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Govt. Affairs

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By Carley Mossbrook
Staff Writer
Capitolwire

HARRISBURG (July 11) – A passionate debate of a Human Services code bill on Tuesday saw a bipartisan effort to oppose Republican-crafted provisions that would potentially impose work requirements on certain medical assistance recipients and charge some families with disabled children Medicaid premiums.

“I rise in opposition to House Bill 59, which will throw a wrench into the operations of public healthcare in this state and fundamentally threaten care for hundreds of thousands of people across the Commonwealth,” said Rep. Dan Frankel, D-Allegheny.

Others called the bill “offensive,” “harmful” and “cruel.”

But despite concerns from both sides of the aisle, the House of Representatives narrowly approved the bill with a vote of 102-91. No Democrats supported the legislation.

It will now move to the Senate for concurrence.

House Majority Leader Dave Reed, R-Indiana, said the provisions put into the bill on Monday evening were “98-percent agreed” to by the Senate.

However, it’s unclear if the bill, if approved by the Senate in the coming days (or weeks,) would be signed into law by Democratic Gov. Tom Wolf, who has concerns about the Medicaid changes included in the code bill.

The chamber also debated public school and administrative code bills, but delayed a vote on them until the Senate acts on other code bills, including a Fiscal Code bill, said Reed.

It’s unclear if a Tax Code bill will be in the mix.

The House recessed Tuesday evening and plan to return in a week, said Steve Miskin, spokesman for Reed.

HB59 House floor comments

Opponents of the bill mostly focused on the provisions that would potentially establish a premium on disabled children and their families who receive Medical Assistance and have an annual income that exceeds 1000 percent of the federal poverty level.

“I don’t think many of us truly realize just how damaging this legislation can be to families who find themselves in huge financial jeopardy to no fault of their own,” said Rep. Schlossberg, D-Lehigh, who said the changes would raise premiums for 61,000 families in the state.

“The vast majority of families who would be affected by this bill face real and significant financial pain. In many cases, their budgets are already stretched well beyond the breaking point,” he continued.

Based on the federal poverty level, only families with an annual income of more than $246,000 would be required to pay the premium, which the bill’s sponsor, Rep. Dan Moul, said would total $50 monthly.

Moul said Pennsylvania is the only state in the country that doesn’t factor in a family’s income when determining eligibility for Medicaid.

He and others said the expected premium cost is reasonable for those families and will preserve human services funding for those making less.

Rep. Kristen Phillips-Hill, R-York added: “This measure will help ensure that we protect this benefit for the most-needy and the most-vulnerable residents of Pennsylvania.”

Opponents also took issue with a provision that could potentially establish employment requirements for certain Medicaid recipients.

“We have to be very, very careful with this population. They’re our most vulnerable,” said Rep. Gene DiGirolamo, R-Bucks, of recipients who are mostly disabled children, severely disabled adults, chronically ill persons and those in nursing homes.

“I don’t see what people in that population are able to work. We’re going to put another level of bureaucracy and paperwork on top of what they’re already going through,” he added.

Numerous disability rights and community provider groups oppose the proposed requirements, he said.

Supporters say the provision would only impact able-bodied Medicaid recipients.

“No change is going to occur to the people who are excluded currently. The intent of this welfare reform is to break the generational recurrence of dependence,” said Rep. Eric Nelson, R-Westmoreland. “It’s to be able to create an opportunity where a person either has to work 20 hours a week or they have to take a class or they have to volunteer.”

“It is incumbent upon this body to help those who can’t help themselves and also we share a responsibility to help those who can help themselves realize they can do so,” Nelson added. “Requiring an individual to have to volunteer their time is not a big ask. Encouraging someone to work 20 hours a week is also not a big ask.”

The Human Service code bill doesn’t inherently establish the Medicaid premium or work requirement provisions, it would simply instruct the state’s Department of Human Services to seek waivers from the federal government to do so.

Ultimately, GOP lawmakers said the changes made in the code bill are needed as human services costs continue to rise and state revenues remain stagnant.

“I keep hearing about the devastating impact to our most vulnerable, but the Human Services budget is growing at a rate of 6 (percent) to 7 percent a year while our revenues are only growing at an average rate of 3 percent,” said Rep. Dawn Keefer, R-Cumberland. “What about the devastation our Commonwealth and the most vulnerable will experience when our Commonwealth is bankrupt.”

Reed said Monday the provisions within the Human Service Code would “provide a couple hundred million dollars in savings, depending on the waivers that are submitted to the federal government and what the federal government tends to approve.”

He explained many of the changes “are a re-enactment of welfare reforms that were actually put into place during the [Bill] Clinton administration [at the federal level] and the [Tom] Ridge administration [at the state level] that fell by the wayside during the [Ed] Rendell administration.”

“With our entitlement spending being one of the major cost drivers in the state right now, until we’re able to bring that under control, we’re going to continue to have billion-dollar deficits year after year,” Reed continued. “This is a movement to continue to try to address that issue in the long-term as well as the short-term.”

He reiterated similar statements Tuesday following the chamber’s floor vote.

The gubernatorial response to HB59

Wolf hasn’t indicated whether he would sign or veto the legislation, however, J.J. Abbott, his press secretary, offered a scathing statement from the governor in an email Tuesday.

“Governor Wolf strongly opposes these backdoor changes that could have widespread and potentially life-changing effects on the health and well-being of millions of Pennsylvanians. Seniors, people with disabilities and low-income working families don’t need their lives to be made even more difficult by politicians in Harrisburg,” wrote Abbott.

“Beyond the substance of these changes, the process flies in the face of good government and these changes would cost millions of taxpayer dollars just to implement. There was no input from stakeholders or families that would be affected and no formal fiscal analysis,” he added.

“Medicaid is not a handout – it is a lifeline. We need to support these families, not create more hoops for them to jump through,” he concluded.

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Questions, contact Jack Phillips.

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Today, the House will vote on HB 59, the Welfare Code bill. In the bill there are many provisions that would have a negative impact on the families that our members serve. RCPA staff has been in contact with House members and have written a letter to legislators explaining why we oppose HB 59.

Once the House votes on the bill today, it will immediately go to the Senate Rules Committee. If the Senate Rules Committee votes it out of committee favorably, HB 59 will go to the Senate floor for a final vote.

RCPA implores providers to contact their legislators and tell them to oppose HB 59. Members can use RCPA’s letter opposing HB59 for talking points. Questions, contact Jack Phillips, RCPA Director of Government Affairs.

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nc-action-alert

The Senate has released its version of the American Health Care Act and it is worse than we feared. The Senate bill will cut Medicaid even more than the House bill in the future, putting tremendous pressure on safety-net services and providers.

But there is still time to act! The Senate is gearing up for a vote in the coming days, so NOW is the time to speak up and protect Medicaid.

unite-4-bhTaking action is easy:

  1. Dial this number: 202-224-3121
  2. Ask for your Senator.
  3. Share with them this message:
    • Your Message: I am calling to ask the Senator to vote NO on the Better Care Reconciliation Act. Cutting Medicaid and rolling back the Medicaid expansion will have a devastating effect on people with mental illnesses and addictions who rely on Medicaid for lifesaving treatment. Please vote NO. I’m calling from [city, state, and zip] and my name is [first and last name].
  4. Call your other Senator and share the same message!

Thank you to all who have taken action on this issue so far this year. We appreciate your hard work and dedication and ask that you continue to mobilize and advocate on this critical issue! Together, we can protect and preserve Medicaid for millions of Americans in need.

 

Questions, contact Jack Phillips.

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The Pennsylvania General Assembly will be working this week to get a final budget passed by the Pennsylvania Constitution’s mandate of June 30. There are many moving pieces to this year’s budget as well as the continuing question of where legislators will get revenue to balance the budget. Please take a look at the Penn Live article written by Charles Thompson. The article gives a detailed overview of the budget negotiations as they stand right now. Questions, contact Jack Phillips, RCPA Director of Government Affairs.

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Until today, it was hard to imagine a bill could be worse for Americans living with addiction and mental illness than the AHCA bill passed last month by the House of Representatives.

The Senate version of the American Health Care Act purports to be a “repeal and replace” of the Affordable Care Act, but is really a draconian restructuring and gutting of Medicaid, the program that covers 20% of Americans and is one of the primary payers of addiction and mental health treatment in the U.S.

Instead of “repeal and replace,” it is “wreck and wreak havoc.”

The bill’s supporters have said that their newest proposal would “soften the landing” for Americans who will lose Medicaid coverage. In reality, the landing would be catastrophic. There is nothing “soft” about ripping health care away from the 11 million Americans enrolled in the Medicaid expansion. The new bill also shifts hundreds of billions of dollars in costs to states—leaving them with a Sophie’s Choice of which populations and benefits to cut in order to close their budget shortfalls. Seniors? Pregnant woman? People with a preexisting condition, like cancer or a heart attack? Who do we help, and who do we turn our back on?

The Senate bill also slices and dices Medicaid enrollees into the deserving and the undeserving, exempting some populations with disabilities from the caps while leaving other vulnerable individuals—like people with addictions—out in the cold. Lawmakers must remember that people with addictions do not qualify as “disabled” under a Gingrich-era change that excluded them from Social Security Disability. The proposed cuts to Medicaid would disproportionately harm those who rely on Medicaid for lifesaving opioid addiction treatment, at a time when mortality from the opioid epidemic is growing at devastating speed each year. We are facing a national emergency on opioids – now is hardly the time to reduce our efforts.

The bill’s feeble attempts to bolster psychiatric treatment while stripping health care away from millions are paltry at best. While the outdated law prohibiting Medicaid funding for services provided in residential or inpatient treatment settings deserves to be changed, the small tweak to this payment exclusion that is included in the bill will do nothing to mitigate the loss of Medicaid coverage for millions—nor does it provide for important outpatient care serving people in their own communities. The proposed one-year grant fund for mental health and addiction treatment in 2018 doesn’t come close to meeting the real—and growing—need for care. Grants are not a substitute for health coverage. We don’t rely on grants for the treatment of heart disease or cancer, and addiction and mental health should be no different.

Congress has made incredible strides in advancing access to care for mental illness and addiction in recent years. It is shocking that members of Congress – many of whom have family members who would be affected and all of whom represent constituencies who would be gravely harmed – would even consider a bill that would obliterate these gains, returning us to the days when people with mental illness or addiction couldn’t access treatment.

This is not our vision for America. Slashing billions of Medicaid dollars from state budgets would cost hundreds of thousands of lives. The National Council urges the Senate to vote down this reprehensible bill.

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The National Council for Behavioral Health is the unifying voice of America’s community mental health and addictions treatment organizations. Together with 2,800 member organizations, it serves more than eight million adults and children living with mental illnesses and addiction disorders. The organization is committed to ensuring all Americans have access to comprehensive, high-quality care that affords every opportunity for recovery and full participation in community life. The National Council, the Maryland Department of Health and Mental Hygiene, and the Missouri Department of Mental Health pioneered Mental Health First Aid in the U.S. and has trained more than 1 million individuals to connect youth and adults in need to mental health and addictions care in their communities. To learn more about the National Council, visit the official website.

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