November 2010

The outcome of the November 2^nd elections resulted in a shift in power in the United States House of Representatives as Republicans gained majority for the 112^th Congress. The Republican Party also gained seats in the Senate, narrowing the Democrats margin to 53 to 47, all but eliminating chances of obtaining the 60 votes needed to stop a filibuster. Ohio’s John Boehner will become the Speaker of the House.  Representative Nancy Pelosi will shift from Speaker to Minority Leader.

Health Care Reform

The Department of Health and Human Services (HHS) announced that it would be reducing premium rates for uninsured people with pre-existing medical conditions to join temporary high-risk pools.  HHS will lower premiums by about 20% in 2011 for the 23 states participating in the federal government run Pre-existing Condition Insurance Plan. The high-risk pools are very important for people with disabilities who are frequently priced out of most private health insurance plans. The pools are intended to provide needed coverage until the health status non-discrimination provisions and the establishment of the health insurance exchanges take effect in 2014.  As of November 1, one of Ohio’s border states, Pennsylvania, had the largest enrollment of any state and charges a $283 monthly premium, one of the lowest rates in the country.

The HHS released proposed regulations requiring insurance companies to spend 80-85% of the health care premiums they receive on actual health care services and quality improvement activities rather than administrative costs.  Insurers will be required to begin tracking their spending in 2011, and in 2012 will report on the results. In 2012, any insurer that does not spend 80-85% on actual health care services and quality improvement activities will also have to give plan members a rebate based on their excess spending in administrative costs. 

Education - IDEA's 35th Anniversary Celebration

The United States Department of Education hosted a celebration of the 35^th Anniversary of the enactment of the Education for All Handicapped Children Act, now known as the Individuals with Disabilities Education Act (IDEA).

United States Congress 

The 111^th Congress was in session prior to Thanksgiving.  Facing a huge "to do" list, most pending bills on this list will be postponed for action until the new 112^th Congress convenes next year. Bills most likely to be dealt with include extending the Continuing Resolution that keeps the federal government operating without the enactment of fiscal year 2012 Appropriations bills; extending the tax cuts enacted in 2001 and 2003 which would expire on December 31^st; and, extending unemployment insurance coverage and child nutrition legislation.  At press time, President Obama was working with members of Congress on the budget, potential extension of the Bush Administration tax breaks and the potential for an omnibus bill to permit the ongoing flow of Federal funds.

Medicaid - States Considering Opting Out

There have been discussions in the Texas state legislature about a proposal to opt out of the Medicaid program citing their belief that they could provide more cost-effective and efficient care by giving up federal funds entirely or by getting federal waivers to provide health care on their own terms. There are members claiming that if states dropped Medicaid, many low-income people would instead receive federal subsidies to buy private insurance coverage through the state health insurance exchanges created by the Affordable Care Act. States would then become totally responsible for Medicaid beneficiaries who require long term care.

Fiscal Commission

The Co-Chairs of the bipartisan National Commission on Fiscal Responsibility and Reform released their draft proposal on November 10^th. The proposal contains reductions in entitlement, discretionary, and defense spending. Of greatest concern to the disability community are:

•       Social Security: Increasing the age of retirement to age 69, which would disproportionately affect people with health problems as well as persons who receive Disabled Adult Children (DAC) benefits.
 

•       Medicaid: Capping spending on long term services and supports by creating a block grant.

The Commission only has authority to make recommendations. Any formal action would have to be voted on by Congress and signed by the President.

Demonstration Waivers

The Centers on Medicare and Medicaid Services (CMS) issued a Notice of Proposed Rulemaking on new requirements for accountability and transparency in the review and approval of Section 1115 demonstrations. Section 1115 demonstrations are used by states to test new ideas in Medicaid coverage. Individuals with disabilities have much at stake when changes to Medicaid.

National Perspective is a publication of the Ohio Association of County Boards of DD, designed to update Association members on national and federal issues of interest.