Disabled Americans tend to be a benign political constituency that most believe deserve attention, yet they are all too often ignored in the political process. The current top legislative priority of this group, the Community Choice Act, is no exception.
The bill would dramatically improve the living standards of many of those requiring attendant care. But despite drawing little public opposition and very ardent support from advocates, the legislation was omitted from the comprehensive health care package and remains stalled in both the House and Senate.
In Episode 9, we break down the House version of the Community Choice Act. As always, see the links at the bottom for further info.
One-page summary below the fold…
H.R. 1670: Community Choice Act of 2009
Sponsor: Rep. Danny Davis (D-IL7)
Click here to download this summary (pdf)
Cosponsors: 131 (113 Democrats, 18 Republicans). Full list at http://thomas.loc.gov/cgi-bin/bdquery/z?d111:HR01670:@@@P
Status: In Energy & Commerce Committee. No action scheduled. Hearings were held in 2008, but not in this Congress.
Senate Companion: S. 683, sponsored by Sen. Tom Harkin (D-IA). In Finance Committee, no action scheduled.
Purpose: The Medicaid long-term services budget is heavily tilted towards institutional care. Every state must provide nursing home services under Medicaid, but alternative, community-based services are optional. Advocates for the elderly and disabled seek more flexible coverage for institutional services that allows them to continue living in their own homes, and this bill would create a mechanism for that change to occur.
Summary: H.R. 1670 would require state Medicaid plans to cover community-based attendant services for those otherwise qualifying for nursing home or other institutional care by October 2014. It would support implementation of that mandate in the following ways:
• During the interim period, increases the federal funding (FMAP) percentage by 10% for activities of “early coverage” states promoting such support and services;
• Allows up to 90% federal funding for patients whose costs exceed 150% of average nursing home costs;
• Issues a set of standards that states must meet to qualify for the enhanced FMAP rate;
• Authorizes HHS discretionary grants to eligible states that create a Consumer Task Force to assist in the development, implementation, and evaluation of adaption and capacity building initiatives;
• Creates a demonstration project involving up to five states that would help identify potential efficiencies in the provision of community-based care to individuals eligible for both Medicaid and Medicare.
CBO Score: None provided. Outside cost estimates range anywhere from $1.4 billion to $20 billion per year.
Supporters: ADAPT, National Council on Independent Living, American Assn of People with Disabilities, etc.
• Supporters tend to exhibit deep passion about this bill, framing it as a matter of basic justice. The elderly and disabled deserve humane treatment and federal laws should not encourage their confinement to institutions.
Opposition: Voice of the Retarded, likely the American Health Care Assn (nursing home lobby), fiscal conservatives
• Some of those opposed to the Community Choice Act believe the costs incurred could have the unintended effect of squeezing out other currently optional programs, including services for citizens with severe and profound mental retardation. Others simply balk at the bill’s projected budget impact.
Full bill text: http://www.govtrack.us/congress/billtext.xpd?bill=h111-1670
Official CRS summary: http://www.govtrack.us/congress/bill.xpd?bill=h111-1670&tab=summary
ADAPT (key coalition of supporters) overview and links to further information: http://www.adapt.org/cca.php
American Prospect article from July 2009 on the fate of the bill: http://www.prospect.org/cs/articles?article=should_disability_funding_be_part_of_health_reform
VOR statement of opposition: http://www.vor.net/legislative-voice/legislation/opposition-to-micassa
Academic report estimating the costs of expanding community-based services: http://www.ncil.org/news/LaPlanteCCA.pdf