June 26, 2017
The Honorable Mitch McConnell, Majority Leader
United States Senate
S-230 U.S. Capitol
Washington, DC 20510
Dear Senator McConnell:
The National Advisory Board (NAB) on Improving Health Care Services for Older Adults and People with Disabilities wishes to once again express our grave concern and opposition to the Better Care Reconciliation Act (BCRA), the current healthcare reform legislation proposed by the Senate. For the past 10 years, our diverse group of nonpartisan healthcare professionals and consumer advocates who are experts on long-term services and supports has been studying the populations in need of these services and the infrastructure that has evolved to meet their needs in the community. While we are sponsored by Anthem, our group functions independently in multiple arenas: internally providing guidance and advice to Anthem and their affiliates and externally conducting inquiries and studies, providing public comments and sharing pertinent opinions and advice with other health insurers, trade associations and industry representatives.
We have produced numerous reports of our findings, including the often-cited Declaration for Independence. The latter seminal document includes six foundational principles on which we believe America’s long-term service and supports service system must be based:
- Enhance self-care through improved coordination
- Encourage community integration and involvement
- Expand accessibility of services and supports
- Uphold personal preference
- Empower people to participate in the economic mainstream
- Invest in improved technology
We believe it is fundamental for people who have functional impairments that limit their ability to independently carry out activities of daily living to have necessary support services that will enable them to function effectively in their homes and in the community. In most cases, the alternative to having these services available for those who need them is institutionalization, which is expensive, segregating, and stifling.
We are most concerned about the lack of transparency, adequate funding, and support for Americans who access their health care through Medicaid programs. As proposed, this legislation will most certainly result in restricting access to needed home and community-based service (HCBS) programs, Community First Choice (CFC) programs, Money Follows the Person (MFP) programs, and other vital essential health benefits and community service programs that now save money and foster independence.
The Senate health care repeal bill will result in moving people who were already supported by these cost effective, participant-directed programs back into relatively high-cost nursing homes and other facilities that restrict independence and community participation and will lead to acute health care issues that are detrimental for the person and more expensive for the State.
- Raising costs. Increases premiums and deductibles, forcing people to pay more for the same coverage.
- Imposing an age tax and allowing insurance companies to charge up to five times as much for people over 50.
- Making even deeper cuts to Medicaid.
- Sunsetting the Essential Health Benefits.
- Weakening the protections, including for people with pre-existing conditions. Allowing coverage to be denied for maternity care, mental health care, substance use treatment, and other services, meaning people with pre-existing conditions would have to pay more for the care and services they need.
Certain key aspects of the BCRA are based on phantom economic assumptions. Drastic cuts to Medicaid will force tens of thousands of people who are now living in the community, with assistance from Medicaid-funded home and community-based service programs, to be prematurely and unnecessarily referred by hospitals and doctors to expensive nursing homes and institutions. Many of the efficiencies in service provision and lowered cost of care, gained through state partnerships with managed care companies for Medicaid beneficiaries with significant disabilities, will be lost due to the BCRA cost shifting strategy.
It is our wish that due consideration be given to the potential cataclysmic effects of the current proposal on people with disabilities and older adults who need long-term services and supports in order to be productive, contributing members of our communities. As currently constructed, the BCRA will have disastrous outcomes. We urge you to amend the Bill to ensure the Medicaid program remains comprehensive and adequately funded. We would be happy to provide additional information or answer any questions you may have.
Lex Frieden, Convener