Uninsured individuals can use these websites to shop for and enroll in insurance plans that offer a basic package of benefits on health care exchanges, also known as marketplaces, where insurers compete for business.  Under the ACA all policies sold in the exchanges must cover what physicians and consumer advocates call “essential health benefits.”  They include hospitalization, ambulatory services, emergency services, maternity and newborn care, mental health and substance abuse services, prescription drugs, lab tests, wellness and preventive services, pediatric services including dental and vision care, and rehabilitative services.  (See more information on benefits.)

Sixteen states and the District of Columbia opted to set up their own exchanges; 7 states are doing a partnership with the federal government; and the other 34 states are relying on the federal government to set up their exchanges.  Lower and moderate income families and individuals with incomes between 100 and 400 percent of poverty will be able to apply for subsidies to offset the cost of premiums they cannot now afford.  Premiums and out-of-pocket costs will vary depending on the level of insurance coverage: bronze, silver, gold and platinum.

The ACA was signed into law by President Obama on March 23, 2010.  Since then, certain provisions of the ACA have already gone into effect.  Insurance companies are now required to provide their customers with free preventive care and screenings for illnesses, discounts for seniors for prescription drugs, wellness visits with no co-pays, the option for those up to 26 years of age to remain on their parents’ health care policy, an end to denying coverage to children with pre-existing conditions, and the requirement that they reimburse customers if they spend less than 80 percent of premiums on care.

On January 1, 2014, coverage purchased through the exchanges will take effect.  Insurance companies will then no longer be able to deny coverage to adults with pre-existing conditions or charge higher premiums based on sex or medical history.

The ACA includes an individual mandate that requires most individuals to have insurance so the system no longer bears as heavy a burden for providing coverage for the uninsured.  Annual penalties for failure to be insured are $95 per adult and $47.50 per child, or up to one percent of a family’s income.  Businesses of 50 or more employees will be required to provide health benefits for their employees.  Starting in 2015, if employers do not provide health coverage they will pay a tax penalty.  The 6-month open-enrollment period for the exchanges ends on March 31 for the 2014 calendar year.  Subsequent years will have a 3-month enrollment period from October through December.

Included in the ACA was the requirement that states expand their Medicaid program to cover non-elderly poor people who are 133 percent below the poverty line, or about $31,300 for a family of four.  The federal government is committed to covering 100 percent of the cost of the expansion through 2016, no less than 93 percent of the cost between 2017 and 2019, and 90 percent of the cost thereafter.  Both the individual mandate to buy health insurance and the Medicaid expansion were challenged in court.  On June 28, 2012, the U.S. Supreme Court upheld the individual mandate but said that states could not be required to expand their Medicaid programs, thus making it optional.  Twenty-four states and the District of Columbia have opted to expand Medicaid.  States can reconsider and opt for expansion at any time.  The states that have declined to expand their Medicaid programs have a disproportionate number of poor blacks, single mothers and low-wage workers who are too poor to qualify for insurance subsidies in the exchanges (their incomes must be at least 100 percent of the poverty line).  The New York Times recently estimated that two-thirds of the poor African Americans and single mothers who now lack health insurance will not get coverage because their states so far have failed to expand their Medicaid programs.  The Congressional Budget Office estimates that in 2014, about 14 million uninsured will be covered by the ACA through the exchanges and Medicaid expansion.  By 2019, that number will have risen to 25 million.  That still leaves millions uninsured.

Members of the Tea Party in Congress have refused to acknowledge that ACA is the law of the land.  Under pressure from them, the House of Representatives has voted over 40 times to repeal the ACA.  As Congress struggles to extend funding for appropriated programs in a Continuing Resolution (see article in this Human Needs Report) the House has attempted to add provisions to defund the entire ACA, to delay implementation of the exchanges for one year, and to repeal its medical device tax.  Democrats and the White House have remained united and strong in opposing these attempts to undermine the ACA.

Republicans argue that a one-year delay will provide more time to iron out the bill’s kinks.  Democrats know that delaying implementation of the exchanges would have devastating consequences, giving strength to attempts to kill the law.  For more information see the Center on Budget and Policy Priorities analysis of the impact of delaying the ACA.

The medical device industry and others that would benefit from a flood of new customers were asked to make a contribution to offset the cost of expanding coverage to millions of uninsured.  The 2.3 percent medical device industry tax was that sector’s contribution to help pay for the ACA.  This lucrative industry has total sales of over $100 billion a year, concentrated on a small number of large companies.  They have lobbied heavily against the tax and their presence in both Democratic and Republican dominated states has given bi-partisan support to the repeal of the tax.  However, Senate Democrats are united in opposing any changes to the ACA in the context of resolving the continuing resolution.

Like the Medicare and Medicaid adoption in 1965 and the Medicare Part D prescription drug benefit in 2003, implementation of the ACA will have bumps in the road.  ACA opponents, including some Republican governors and legislators, are attempting to sabotage the law.  In some cases, they have refused to provide accurate information about the law to their constituents and have discouraged their participation in the exchanges.  The drumbeat of misinformation has contributed to public opinion polls indicating both a lack of support for the ACA and inaccurate information about it.  These efforts have been countered by national, state, and local organizations who are working to provide education and encourage enrollment in the exchanges.  Proponents of the ACA believe that, just as most of Medicare’s initial detractors came to support the program, once people experience the benefits of the ACA, support will quickly grow.

The post CHN: The Affordable Care Act – Enrollment Begins appeared first on Coalition on Human Needs.

The influence of the extremists in the House was clear in the decision of the House leadership to put forward a temporary spending bill with a poison pill permanently defunding the 2010 health care law.  The Continuing Resolution (CR) extends spending on military, domestic and international appropriations at this year’s levels through December 15.  The House estimates the annualized costs of continuing this year’s spending at $986 billion.  This level continues the sequestration cuts begun in 2013.  If spending continues all year at this rate, domestic and international programs subject to appropriation will be cut by 17.8 percent compared to FY 2010.  (For more detail on the proposed CR, see The Approaching Crunch, in the August 7, 2013 edition of The Human Needs Report.)

The Senate and President Obama have both made clear that they will not accept defunding of the health care law.  The Senate will now take up the House bill (H.J. Res. 59) this week, and will move to delete the health care provision.  Senator Ted Cruz (R-TX) has threatened to filibuster to prevent the Senate from passing a version that does not defund the Affordable Care Act.  As a matter of Senate procedure, he will have to filibuster the bill that comes from the House, which is awkward because it contains the defunding provision he favors.  If there are 60 votes to move the bill forward, an amendment to strip the bill of the health law provisions will only require a simple majority.  Most observers believe the Senate will have the 60 votes to end a filibuster and will certainly have a majority to get rid of the ACA cuts.

Senate Appropriations Committee Chair Barbara Mikulski (D-MD) greatly prefers a CR that would last only till mid-November, at least if it is set at only current year funding.  The Senate Democrats and the President oppose permanent funding for FY 2014 at this year’s very low levels; their alternative is $1.058 trillion in appropriations, an amount that does not include continued sequestration cuts.  If a stopgap spending bill lasts until December 15, it is feared that Congress will not come to grips with making the changes needed and will simply keep extending current levels into the new calendar year.  As the months progress, it will be more and more difficult to undo the FY 2014 sequester reductions.  On the other hand, a November 15 deadline leaves more time to negotiate an end to sequestration.

Once the bill is returned to the House with changes including deletion of the ACA defunding, it will be perilously close to the end of the fiscal year.  With only a few days to spare, the House will have to decide (a) if it will insist on dismantling ACA or (b) agree to a cleaner extension.   Plan (a) will shut down much of the federal government.  The Wall Street Journal was not encouraging about this approach in a recent opinion piece:  “Kamikaze missions rarely turn out well, least of all for the pilots.”

A decision to agree to a cleaner extension will require Democratic votes in the House, on the assumption that many disgruntled extremists among the Republicans will vote no.  Getting to a majority may be difficult even without the ACA cuts, because members of the House Progressive Caucus do not want to vote for a spending bill that continues the sequester cuts.  Co-Chairs of the Progressive Caucus, Keith Ellison (D-MN) and Raul Grijalva (D-AZ) are “whipping” their 75 members to urge a no vote on a CR that continues the sequester cuts in this year’s spending.

Deadbeat Nation?  Not limiting their Affordable Care Act threats to a federal government shutdown, the House leadership has also announced plans to tie a set of conditions to a one-year extension of the debt limit.  To authorize the federal government to continue borrowing past November 2014, the House Republican plan is said to require a one-year delay in Affordable Care Act implementation.  It would also include cut proposals that have surfaced in previous deficit reduction negotiations, such as requiring higher contributions towards pension plans by federal workers, repeal of parts of the ACA, cuts in SNAP (see SNAP article in this issue), and charging higher-income Medicare recipients more for their coverage.  Reducing the cost of living adjustment for Social Security (using the “chained CPI”) has also been proposed in the past.  These proposals have all been vigorously opposed by organized labor and other advocates as well as by many Democrats.  The House proposal assumes that a year’s debt limit increase would be about $600 – $700 billion.  They would “pay” for that increase by cuts similar to those just described.

The Administration has been willing to consider some of these proposals in the past, but has said it will not agree to more cuts without an agreement to raise revenues.  The House leadership has told the Republican caucus that the debt limit bill will also include instructions to the tax-writing committees to come up with tax reform legislation.  If similar to language previously adopted in the House, the instructions will probably direct the House Ways and Means Committee to lower tax rates for individuals and corporations and be revenue neutral.  That would mean that revenue losses from reducing rates would be offset by closing loopholes or reducing other tax expenditures, but that there would not be a net revenue gain that could be used to replace sequester cuts or to meet other needs.  Such an approach would not sit well with Senate Majority Leader Harry Reid (D-NV) and many in his caucus.

If Congress does not increase federal borrowing authority by approximately mid-October, the government will be unable to pay all its bills.  The House bill to tie the debt ceiling to the ACA and other cuts could be introduced as early as September 25.  Here too, Democratic opposition will be firm.  In his Weekly Address on September 21, President Obama said “The United States of America is not a deadbeat nation.  We are a compassionate nation.  We are the world’s bedrock investment.  And doing anything to threaten that is the height of irresponsibility.  That’s why I will not negotiate over the full faith and credit of the United States.  I will not allow anyone to harm this country’s reputation, or threaten to inflict economic pain on millions of our own people, just to make an ideological point.”

Economists across the political spectrum have raised alarms about even threatening to tamper with the debt ceiling.  Martin Feldstein, chairman of the Council of Economic Advisors under President Reagan said “The debt ceiling is a very dangerous thing to play with.”  Alan Blinder, former vice chair of the Federal Reserve, said “In short, the consequences of hitting the debt ceiling are too awful to contemplate…A sane Congress wouldn’t even think about it.”  Republicans will have to think hard about how voters will react to this two-pronged threat to the economy.

The post CHN: House Extremists in the Pilot’s Seat: Hurtling Towards Government Shutdown and Debt Crunch appeared first on Coalition on Human Needs.

On June 28, the Supreme Court made an historic decision: they upheld the individual mandate in the Affordable Care Act. This news came with a bitter pill for low-income advocates, however – that states now have the option to refuse to expand Medicaid to cover people with incomes up to 133 percent of the poverty line, choosing to forego federal funds provided to them for this purpose.

The Medicaid expansion is fully funded by ACA for its first three years (after which the federal match phases down to 90 percent by 2020). If a state chooses not to expand Medicaid however, many low-income people will remain uninsured. The Affordable Care Act was designed assuming that those individuals with incomes below the poverty line would be covered by Medicaid. Based on this assumption, Congress set the income eligibility range for subsidies aimed at helping people purchase coverage in insurance exchanges at 100 to 400 percent of the poverty line. If a state does not accept the Medicaid expansion, individuals living below the poverty line who are not now covered by their state’s Medicaid program will not be eligible for premium subsidies either.  The Congressional Budget Office estimates that because some states will refuse to expand Medicaid, 6 million people will not receive health coverage through that program.  Of these, CBO expects 3 million with incomes from 100 – 133 percent of the poverty line will get subsidized coverage through their state’s insurance exchange.  The remaining 3 million will fall into the “coverage gap” – left without any coverage at all. For further details, see this piece from Robert Greenstein at the Center for Budget and Policy Priorities and this blog post from the Center.

The expansion is a very favorable deal for states, and not only because it is almost fully federally funded. Hospitals also benefit from the expansion because they are ensured Medicaid payment for services that are not currently reimbursed. Essentially, for a small cost to states that would be partly offset by savings in uncompensated care, CBO had estimated that the Medicaid expansion with all states participating would cover an additional 17 million low-income people.

So why are so many states threatening not to take the Medicaid expansion? Governor Rick Perry of Texas, along with Republican governors from at least 10 other states, has announced that he will not expand Medicaid. Many advocates believe their opposition is based on partisan politics or ideology, although these governors claim that states would bear a financial burden by expanding Medicaid (see this color-coded map from ThinkProgress to see which way states are leaning).  The small proportion states would pay is expected to amount to a 2.8 percent increase over their Medicaid costs without the expansion, less the savings from reducing uncompensated care payments to hospitals (because more patients would have insurance).  To most anti-poverty advocates, accepting the expansion seems like a no-brainer for states because of the benefits it provides and the fact that is almost fully funded by the federal government. Health care providers who expected more insured patients through the ACA are already starting to exert pressure on states to accept the option.  How many states will refuse the expansion money is yet to be seen – while they decide, the coverage of millions of low-income Americans hangs in the balance.

The Supreme Court’s validation of most of the health care law does not change the fierce opposition to it among right-wing members of Congress.  The House of Representatives has taken more than 30 votes to repeal the law, all of which have been rebuffed by the Senate.  The House has also attempted to deny the funding required to implement the law, most recently by cutting about $8 billion from the Department of Health and Human Services in the appropriations bill that was approved by a House subcommittee (see Appropriations article, this issue).  The Senate and the President will prevent the law from being de-funded, but the partisan attacks on the law can be expected to continue.

The post CHN: Medicaid Expansion Favorable for States, Yet Some Still Refuse to Cooperate appeared first on Coalition on Human Needs.

The Medicaid program is a critical source of health care coverage for low-income children, some of their parents, seniors, and people with disabilities.  An estimated one in five Americans enrolled in the Medicaid program in 2011.  Medicaid, along with the Children’s Health Insurance Program (CHIP) which provides health care to children in families with slightly higher incomes, covered 31 million low-income children, 11 million non-elderly low-income parents and pregnant women, 8.8 million non-elderly individuals with disabilities, 4.6 million low-income seniors and 3.7 million seniors with disabilities.  But people who do not fit the above categories have not qualified for Medicaid, no matter how poor they are.  The Affordable Care Act will change that, allowing all whose incomes are low enough to receive health care through Medicaid.

Under the ACA, the federal government would pay 100 percent of the cost of expanding Medicaid for the first three years and 90 percent or more of the cost thereafter.  The states who are plaintiffs in the Supreme Court case are calling the Medicaid expansion coercive.  That was met with some skepticism during oral arguments.  Justice Kagan asked what was coercive about states receiving a “boatload” of federal dollars to implement the expansion.  There is plenty of precedent for Medicaid expansions that have required states to share the costs.  States always have the option to drop out of the program; they have not because Medicaid provides vital services with the federal government paying a generous share of the cost.  If the Medicaid expansion in the ACA is declared unconstitutional it would have alarming implications for all of Medicaid, not just the new provisions, and could throw into question other programs in which states are required to pony up funds as a condition of receiving federal funds.  For more information on Medicaid’s role under health care reform see this Kaiser Family Foundation issue brief .

The Court is expected to make its ruling on the constitutionality of the provisions in the Affordable Care Act in late June when the session ends.

The post CHN: Stakes Couldn’t Be Higher for Low-Income Uninsured appeared first on Coalition on Human Needs.

The hearing uncovered growing abuses by unscrupulous agents in private companies marketing Medicare Advantage plans to unsuspecting seniors who are convinced to enroll in a plan they may not understand and that may be inappropriate for their situation.  Agents often receive bonuses and gifts based on their ability to increase enrollment in their company’s plans.  Marketing abuses include agents misrepresenting their association with Medicare, using scare tactics and tricking seniors into unknowingly signing application documents.  Currently, 8.5 million beneficiaries, or 19 percent of the Medicare population, are enrolled in Medicare Advantage plans.  As long as companies can pad profits through high subsidies and continue to engage in deceptive market practices, enrollment will increase in Medicare Advantage programs.  Some would go as far as to argue that this ultimately could lead to privatization of the Medicare program.

The debate over Medicare Advantage plans has come into focus in the context of the reauthorization of the State Children’s Health Insurance Program (SCHIP).  SCHIP is a program that provides affordable health care with a robust benefit package for low-income children and families unable to afford health insurance but not poor enough to be eligible for coverage under Medicaid.  In order to expand coverage to more children, advocates and many in Congress support increasing the federal government’s investment in SCHIP by $50 billion over the next 5 years.  The rules adopted by Congress this year require that spending increases in mandatory programs like SCHIP be paid for (offset) by comparable reductions in spending or increases in revenue.  CBO estimates that eliminating overpayments in Medicare Advantage would save $54 billion between 2009-2013, enough to offset $50 billion in new funding for SCHIP.

Many would argue that reducing or eliminating overpayments to private insurance companies in the Medicare Advantage plans is an excellent offset for increasing resources to the SCHIP program.   For advocates the choice is clear.  Funding windfalls for insurance companies that place traditional Medicare at a competitive disadvantage is not just a low priority; it is downright undesirable.  The nation’s interests are far better served by directing these funds to increase access to health care coverage for more children.

Both the House and Senate are expected to mark up SCHIP reauthorization bills in July.

The post CHN: House Examines Medicare Advantage Program appeared first on Coalition on Human Needs.

Most significantly, the President proposed expanding Health Savings Accounts (HSAs), tax-free savings accounts created in the 2003 Medicare law that can be used to pay deductibles and out-of-pocket costs of health care provided through a high-deductible health insurance plan. Many economists and analysts point out that HSAs offer the greatest benefits to those at the highest tax brackets who need help with health care the least. HSAs drive up the cost of health care for low-income and sicker people who would be more likely to stay in traditional lower-premium plans. Further, higher out-of-pocket costs will induce many lower-income people to avoid seeking necessary care, which could eventually result in health problems that are more costly to treat. The idea behind HSAs is to create a greater incentive for people to avoid unnecessary health care costs, but research shows that the vast majority of health care costs are spent on the ten percent of people who have major illnesses or disabilities, situations in which health care cannot be safely avoided. Critics also argue that some ways of expanding HSAs could even encourage employers to stop providing coverage, making health care further out of reach for the average worker. (For more information, see the recent paper released by the Center on Budget and Policy Priorities at http://www.cbpp.org/1-31-06health.htm)

The President’s speech included other proposals that could affect services for moderate- and low-income families. The President pledged, as he has in previous budget cycles, to reduce or eliminate a number of programs his administration deems to be not successful. He will propose to save $14 billion in fiscal 2007 by eliminating 140 programs. The President called for reducing or eliminating 150 programs last year and 65 programs the year before that and each time Congress has largely declined to do so. The sorts of programs targeted for elimination last year included the Safe and Drug Free Schools program, Upward Bound for low-income high school students, and Hope VI funding for revitalizing public housing. Although funding has been cut for these programs, Congress rejected the President’s plan to eliminate them.

The President also announced a proposal to “train 70,000 high school teachers to lead advanced placement courses in math and science, bring 30,000 math and science professionals to teach in classrooms, and give early help to students who struggle with math so they have a better chance at good, high-wage jobs.” This proposal would be one prong of his American Competitiveness Initiative, which would also increase federal funding for scientific research and make permanent the research and development tax credit. Educators generally agree with the need for more focus on math and science, but the new initiatives are hardly adequate to make up for other shortfalls in federal education policy, such as underfunding the Leave No Child Behind Law by $40 billion over the past five years.

The post CHN: State of Union Address Foreshadows Fiscal 2007 Budget appeared first on Coalition on Human Needs.

The difference between those two bills must be ironed out in the next few days. The final bill that emerges from the conference committee will be voted on in each chamber. The reconciliation bill represents the top priority for right-wing members – yet many representatives and senators have voiced concerns over a wide variety of provisions under consideration. It is not yet clear Republican leadership will find enough votes to pass any final bill. House Speaker Dennis Hastert (R-IL) has threatened to keep the House in session until December 20 or later until the House agrees to the budget cuts.

Although right-wing members claim the cuts are necessary to reduce the deficit, any money “saved” from cutting services is being directed to pay for new tax cuts benefiting the wealthy. In fact the coupling of two reconciliation bills – one cutting services and one cutting tax cuts – actually increase the deficit. For more information about the tax cuts, see related article in this issue.

To combat the budget cuts, low-income advocates are planning a National Week of Prayer and Action for Compassionate Priorities for December 12-16. Advocates are being encouraged to call their representatives and senators next week and the Emergency Campaign for America’s Priorities is staging more than 90 events across the country. The faith-based organization Sojourners will hold a prayer vigil at the U.S. Capitol on December 14. Dozens of other prayer vigils will be held elsewhere in the country that week.

There are stark differences between the House and Senate versions of the budget-cutting bill – and those differences could trip up negotiators. If Congress is not able to approve the final bill before the end of the year, they could attempt to bring it up again in January. The budget resolution for fiscal year 2006, which Congress approved in the spring and which granted authority for the reconciliation bill, will remain in effect until Congress passes the next budget resolution for fiscal year 2007.

The Senate budget cutting bill (S. 1932) was approved November 3 by a vote of 52 to 47 with all Democrats except Mary Landrieu (LA) and Ben Nelson (NE) opposed. All Republican senators but five voted for the cuts. The House budget-cutting bill (H.R. 4241) was approved November 18 with all Democrats opposed and all but 14 Republicans in favor.

Here is a brief summary of what is in the House and Senate bills. (This list is not comprehensive.)

Medicaid: The Senate would cut Medicaid by about $6.1 billion over the next five years – but the burden of those cuts would be borne by the drug and insurance industry. H.R. 4241, on the other hand, would cut $11.4 billion from Medicaid and would allow states to require poor mothers and children to pay more for their health care. A family of three earning $18,000 a year could face total Medicaid charges of as much as $900 per year. The Congressional Budget Office (CBO) estimates 80 percent of the savings generated from these changes will come from people not getting care because they can’t afford it. The CBO estimates 100,000 people will lose Medicaid altogether. Senator Gordon Smith (R-OR) pledges to oppose any Medicaid cuts that harm beneficiaries.

Food Stamps: The Senate chose not to cut Food Stamps. The House bill denies Food Stamps to at least 255,000 people . At least 185,000 low-income working families with children will lose assistance, plus 70,000 legal immigrants who have been in this country for five years or more. Several Republican senators signed a letter urging rejection of Food Stamp cuts in final bill: Gordon Smith, Mike DeWine (OH), Richard Lugar (IN), Susan Collins (ME), Arlen Specter (PA), Chuck Hagel (NE), Rick Santorum (PA), Olympia Snowe (ME), Jim Talent (MO), Norm Coleman (MN), Lincoln Chafee (RI), Elizabeth Dole (NC), and Charles Grassley (IA).

Child Support: The House bill cuts $5 billion from child support enforcement. As a result of this cut, children in families owed child support by an absent parent will lose $24 billion in support over ten years. The Senate bill does not cut child support enforcement. Forty senators have signed a letter objecting to cuts to child support enforcement.

Aid to Disabled: H.R. 4241 cuts $730 million from Supplemental Security Income (SSI). Poor people with severe disabilities will have to wait longer to receive the aid the federal government owes them. It often takes months or a year for a disabled person to be approved for SSI. Now he or she gets a lump sum payment that can help pay back rent or other bills for the period when no money was coming in. The House bill would spread out the owed benefits over many months – and if the disabled person dies while waiting, the government gets to keep the money. The Senate bill does not cut SSI.

TANF/Welfare Reform: The House bill requires many more families to participate for longer hours in paid or unpaid work. The bill provides an inadequate $500 million in new child care funds – half of what previous House bills proposed. As a result, 330,000 fewer children will receive child care help. The bill makes it harder for poor parents to get education, training, rehabilitation or other services to enable them to work at decent pay. S. 1932 does not include TANF provisions. Welfare advocates have been asking senators to object to including TANF in a reconciliation bill. Six Republican senators have signed a letter being circulated by Olympia Snowe (ME) asking Majority Leader Bill Frist (TN) to ensure TANF stays out of a final bill. Signers include: Senators DeWine, Chafee, Coleman, Specter, and Collins.

Foster Care: The House bill cuts $600 million from programs for abused and neglected children. The bill limits eligibility for federal foster care payments for grandparents taking care of their grandchildren. The Senate bill does not make cuts to child welfare programs.

LIHEAP: The House bill includes a $1 billion increase for home energy assistance for low-income households. Acknowledging predictions of sky-high heating oil and electricity costs this winter, Republican leaders added LIHEAP money as a sweetener to the bill to attract Northeastern and Midwestern moderates. The Senate bill does not include additional LIHEAP funds.

Arctic Drilling: The Senate bill would open the Arctic National Wildlife Refuge to drilling; the House bill does not. To many observers, drilling in the Arctic will be a lynchpin issue in the negotiations. A group of House moderates vow to defeat any bill that includes arctic drilling but Senator Ted Stevens (R-AK) has said he would vote against a bill that does not include drilling.

For More Information

CHN: TANF Has No Place in Reconciliation   *** Page Not Found
CBPP: Judging the Outcome of House-Senate Negotiations
CHN alert on next week’s activities

The post CHN: House and Senate to Attempt Passing a Final Bill Cutting Aid to Poor appeared first on Coalition on Human Needs.

Less than two months ago hurricane Katrina swept the Gulf Coast, revealing the calamitous consequences of failing to invest in communities and people. President Bush addressed the nation on September 15 from New Orleans, noting the “deep, persistent” poverty of the region and said, “We have a duty to confront this poverty with bold action.”

Instead of “bold action,” conservatives in Congress are pushing ahead with business as usual — with cuts to services for poor people and new tax breaks for the wealthy. Instead of expanding opportunities or providing health care, nutrition assistance or employment opportunities to those who need it most, the House and Senate will be moving ahead as early as next week with legislation that cuts Food Stamps and Medicaid.

The budget resolution approved by Congress in the spring called for $35 billion in cuts over five years to services that mostly help low-income families. The cuts will come from mandatory programs (sometimes called entitlements) such as Medicaid, student aid and Food Stamps. Temporary Assistance for Needy Families (TANF), the Earned Income Tax Credit (EITC) and Supplemental Security Income (SSI) for people with disabilities may also be at risk. The budget resolution also called for $70 billion in new tax breaks that will primarily benefit the wealthy.

The $35 billion in cuts now appears to be only a starting point. Next week the House may consider amending the budget resolution to make at least $50 billion in cuts. (For the moment, the Senate is sticking with the $35 billion target.) In addition, Congress may consider an across-the-board cut to all discretionary programs (those that must be funded annually — see related story, this issue.)

To accomplish the $35 to $50 billion in cuts, Congress will use a technique called reconciliation. Various committees will pass legislation cutting from programs under their jurisdiction. For example, the Senate Agriculture committee is expected to pass a bill next week that will change eligibility requirements of the Food Stamp program resulting in a nearly $600 million cut, expected to affect 200,000 people. Once committees have passed their separate bills, the Budget Committee will package them together into a single bill that will be sent to the floor for a vote. In the Senate, a reconciliation bill requires just 51 votes for passage.

The original deadline Congress set for itself to make cuts was mid-September. The Senate has put off that deadline to the end of October and the House will take at least one week longer to make the cuts. Votes on the floor are expected in late October or early November, but that timeline could slip.

Later in the fall the House and Senate plan to pass legislation with $70 billion in new tax breaks over five years. An important piece of the tax cut package is expected to be an extension of the capital gains and dividend rate reductions, which are supposed to expire in 2008. The Center on Budget and Policy Priorities predicts 53 percent of the benefits from that tax break will go to millionaires (the top 0.2 percent of taxpayers.)

Ostensibly, the House is calling for deeper cuts to services in order to pay for the cost of recovery. But many observers say “how to pay for the cost of Katrina” is the wrong question. The budget resolution approved by Congress actually increases the deficit by $35 billion (spending for low-income services is reduced by $35 billion but new tax breaks will cause the government to lose $70 billion in revenue.) The tax breaks of 2001 and 2003 are costing the federal government more than $225 billion this year alone in lost revenue.

Several Senators and members of the House have admitted that figuring out where and how to cut services will not be easy. Human needs advocates are planning massive call-in days on October 17 and 18 to tell Senators and Representatives to abandon their plans for service cuts and tax breaks. Last week more than 750 organizations in all 50 states signed a letter calling on Congress to discard its plans to cut services for the needy while passing more tax breaks for the wealthy.

Three Senate committees with reconciliation markup sessions scheduled at this writing are Health, Education, Labor and Pensions (Tuesday, October 18, 2:30 p.m.), Agriculture (Wednesday, October 19, 9:30 a.m.), and Energy and Natural Resources (Wednesday, October 19, 10:00 a.m.). The Budget Committee is scheduled to meet to report out the legislation compiled from other committees on October 26.

The post CHN: House Presses for Even Larger Cuts to Low-Income Services appeared first on Coalition on Human Needs.

The Administration continues to promote the existing process through which states can apply for waivers under section 1115 of the Social Security Act. The Administration claims that the waivers are more workable and will result in full compensation to the states receiving the influx of hurricane survivors who are eligible for Medicaid.

Supporters of S. 1716, sponsored by Senate Finance Chairman Charles Grassley (R-IA) and ranking Finance Democrat Max Baucus (D-MT), point out that the waiver process is unnecessarily cumbersome in an emergency situation and that the waivers do not expand the eligibility rules of the Medicaid program for Katrina survivors. Under Medicaid rules, a person must fall in one of five categories to be eligible: children, pregnant women, parents of dependent children, seniors or people with severe disabilities. Childless adults under 65 years of age who do not have a very severe health conditions cannot access Medicaid under the waivers no matter how poor they are.

There are reportedly thousands in Louisiana and in states where survivors have relocated who are denied Medicaid for this reason, some of whom are lacking needed medications. (See two recent reports from the Center on Budget and Policy Priorities: Edwin Park, “Failing to Deliver,” http://www.cbpp.org/9-29-05health.pdf ; Donna Cohen Ross, “Many Katrina Survivors Seeking Medicaid in LA Shelters Remain Without Coverage,” http://www.cbpp.org/10-12-05health3.pdf .)

Advocates have also pointed out that the states hit by the hurricane are in fiscal ruin that is only exacerbated by the waiver policy. The administration has forced Louisiana, Mississippi and Alabama to sign IOUs to pay their normal proportion of Medicaid costs for those survivors who are now residing in another state and receiving Medicaid there under a waiver. The hurricane-affected states also have increased numbers of people eligible for Medicaid still within their borders, putting new demands on the program, and yet the administration’s waiver policy offers no funding assistance.

To address these issues, the Emergency Health Care Relief Act (S. 1716)

.  streamlines the application procedures;

.  makes Medicaid available to any Katrina survivors with below-poverty incomes (or up to twice that level for pregnant women and children) for at least 5 months;

.  provides full federal funding for these benefits;

.  provides full federal funding for the State Children’s Health Insurance Program (SCHIP) in the three affected states through the end of 2006;

.  provides compensation to health care providers serving evacuees and provides support to individuals to allow them to continue private insurance formerly received through their employers.

Senator Grassley, whose committee was tasked with finding $10 billion in spending cuts in the budget resolution passed in April (H. Con. Res. 95), has reportedly warned of a “domino effect” that would result if S. 1716 is not passed. He stunned a packed hearing room on September 28 by suggesting that his committee would be unable to make the $10 billion in cuts that are to be included in the budget reconciliation bill if the Katrina Medicaid legislation is not enacted. Over a week later a GOP Finance Committee aide suggested the failure of S. 1716 could lead to the failure of the planned reconciliation bill to cut spending, which in turn would mean there is less money available to fund the tax cuts that are to be included in a second reconciliation bill.

The Katrina Medicaid legislation is thought to have wide support in the Senate, but Senators John Sununu (R-NH) and John Ensign (R-NV) blocked the bill from coming to the Senate floor. There is a good chance the bill might pass if Majority Leader Bill Frist (R-TN) were to call it to the floor.

Meanwhile, Senator Baucus has refused to work with Chairman Grassley on finding cuts unless the Katrina Medicaid legislation is approved. If Grassley has to depend entirely on Republican Finance Committee members to approve the reconciliation cuts, his success will hinge on persuading moderates Olympia Snowe (R-ME) and Gordon Smith (R-OR), who have indicated that they oppose any cuts in Medicaid that would harm beneficiaries.

To get out of this difficulty, Chairman Grassley is now making plans to insert the Katrina Medicaid legislation into his reconciliation bill. But this approach requires additional spending cuts to pay for the Katrina provisions – cuts that would not be needed if the Katrina bill were passed as emergency legislation, which of course it is. S. 1716 was originally estimated to cost $9 billion, but Grassley has whittled it down to $6.1 billion. If $6 or more billion is added to the reconciliation bill, the total cuts will have to be at least $16 billion to net the $10 billion required by the budget resolution. Chairman Grassley has identified cuts in Medicare and reduced the amount to be cut from Medicaid in an attempt to win enough votes to get the bill out of committee. But it remains unclear whether the numbers and the votes add up.

The post CHN: Victims of Katrina Still Waiting for Medicaid Help appeared first on Coalition on Human Needs.

On October 6 the House agreed by a voice vote to pass H.R. 3971, which would have extended TMA for three months (through December 2005) and extended QI-1 for one year (through September 2006.) The next day the Senate amended the bill to extend TMA for six months (through March 2006) and would have extended the Temporary Assistance for Needy Families program for an additional three months (through March 2006). Under current law, the TANF program will expire December 31, 2005. The House recessed without taking up this change, and without final agreement, the provisions expired.

Because there is separate authorization to continue Medicaid for most of the families affected for four months, if Congress takes up this soon on its return there should be little impact. If Congress fails to act, both these benefits for low-income people will be lost. Advocates will continue to push the House to extend QI-1 and TMA.

Status of H.R. 3971: http://thomas.loc.gov/cgi-bin/bdquery/z?d109:HR03971:@@@L&summ2=m&

The post CHN: House and Senate Fail to Extend Help for Low-Income Medicare Recipients appeared first on Coalition on Human Needs.