Action Alert
December 21, 2005

NCIL ADVOCACY UPDATE: Budget Reconciliation Passes Senate. BUT House Must Vote Again

Thank you to NCIL members for all your hard work and determined advocacy on budget reconciliation - particularly regarding the closely-fought battle in the Senate that culminated in a tie-breaking vote by Vice President Dick Cheney. For reasons outlined in our letter that can be found attached and below, we vigorously oppose the final budget reconciliation package. Although there is both bad news and some silver linings to report, please note that our work on this issue is not yet complete and will continue in the New Year.

The bad news: Despite our best efforts to stop damaging changes to Medicaid and Medicare that will adversely impact health care for beneficiaries with disabilities, we did not quite succeed in defeating budget reconciliation in the House or the Senate. Only 4 hours after the text of the budget reconciliation package was made public, the House voted early Monday morning to pass the budget reconciliation package in a pre-dawn 212-206 vote. For the roll call vote, see http://clerk.house.gov/evs/2005/roll670.xml.

With the exception of those who negotiated the package, most Representatives only had 4 hours to review and 40 minutes to debate this complex 700-plus-page legislation that includes damaging and controversial provisions that would harm many Medicaid and Medicare beneficiaries with disabilities. We believe that such hasty consideration does a disservice to the American people and urge Congress never to repeat this rush to judgment.

On the Senate side, there was more time to consider the conference package and many hours of debate, but the outcome was similarly disappointing. Even though all 44 Democrats, Independent James Jeffords (VT) and five Republicans Gordon Smith (OR), Mike DeWine (OH), Olympia Snowe (ME), Susan Collins (ME) and Lincoln Chafee (RI) voted against this legislation, we are disappointed to report that two Republican Senators whom we had hoped would stand by us, Senator Arlen Specter (PA) and Senator Norm Coleman (MN) supported the conference package. Their failure to join us put the decision to pass the legislation in the hands of Vice President Dick Cheney who cut short a visit to the Middle East to cast the decisive vote. For the Roll Call vote,
see http://www.senate.gov/legislative.

The good news: Fortunately, due to procedural issues, the reconciliation package is not yet law and the House of Representatives will have to vote on it one more time before it could become law!!! Due to a successful procedural point of order brought by Kent Conrad (ND) - the ranking Democrat on the Senate Budget Committee - certain provisions that violated Senate rules were stricken from the reconciliation package before it obtained Senate approval.

As a result, the House will have to vote one more time on budget reconciliation and THIS TIME members will not have the excuse that they didn't have time to review the legislation. Technically, the House could vote by unanimous consent to approve budget reconciliation tomorrow, but since House Democrats will refuse unanimous consent by asking for a roll call vote, final action will be postponed until January or perhaps early February at the earliest. This gives us one more chance to educate members on the adverse impact that the cost sharing, benefits package flexibility and other features of the final reconciliation package would have on persons with disabilities. Please consult the attached letter or e-mail Daniel Davis at Daniel@ncil.org for more details on what is in the budget reconciliation package and NCIL's reasons for opposing the bill.

One other silver lining to consider is that the Family Opportunity Act and a modified, watered-down version of Money Follows the Person is in the budget reconciliation package. The underlying provisions of the conference agreement are so fundamentally flawed that we cannot support the legislation, but if it does become law, $1.75 billion will go to the states to transition persons with disabilities into the community. That provision would not have survived without your hard work!!!

>> Future Action Steps:
HOUSE: Contact your Representative either next week or after New Year's Day about their upcoming budget reconciliation vote. Especially if he or she voted in favor of the budget reconciliation spending package, urge him or her to reconsider in light of the damage it will do to beneficiaries with disabilities.

SENATE: If Senators Smith, DeWine, Chafee, Collins and/or Snowe represent you, please contact them and let them know how much the disability community appreciates their principled stand on behalf of Medicaid beneficiaries with disabilities. These Senators deserve our commendation, since it is never easy for a member of a party to go against the leadership on such a closely contested issue.

NCIL members have done wonderful work and should enjoy the holidays with full knowledge that together we are making a positive difference! In the New Year, we will "Lead On!!!"

NCIL Letter of Opposition Budget Reconciliation Final

19 December 2005

Dear Senators:

The National Council on Independent Living (NCIL) strongly opposes the budget reconciliation conference agreement scheduled to come before the Senate for a vote tomorrow. Rather than reflecting the beneficiary-centered, "first do no harm" approach of the Senate reconciliation bill, the final conference agreement protects special interests at the expense of low income Medicaid and Medicare beneficiaries with disabilities.

NCIL is the oldest cross-disability, national grassroots organization run by and for people with disabilities. Our membership is comprised of centers for independent living, state independent living councils, people with disabilities and other disability rights organizations. As a membership organization, NCIL advances independent living and the rights of people with disabilities through consumer-driven advocacy. NCIL envisions a world in which people with disabilities are valued equally and participate fully. A key part of our work is to eliminate the institutional bias of Medicaid by moving persons with disabilities out of institutions and into community settings so they can control their own destinies and live independently.

The final conference bill is not premised on the bedrock American value of shared sacrifice, but instead disproportionately asks those on fixed incomes, with limited means, to shoulder the costs. The cost sharing, benefits package flexibility and enforcement provisions have the potential to dramatically exacerbate the institutional bias and derive savings by deterring people from obtaining medically necessary care. By contrast, the Medicare stabilization fund - a ten billion dollar insurance subsidy included as a part of the Medicare Modernization Act that was deemed unnecessary by MedPAC - emerges unscathed in the final reconciliation package. This is unconscionable. Where is the emphasis on civic responsibility and containing exorbitant expenditures when it comes to the pharmaceutical industry, the managed care industry, and other well-heeled providers?

Furthermore, we are concerned that there may be drafting errors that could undermine the EPSDT benefit and allow states to charge substantial cost-sharing to the poorest of beneficiaries. Low-income Medicaid beneficiaries with disabilities on SSI already cannot afford unsubsidized rental housing in any Metropolitan Statistical Area in the country. They cannot afford to pay more, yet they may be made to pay more due to rushed draftsmanship. This is what happens when bills are rushed through without full consideration and due deliberation.

Though we appreciate the inclusion of Money Follows the Person and the Family Opportunity Act in the final bill, NCIL and our members cannot support legislation that would:

>> Force low-income Medicaid recipients, with and without disabilities, to pay more for their care - and if they cannot shoulder the costs - deny them access to necessary medical care

>> Make it harder for Americans with disabilities needing long-term careto qualify for Medicaid through tighter assets restrictions

>> Undermine the EPSDT benefit by making the EPSDT wraparound benefit optional to the states, curtailing personal assistance services for children with disabilities, and/or making the benefits more difficult to obtain through increased reliance on Medicaid managed care. We are concerned that many children with disabilities could end up losing access to key Medicaid benefits like therapy services, eyeglasses, hearing aids, mental health and personal assistance services because of this change. EPSDT has been the key for thousands of young people with disabilities to receive home and community based services, especially in States with waiting lists for home and community based Medicaid waivers. Without these services, young people with disabilities may lose dignity, opportunity and independence and be unable to realize their full potential.

>> Systematically weaken or undermine core safeguards built into the Medicaid program

>> Formalize waiting lists for home and community based services in statute

This is inconsistent with the spirit of the season, the will of the American public, the best interests of persons with disabilities and the dictates of common sense. Accordingly, we urge the Senate to reject the reconciliation conference package and insist that the House accede to the fair and responsible provisions adopted by the Senate earlier this year.

Respectfully,

John Lancaster, Executive Director
Kelly Buckland, President