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The means by which Senate Republicans can pass an Affordable Care Act (ACA) repeal/replace bill by a simple majority budget process called reconciliation (and thus not requiring Democratic support of any kind) ends next week, at the end of September.

The Graham/Cassidy bill is now presenting a major threat to Medicaid – it replicates cuts presented in previous health proposals (using exact language from the Better Care Reconciliation Act – BCRA). According to earlier Congressional Budget Office (CBO) estimates, it will cut Medicaid (outside of expansion) by $175 billion between 2020–2026, and $39 billion will be cut from the Medicaid program in 2026 alone.

RCPA requests members to contact Senators Casey and Toomey, and ask them to OPPOSE the Graham/Cassidy bill. For your convenience, the following materials will give you valuable information and talking points when speaking with staff or the Senators.

Questions, contact Jack Phillips, RCPA Director, Government Affairs.

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Please join Sen. Bob Casey (PA) as he addresses the Graham-Cassidy proposal and the effects on Medicaid, adults with disabilities, children with complex health needs, schools, veterans, and those who are aging. Details for joining below:

What: Conference call with Sen. Bob Casey
When: Friday, September 22, 5:45 pm–6:15 pm EDT
Call in number: 866-317-5076, no PIN or ID necessary
No RSVP necessary

Questions, contact Jack Phillips, RCPA Director, Government Affairs

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Yesterday, the State Senate voted 43–7 to non-concur with the House GOP’s budget revenue plan. The vote to non-concur intensifies the three-month budget stalemate between parties. Now that the House plan was rejected, leaders will have to go back to the drawing board to see how to cobble together the necessary votes to pass a budget revenue bill. The House may decide to tinker with the Senate revenue package, contained in HB 452, which includes the following revenue:

  • $571 million in new or increased taxes (which include a severance and gross receipt tax on Marcellus Shale drillers);
  • $1.3 billion in borrowing against the Tobacco Settlement Fund;
  • $200 million from fund transfers; and
  • $200 million from gaming expansion.

Or the House may amend HB 453, which was what the Senate rejected last night. HB 453 contains more than $2.4 billion in funds which come mostly in the form of transfers from various state special funds that, according to the Republicans, who crafted the revenue package, have “inordinately high” account balances.

After non-concurring with the House revenue package, the Senate recessed to the call of the Senate President Pro Tem, which means, members will remain on a six-hour call, ready to return to the Capitol should there be a resolution to the budget situation on which the chamber could vote. The House will return to session on Monday, September 25 at 1:00 pm.

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By Chris Comisac
Bureau Chief
Capitolwire

HARRISBURG (Sept. 20) – As warned by many, credit rating agency Standard and Poor’s downgraded Pennsylvania’s bond rating.

“The downgrade largely reflects the commonwealth’s chronic structural imbalance dating back nearly a decade, a history of late budget adoption, and our opinion that this pattern could continue,” said S&P Global Ratings credit analyst Carol Spain on Wednesday about the decision to reduce Pennsylvania’s general obligation bond rating from AA- to A+. The downgrade increases the cost of borrowing by the Commonwealth, which in turns costs taxpayers more.

Spain added the downgrade – the sixth by the three major credit rating agencies since 2012 – reflects the weakening of Pennsylvania’s liquidity position, notably the delay or non-payment of scheduled expenditures for the first time in the Commonwealth’s history.

S&P noted state Treasurer Joe Torsella and Auditor General Eugene DePasquale cited the lack of near-term prospects of a balanced budget in their decision to refuse to authorize, as has been done in past years, lending to the state’s General Fund. Without a short-term loan from the Treasury, the state’s cash flow situation this month – revenues collected later in the month, but bills to pay earlier in the month – prompted the Commonwealth to delay paying $1.167 billion to Medicaid managed care organizations and a $581 million payment to cover the state’s share of public school employee pension obligations.

“We understand that the Commonwealth plans to make payments to both the Medicaid insurers and school districts within a week of the scheduled due dates; however, in the absence of additional liquidity, and with the likely need for external borrowing, these late payments could recur,” Spain said.

And while the ongoing budget mess, and the proposals offered by both the House and Senate, are major concerns for S&P, the agency had more of a problem “from a credit perspective” with the delayed payments.

“Deficit borrowing does not exemplify strong budget management practices, but, in our view, borrowing that restores the Commonwealth’s liquidity to a position in which it can make timely payments would be preferable from a credit perspective than an accumulation of unpaid bills,” explained Spain.

Wednesday’s downgrade of Pennsylvania’s credit rating appears to be a bit of a Rorschach test, with the reactions to the downgrade depending on the ideological and policy perspectives of the state officials reading the report.

“For months, I have warned that a credit downgrade was looming. I have said repeatedly for three years that we must responsibly fund the budget with recurring revenues. My budget proposal was balanced, cut more than $2 billion in expenditures and consolidated agencies, while also fixing the deficit,” said Gov. Tom Wolf in a statement Wednesday morning.

Senate Republican leaders, who like the governor have been urging a longer-range budgetary perspective, added in a combined statement: “The significance of this downgrade is something that we grasp and is part of why the Senate worked to finalize a responsible budget package in July. We agree with S&P’s concerns about the need for stability in our financial plans to address the ongoing structural deficit. We are concerned about the overall fiscal health of the Commonwealth. The perceptions of Pennsylvania and its finances are vital when attracting economic growth of small and large employers.”

Legislative Democrats were more pointed in their assessment of the situation, blaming House Republicans.

“The plan that House Republicans finally passed last week was a bad joke. It cuts vital services and doesn’t add up. It used almost every gimmick that the credit rating agencies specifically warned against. Costing Pennsylvania taxpayers millions of dollars in future costs is no joke, but that’s what House Republican obstruction has achieved,” said House Minority Leader Frank Dermody, D-Allegheny.

“Given the House Republicans’ inaction for months followed by the passage of an irresponsible plan, it is not surprising that Pennsylvania’s credit rating was downgraded. Their plan was revenue deficient and would fail to put Pennsylvania on solid financial footing,” added Senate Minority Leader Jay Costa, D-Allegheny. “After review of the House Republican plan – including the $630 million in fund transfers – S&P took decisive action to downgrade our credit rating.”

House Republicans seized on S&P’s concern regarding unpaid state bills.

“When those in charge of the checkbook – the same fiscal officers who approved the deficit spending last fiscal year – very publicly refuse to pay bills, even as bank accounts hold billions, of course our credit rating will take a hit,” the leadership of the House Republican Caucus stated in a press release.

“Pennsylvanians are paying taxes and it is very disappointing Commonwealth budget costs will increase thanks to a small group of unknown people at Standard & Poor’s who make decisions based on interviews with a governor and press releases from the state’s fiscal officers,” added the House GOP.

S&P, along with Moody’s and Fitch, are the three main credit rating agencies globally. They wield significant power in the United States, with the federal government requiring banks to use their ratings. Given that influence, the agencies, their ratings and their methods have also been faulted for a least a portion of the many financial crises in this nation and around the world during the past decade.

The House GOP noted S&P’s prior credit rating for the state was AA-, which S&P website indicates Pennsylvania had a “very strong capacity to meet financial obligations.” The new rating of A+ means the state has a “strong capacity to meet financial commitments, but somewhat susceptible to adverse economic conditions and changes in circumstances.”

 

Despite the various interpretations of the downgrade, state officials – to a person – said the downgrade should be a wake-up call to get serious about balancing this year’s state budget and addressing the Commonwealth’s chronic imbalance, dating back nearly a decade, between expenditures and revenues, which has been eroding the state’s ability to pay its bills without additional short-term borrowing of significant amounts of money.

In addition to lowering the rating for the state’s general obligation bonds, S&P lowered its departmental appropriation rating for Pennsylvania to A- from A, and their departmental and moral obligation rating to BBB+ from A-, with the outlook for all of the bond ratings as “stable” (compared to the prior “negative” outlook, which means a downgrade is more likely).

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ALERT – Act Now to Stop Irreparable Medicaid Cuts!
Latest Available data on Graham/Cassidy

The next few days are critical!
Call Congress at (202) 224 3121 and
click here to send your Senators an email to VOTE NO.

The process by which Senate Republicans can pass an Affordable Care Act (ACA) repeal/replace bill by a simple majority budget process called reconciliation (and thus not requiring Democratic support of any kind) ends next week, at the end of September.

The Graham/Cassidy bill is now presenting a major threat to Medicaid – it replicates cuts presented in previous health proposals (using exact language from the Better Care Reconciliation Act – BCRA). According to earlier Congressional Budget Office (CBO) estimates, it will cut Medicaid (outside of expansion) by $175 billion between 2020-2026, and $39 billion will be cut from the Medicaid program in 2026 alone.

The situation has gotten worse. Last night, Chairman Alexander (R-TN) of the Senate HELP Committee who was leading bipartisan ACA fix efforts announced that the bipartisan deal is dead. That leaves the door wide open for Graham/Cassidy passage. Republican Senators are being told that the bill will benefit their state – that is false. This is a bill that seeks to save billions of federal dollars, not make policy improvements to health care programs.

The ACA will be replaced by block grants with likely less funding to states than they currently receive. and all of that money stops flowing completely to states in 10 years. The Medicaid program will be cut significantly and states will be expected to either pick up the bill or make tough decisions about whose lives are most at stake.

So here’s the timeline:

There are two Jewish holidays in the next two weeks that shorten the Senate session calendar. Today, Senators leave to observe Rosh Hashanah and will return Monday. They will have to pass a bill by Wednesday or Thursday because Yom Kippur (also observed by the Senate) begins at sundown next Thursday.

We will soon see a new Congressional Budget Office summary on the impact of Graham/Cassidy, and we expect the bill to be pushed hard next week to get to passage. We need three Republican Senators to oppose the bill in order for it to fail. Key Senators that could stop the bill are the same champions that ANCOR has awarded Congressional Leadership Awards to this year for defending our programs – Senator McCain (R-AZ), Senator Collins (R-ME), and Senator Murkowski (R-AK). Please make sure that if you are a constituent, or have connections in their states, that they hear from you!

IF YOU LIVE OR HAVE FRIENDS, FAMILY, OR COLLEAGUES IN STATES WITH REPUBLICAN SENATORS THEY MUST HEAR FROM US THAT THE GRAHAM/CASSIDY BILL WILL CREATE IRREPARABLE HARM TO PROGRAMS THAT PROTECT PEOPLE WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES!

THE NUMBERS ARE CLEAR THAT THIS IS A BAD DEAL FOR STATES! MAKE SURE YOUR REPUBLICAN REPRESENTATIVES IN THE HOUSE ARE RECEIVING THE SAME MESSAGE!

Capitol  Switchboard: (202) 224-3121

Graham/Cassidy Text

  • Medicaid per capita cap section begins Section 124, page 65
  • Provider tax reduction is Section 123, page 64
  • Penalization to states that overspend, page 66
  • Per capita formula base period, page 68
  • Per capita formula inflation rate (CPI-M+1% until 2026 then CPI-M), page 76

Limited HCBS demo (we have intel this is for fear that per capita caps will end some state HCBS programs and need demo money to survive), page 96

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The Department of Human Services has implemented the following staffing changes:


Johanna Fabian-Marks and Gwen Hauck are joining the secretary’s office. Both of these women have previously worked at the PA Insurance Department.

Policy Director Jen DeBell will be leaving DHS on September 15 to join PennAEYC (Pennsylvania Association for the Education of Young Children). Caitlin Palmer will be re-joining DHS as the new policy director.

Patricia Allan has been named as acting executive director of CHIP.

Dr. Dale Adair, the Acting Deputy Secretary of OMHSAS, has left the Commonwealth to head to South Carolina and Ellen DiDomenico will serve as Acting Deputy Secretary until further notice.

RCPA looks forward to working with each of these individuals in their new roles, helping to serve Pennsylvania’s most vulnerable citizens.

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Yesterday, a group of state House Republicans held a press conference announcing they have found more than enough money to pay for both last year’s budget deficit and this year’s additional spending without raising any new taxes.

The more than $2.4 billion in funds would come mostly in the form of transfers from various state special funds that, according to the work group, have “inordinately high” account balances.

The state’s operating budget contains 218 such funds, most having both a balance for yearly operating expenses and a reserves balance (some also have investment fund balances as well), and the work group’s plan is to tap 41 of them. Of that total, the GOP legislators said 34 have been used in a similar fashion in the past, so precedent already exists for what they are proposing to do this budget year.

The transfers are as follows:

Agricultural Conservation Easement Purchase Fund

Proposed transfer: $27 million

Fund balance: $36.7 million

Fund purpose: Created in 1988, this fund was to be used for farmland preservation through the purchase of agricultural conservation easements.

 

Banking Fund

Proposed transfer: $25 million

Fund balance: $36.1 million

Fund purpose: It provides for the administration of the Department of Banking and Securities and regulation of the financial services industry and are to be used in the event of a seizure or liquidation of a financial institution, association or credit union.

 

Environmental Stewardship Fund

Proposed transfer: $72.7 million

Fund balance: $104.8 million

Fund purpose: This fund, which is fueled by money that comes in from landfill fees, is to provide for farmland preservation, open space protection, abandoned mine reclamation, watershed protection and restoration, water and sewer infrastructure, and improvement and conservation of state and community parks and recreational facilities.

 

Hazardous Sites Cleanup Fund

Proposed transfer: $50 million

Fund balance: $80.4 million

Fund’s purpose: Created in 1987, this fund is to finance the cleanup and restoration of abandoned hazardous waste sites in the commonwealth.

 

Keystone Recreation, Park and Conservation Fund

Proposed transfer: $100 million

Fund balance: $147.6 million

Fund’s purpose: This is to provide for increased acquisitions, improvements, and expansions of state and community parks, recreation facilities, historic sites, zoos, public libraries, nature preserves and wildlife habitats.

 

Machinery and Equipment Loan Fund

Proposed transfer: $49 million

Fund balance: $59.5 million

Fund’s purpose: Created in 1988, this fund is to provide low-interest financing for machinery and equipment for Pennsylvania businesses to facilitate their growth, competitiveness, and value-added capacity.

 

Multimodal Transportation Fund

Proposed transfer: $120 million

Fund balance: $189.8 million

Fund’s purpose: Created in 2013, this is to provide for additional funding for passenger rail, rail freight, ports and waterways, aviation, bicycle and pedestrian facilities, roads and bridges and other modes of transportation.

 

911 Fund

Proposed transfer: $40 million

Fund balance: $74 million

Fund’s purpose: Created in 2015, this fund, fueled by a surcharge on cell phone bills, is to support a statewide integrated 911 plan.

 

PA Infrastructure Bank Fund

Proposed transfer: $30 million

Fund balance: $52.9 million

Fund’s purpose: Established in 1997, this fund is to make loans to or enter into leases with qualified borrowers to finance the costs of transportation projects and rail freight infrastructure.

 

Public Transportation Trust Fund

Proposed transfer: $357 million

Fund balance: $477.8 million

Fund’s purpose: Created in 2007, this is to provide dedicated funding for public transportation to cover public transit agencies’ operating costs, capital and asset improvements, and programs of statewide significance.

 

Racing Fund

Proposed transfer: $27 million

Fund balance: $36.2 million

Fund’s purpose: This fund is to be used for the regulation of horse and harness racing.

 

Recycling Fund

Proposed transfer: $75 million

Fund balance: $89.5 million

Fund’s purpose: Created in 1988, this fund, fueled by a fee on waste disposed at landfills or recycling centers, is for recycling and planning grants, market and waste minimization studies, and public information and education activities.

 

Small Business First Fund

Proposed transfer: $25 million

Fund balance: $27.5 million

Fund’s purpose: This provides low-interest loans for small businesses of 100 employees or less for such projects as land and building acquisition and construction, machinery and equipment purchases, working capital, compliance with environmental regulations and municipal or commercial recycling.

 

Underground Storage Tank Indemnification Fund

Proposed transfer: $100 million

Fund balance: $224.7 million*

Fund’s purpose: Created in 1989, this fund is to provide claim payments to owners and operators of underground storage tanks who incur liability for taking corrective action or bodily injury or property damage caused by a release from underground storage tanks.

*Rep. Dan Moul said this was the year-end balance on June 30, 2017.

 

Volunteer Companies Loan Fund

Proposed transfer: $25 million

Fund balance: $49.3 million

Fund’s purpose: This fund provides loans for acquisition and replacement of volunteer fire, ambulance, and rescue company equipment and facilities.

 

Pennsylvania Professional Liability Joint Underwriting Association

The plan proposes to take $200 million from this fund that was created by state law to offer medical malpractice insurance of last resort for doctors and medical facilities.

 

Budgetary reserve

The plan proposes to eliminate $189.4 million that was included in the enacted 2017/18 state budget that was put in reserve by Gov. Tom Wolf to ease the state’s cash flow problem while waiting on a completed revenue package.

 

Among the items that would be impacted by cutting out this funding altogether are the $5 million for Capitol Complex fire protection that is paid to the City of Harrisburg; $4 million for the mobile science van program; and more than $1.1 million for mental health services, along with 65 other budget lines that would get trimmed.

 

Unspent money from past years

The plan includes using $400 million in money that was appropriated in past years but went unspent.

 

Managed Care Organization Assessment Increase

The plan proposes to use the increase in the annual monetary assessment on managed care organizations that went into effect on July 1 to generate $100 million to help fully fund the state budget.

 

Redirecting tax dollars to general fund from restricted accounts

The plan calls for diverting $100 million of tax money that is carved out for special funds and redirect to help bring the state’s general fund into balance.

 

VW Settlement

The plan calls for using the $30.4 million that Pennsylvania received from a settlement of a multi-state lawsuit against Volkswagen over the company’s diesel emissions-cheating scandal.

 

Tapping the PA Liquor Control Board for more money

The plan also would require an additional $25 million transfer from the Pennsylvania Liquor Control Board from wine and spirit sales, for a total of $210 million.

 

Imposing a sales tax on online marketplace

The plan proposes to recover more state sales tax from online purchases to generate $31.7 million. The Senate-passed tax and borrowing plan to balance the budget also included this as a revenue generator.

 

Cutting tax credits

The plan calls for cutting in half funding available for most state tax credit programs but leaves the popular Educational Improvement and Opportunity Scholarship tax credit programs untouched. This is expected to free up $28.3 million.

 

The PA House is scheduled to reconvene next Monday, September 11, and during the session week the House as a whole will determine whether there’s enough support within their own caucus to pass the work group’s proposal. House Democrats and the Governor’s office do not support the work group’s plan.

 

As more information becomes available, RCPA will keep members informed. In the meantime, if you have questions, please contact Jack Phillips, RCPA Director, Government Affairs.

 

*Information contained in this info sourced from a Pennlive.com article – Here’s a breakdown of ‘taxpayers’ budget’ and how it avoids a major tax increase or borrowing money, posted on September 05, 2017, at 06:20 pm | Updated September 06, 2017 at 06:18 am and a Capitolwire news story written by Capitolwire Staff Writers Robert Swift and Carley Mossbrook.

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The draft of the 2018–2019 Community Mental Health Services Block Grant (CMHSBG) is now available for comment. This application was developed with stakeholder input from the Mental Health Planning Council; view/download the application here.

The application provides a review of the current strengths and needs in the Pennsylvania Mental Health System and plans priority areas for improvement.

Any comments or questions regarding the 2018–2019 CMHSBG may be directed to Wendy Tucker via email or phone at 717-705-8280. The comment period will close August 31.

In the interest of time, please feel free to submit comments to Wendy Tucker directly; however, we would be very interested in your input into the draft. Please copy Sarah Eyster or Robena Spangler with your comments. Thank you for your anticipated response to this opportunity.

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Governor Wolf announced that he has selected Teresa Miller, current Commissioner for the Pennsylvania Insurance Department, to lead the Department of Human Services, effective Monday, August 21. Commissioner Miller’s leadership, advocacy, and dedication to the people of the Commonwealth have been evident during her tenure at Insurance, and the Governor’s Office is confident that she will lead DHS with those same characteristics and commitment. As Commissioner Miller joins DHS, Jessica Altman will begin serving at the helm of the Pennsylvania Insurance Department.

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