Overview
Congress left town for the Presidents’ Day recess and returned February 27. The Senate has been occupied over the past several weeks with hearings and votes on Cabinet and other appointments to the new Trump Administration. Former Congressman Tom Price (R-Georgia) was confirmed as Secretary of Health and Human Services. The Senate Finance Committee held a hearing on February 17 on Seema Verma’s nomination to head the Centers for Medicare and Medicaid Advocacy (CMS). The Senate Banking, Housing and Urban Affairs Committee voted January 24 to approve Dr. Ben Carson’s nomination as Secretary of Housing and Urban Development. The full Senate has yet to vote on the nomination.
Affordable Care Act (ACA)
In January, Congress passed a fiscal 2017 budget resolution, S. Con. Res. 3, directing two House and two Senate committees to draft legislation to save $1 billion each over the next ten years by repealing portions of the ACA. The committees’ deadline for getting these budget reconciliation measures back to the House and Senate Budget Committees was January 27. The committees have not met the deadline.
The House Committees on Energy and Commerce and on Ways and Means will be going first in drafting reconciliation legislation. LeadingAge has heard that these committees will begin marking up legislation the week of February 27.
The House does not appear to have reached consensus yet on two Medicaid issues: repeal of the ACA’s Medicaid expansion and the proposal to convert Medicaid into a program of block grants or per capita capped allotments to the states. Thirty-one states and the District of Columbia have expanded Medicaid; 16 of those states are headed by Republican governors. House committees are trying to determine how the loss of the Medicaid expansion funds could be cushioned for these states without seeming to reward them for adopting the ACA initiative.
LeadingAge remains greatly concerned about both the block grant and the per capita cap proposals for transforming Medicaid. Under either proposal, states would lose more funding than could be made up by increased efficiency and “flexibility”, and the gap between funding levels necessary to cover current services and the money actually available in the future would grow over time. If the program is transformed according to current proposals, it will be next to impossible to put it back together again in the future.
There may be some efforts to fence elders away from other populations to protect the services they now receive. But states facing federal funding shortfalls still will have little choice other than to restrict services covered by the program, make it more difficult to qualify for coverage, or cut payments to providers. We continue to advocate strongly against any change in the operating structure or the financing of Medicaid.
Housing and home- and community-based services funding
With the debate over the ACA having delayed work on budget legislation for the remainder of fiscal 2017, it will be some time before congressional budget and appropriations committees will be able to begin the fiscal 2018 budget process. LeadingAge is urging Congress to lift sequestration under the 2011 Budget Control Act and to continue giving spending parity to the non-defense discretionary portion of the budget that includes senior housing and aging services programs.
LeadingAge has detailed appropriations asks for 2018 that will fully fund the renewal of all Section 202 project rental assistance contracts, project-based rental assistance contracts, renewal of all tenant-based rental assistance vouchers and service coordinators. We also are urging Congress to provide money for new construction and to give project rental assistance contract properties access to the Rental Assistance Demonstration program.
New home- and community-based services legislation
LeadingAge is advocating in favor of S. 309, the Community Based Independence for Seniors Act, introduced by Senators Charles Grassley (R-IA) and Ben Cardin (D-MD). The legislation would establish a community-based special needs plan that would give low-income Medicare beneficiaries coverage for home- and community-based services. There is no similar bill in the House as yet.
Nursing home oversight and requirements of participation
LeadingAge has communicated with both CMS and members of Congress on especially egregious examples of survey overreach and will continue working with the new administration on a more reasonable approach to nursing home oversight. LeadingAge is also urging Congress and the Administration to delay the next round of the requirements of participation. This will be one of our three priorities for member Hill visits during PEAK.