal level. ANCOR has you covered at the federal level!
Stay tuned – and hold on…
Diane McComb is ANCOR’s Liaison with State Associations around the country and may be reached at [email protected]