By: Nicole Jorwic, Director of Rights Policy

This week in July is always a big one, this year the disability community came together to celebrate the 27^th anniversary of the signing of the Americans with Disabilities Act and the 52^nd anniversary of the Medicaid and Medicare programs. But a large looming shadow hung over these celebrations, the current healthcare proposals in the House and Senate.

During the past six months, most of my professional life has been consumed by the fight to save Medicaid. Today I was honored to speak as a sibling and professional at a Capitol Hill event celebrating the 52nd anniversary of Medicaid and Medicare, to highlight why we must continue our fight to SAVE MEDICAID.

My Remarks:

My name is Nicole Jorwic, I am the Director of Rights Policy at The Arc of the United States. The Arc promotes and protects the human rights of people with intellectual and developmental disabilities and actively supports their full inclusion and participation in the community throughout their lifetimes.

I am here today though, as a sister. My brother Chris will be 28 years old tomorrow and has autism, he is the reason that I do the work that I do, and as a Medicaid recipient, he is one of the millions of individuals at risk if the proposals in the House and Senate healthcare reform bills become law.

We know the numbers – between 22-32 million will lose coverage, millions will lose Medicaid and anywhere from $202 billion (in the “skinny repeal”) to $836 billion (in the House bill) in cuts to federal Medicaid spending. But those numbers represent people, they represent Chris, they represent the 43 heroes from National ADAPT that were arrested last month after staging a die in at Senator McConnell’s office.

That’s right, a die in because Medicaid is literally life and death for people with disabilities. I was lucky enough to be there in solidarity with National ADAPT last month and as I watched people who I respect and admire being pulled from the wheelchairs they use, literally putting their bodies on the line for people like Chris, I wept.

The current proposals quite simply devalue groups of human beings, gutting the Medicaid program, a program that over 10 million people with disabilities and families like mine rely on, and they show that the drafters of this legislation don’t see the value in investing in the lives of the poor, the aging population, pregnant women, people with disabilities, including my Chrissy.

Medicaid is so much more than a health program, it funds long term supports and services that allow people with disabilities to live their full life in the community. Medicaid funded the communication device that gave my nonverbal brother a voice, so that he can advocate for himself. Medicaid funds the day support services that allow my mom, a college professor, and my dad, a small business owner, to remain in their jobs.

Families like mine started The Arc over 65 years ago to get people OUT of Institutions and included in their communities, and now those antiquated and segregating services may be the only thing left. This is because institutions and nursing homes remain mandatory services, while home and community based services are optional, and will therefore be the first cut when the devastating federal cuts to Medicaid come to the states. We cannot let that happen, we must SAVE MEDICAID. People’s lives literally depend on it. Chris’ does.

The proposals to decimate the Medicaid program to provide tax cuts to corporations and the wealthy is morally reprehensible. As an advocate and Chris’ sister I will do everything I can to stop the current healthcare bills and protect the integrity of the Medicaid program that we are here celebrating today.

By Peter V. Berns, CEO

Peter Berns at the U.S. Capitol with (left to right) Sen. Cory Booker; Janel George, National Women’s Law Center; Rep. John Lewis; Sen. Brian Schatz; and Sen. Kirsten Gillibrand.

This week, I had the immeasurable honor of sitting on the steps of the U.S. Capitol and talking with Senator Cory Booker and Representative John Lewis about our fight to save our health care and access to community living under the Affordable Care Act and Medicaid. Over the course of our discussion, we were joined by Senators Brian Schatz, Kirsten Gillibrand, Chris Murphy, Chris Coons, and Jeff Merkley.

It was an amazing and inspiring evening — even as we feared a looming vote in the Senate on legislation that threatens the health, independence, and lives of millions of Americans with disabilities.

Over the last few weeks, from coast to coast we’ve seen people with disabilities and their allies speaking up and taking action– including chapters of The Arc and their members. Among the many recent highlights from our network:

• Activist Bryan Dooley wrote about his health care advocacy in the Huffington Post, and urged more people to come forward and share their stories, as he did in a video with The Arc.
• The Jennings family traveled from Lancaster County, PA to speak at a #SaveMedicaid rally in Washington, DC. The family was featured in a Kaiser Health News article about the rally that was widely redistributed including in U.S. News & World Report, CNN, and Bill Moyers.
• Marta Connor spoke at a press conference at Children’s National Medical Center in Washington, DC about what Medicaid means to her daughter, Caroline, and their family.
• Chapters of The Arc and their activists placed letters to the editor in their local newspapers in Alaska, Indiana, New Jersey, Missouri, and North Dakota, and influenced media coverage of the Senate bill, including in Colorado, Maryland, Minnesota, Ohio, Pennsylvania, Tennessee, Virginia, and Wisconsin.
• Beyond media, chapters met with their Senators to put a face on the devastating impact of proposed Medicaid cuts, organized on social media, and took to the streets from Washington state to Illinois to Pennsylvania to Virginia.

Virginia chapters of The Arc joined advocates in Washington, DC for a rally on June 6.

While that Senate vote didn’t happen this week, our fight continues. Senators will travel home for a Fourth of July recess with some hoping to vote on a revised bill when they return. Now is the time to ramp up our advocacy even more – keep up the calls to your Senators.

Attend community events and be visible with your support of Medicaid – showing up matters. July 4th is Independence Day, and Medicaid provides independence for millions of people. Make signs and bring friends and family to parades and other community events. Take pictures and share them on social media to encourage others to get involved to protect Medicaid and stop this dangerous bill. Additionally, some Senators may host public town hall meetings during the recess. Check out this resource listing scheduled town hall meetings across the country (it is regularly updated) and find out if your Senators are hosting one.

As Representative John Lewis said to us on the steps of the U.S. Capitol, “Many of us are called at a time to be witness, witness to the truth. You have to tell the truth and speak truth to power. You have to find a way to get in the way. To get in trouble. Good trouble. Necessary trouble, to change things. So I appeal to each and every one of you to go out and to do your very best. If you fail to act, then history may not be kind to us. We cannot let the American people down.”

We couldn’t agree more.

Please #JoinOurFight and take action over the Fourth of July Congressional recess to #SaveMedicaid.

By Annie Acosta, Director of Fiscal and Family Support Policy

May 1, 2017 – Washington, D.C. President Donald Trump released an outline of his tax reform proposal on April 26. In what he calls “the biggest individual and business tax cut in American History,” the President offers a plan than would disproportionately benefit the wealthiest of citizens and substantially add to federal deficits and the debt. Low income Americans, including the disproportionate number with disabilities, would eventually be faced with even greater cuts to critical federal programs to make up for the resulting budget shortfall.

To understand the impact of this tax plan on people with intellectual and developmental disabilities (IDD) and their families, it is also necessary to look at some of the basic facts about current tax policy. As the leading charitable organization advocating on behalf of people with intellectual and developmental disabilities, The Arc seeks to ensure that federal funding for programs that help our constituents to live meaningful lives in the community is preserved.

Essential federal programs like Medicaid, Social Security, Supplemental Security Income, and the many discretionary programs – like education, housing, and employment – are all funded through tax dollars, whether through individual, corporate, payroll, excise, estate, or other taxes. As stated by former Supreme Court Justice Oliver Wendell Holmes, Jr., “taxes are the price we pay for a civilized society.”

In addressing the impact of the plan, it is necessary to look at the assumptions in the plan’s goals, along with some of the details of the proposed changes:

• Grow the economy and create millions of jobs is a basic goal and assumption of this plan. However, the argument that tax cuts will be made up for by increased economic activity has long been discredited by leading economists. At most, a small percentage can be recouped. Read more on this from the Committee for a Responsible Federal Budget.
• Simplify our burdensome tax code. Reducing the current 7 tax brackets to 3 tax brackets (for 10%, 25% and 35%) does little to make taxes any easier to complete. It would simply lower the amount of revenue generated.
• Provide tax relief to American families, especially middle-income families. The implication that America is a high tax country is only true if the United States is compared to all nations, including the majority that are developing. When compared to other developed nations, the U.S. tax burden is below average. Learn more on comparative income taxes from the Pew Charitable Trusts.On average, Americans pay an effective income tax rate of 9.5 percent, according to research by the Tax Policy Center. As shown below, however, the federal tax system is progressive with middle income Americans paying a much lower rate. Those with incomes between $30,000 and $50,000 pay almost no federal taxes, and consequently, would stand to gain very little with the Trump tax cut plan.
  

Source: Internal Revenue Service Publication 542

• Lower the business tax rate from one of the highest in the world to one of the lowest. While the top statutory corporate tax rate of 35% in the U.S. (shown right) is, in fact, among the highest, the effective tax rate is much lower. The average effective tax rate – the actual rate paid after deductions and credits – is slightly lower than other developed countries (27.1% versus 27.7%). See Congressional Research Service (CRS) report for more information.

Further, it is important to note that corporate tax contributions have been steadily declining for decades. As shown below, the corporate share of federal tax revenue now only accounts for 11% of federal revenue, down by two-thirds in 60 years.

One of the reasons for this drop is changes in how corporations are operating and being taxed. An increasing number of corporations’ profits are subject to no taxation (foreign profits that stay abroad) or different taxes (income tax in the case of S corporations). S corporations are structured as “pass through” entities. They do not pay the corporate income tax, but rather pass profits through to owners who pay tax under the individual income tax at a lower rate. Over 90% of U.S. businesses do not pay the corporate tax rate.

President Trump’s plan to allow S corporations to pay the proposed top business rate of 15% instead of the rate they pay under their current individual tax rate (see brackets below) would disproportionately benefit the very wealthy while draining public revenues. Currently, only individual income below $37,950 a year is taxed at 15 percent or less. Under the Trump plan, anyone who makes their income via a pass-through entity would pay the 15% rate no matter how much they made. President Trump owns over 500 such business entities, according to the Trump Organization’s tax counsel.

Source: Tax Foundation

Not explained in the President’s plan is that it will increase deficits by an additional $3 to 7 trillion over 10 years, according to the nonpartisan Committee for a Responsible Federal Budget . The proposed 60% cut in the corporate tax rate alone would lose $2.4 trillion over 10 years. Such massive cuts to revenues could have substantial impact on all human services funding, including services and supports for people with IDD.

House and Senate leadership have consistently required that legislation be “paid for” in order to move through the legislative process and the President’s plan does not include viable pay-fors, therefore creating a major conflict if there is any interest in moving it forward. The Arc will remain vigilant in monitoring the impact of the plan if it begins to move legislatively.

For additional resources on federal taxes and the President’s plan see:

• https://www.crfb.org/blogs/fiscal-factcheck-how-much-will-trumps-tax-plan-cost
• https://www.cbpp.org/research/policy-basics-where-do-federal-tax-revenues-come-from
• https://www.forbes.com/sites/timworstall/2014/12/23/more-than-90-of-us-businesses-dont-pay-the-corporate-income-tax/#3bc328f35e48
• https://www.politifact.com/virginia/statements/2015/oct/20/donald-trump/trump-says-us-has-highest-tax-rate-anywhere-world/

Urge Congress to Vote No on the American Health Care Act.

The House of Representatives is planning to vote today on the American Health Care Act. The vote is expected to be very close. Late last night, the House added a change to the American Health Care Act that will repeal the essential health benefits (EHB). This will make a bad bill even worse.

As it is, the bill is dangerous to people with disabilities. It cuts $880 billion out of the Medicaid program and uses it to help pay for tax cuts for the wealthy, corporations, and providers. The March 20^th Managers Amendment further weakens Medicaid by ending the Medicaid expansion earlier, offering Medicaid block grants to states, and imposing work requirements.

The latest move to ensure that health care plans do not cover these needed services is an attempt by the White House and the House Majority to gain the support of enough Representatives to pass the bill. There are some in Congress who believe these benefits are too generous and costly, and insurers should have the option to drop them.

The repeal of the essential health benefits also effectively removes the prohibition against annual and lifetime limits on health care coverage. 

Even worse, it will likely make it harder for people with pre-existing conditions to find health care plans that adequately meet their needs.

Here are the essential health benefits you stand to lose if this bill becomes law:

• Doctor visits and other outpatient care
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance abuse disorder services including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services including oral and vision care

The essential health benefits were designed to ensure that health plans cover basic needs and they have been critically important to people with disabilities and chronic health conditions. From this list, habilitation and rehabilitative services and devices are particularly important. Habilitative services are health care services that help a person keep, learn or improve skills and functioning for daily living. This category includes physical, occupational, and speech therapy, as well as medical equipment such as wheelchairs.

Without a requirement that basic services be included in the health plans, insurers are likely to drop coverage of therapies or medications that would attract people with more health care needs. Even if people with pre-existing conditions can find adequate plans, it is very unlikely that they would be affordable. Most of the protections to ensure affordable health care are also repealed.

Urge the Members of the House of Representatives to oppose the American Health Care Act. It is a threat to the health of people with disabilities and chronic health conditions and it is a threat to our decades long, bipartisan work to secure community based services for people with intellectual and developmental disabilities.

Recently the House Energy and Commerce Committee and Ways and Means Committee passed legislation to cut Medicaid and repeal major portions of the Affordable Care Act (ACA). This bill is moving fast, and we expect the House to vote on it this week. Simply stated, this legislation is devastating.

Here are five reasons why:

1. People with disabilities get slammed by Medicaid cuts
   $880 billion would get cut from the Medicaid program over the next decade. This cut comes from 1) changing the financing structure of the program to a per capita cap model, and 2) phasing out the “Medicaid expansion,” which incentivizes states to cover people up to 138% of the federal poverty level (income of $16, 642 per year) for an individual.The result is a cost shift to states that would likely force states to choose among options such as:
   
   • Cut eligibility. People with disabilities, low income adults, children, pregnant women, and seniors could be cut from the rolls.
   • Cut services. Current “optional” services such as in home services, assistive technology, transportation, supported employment, and much more could be up for grabs.
   • Cut quality. If federal Medicaid regulations are lost, it could be cheaper for states to warehouse people with disabilities in institutions rather than provide quality home and community based services.
2. Millions of Americans will lose health care
   According to the nonpartisan Congressional Budget Office, there will be 24 million more Americans without health insurance by 2026. This includes 14 million fewer people enrolled in Medicaid. This reality contradicts the many assertions from the President and many Members of Congress that no one would lose health care.

3. Middle class families pay more
   For moderate-income families, the ACHA’s reduction in tax credits could make coverage out of reach. For families with income below 250% of poverty, estimates show that by 2020, when many provisions of the bill kick in, costs would increase by over $9,000.

4. The tax breaks favor the rich, corporations, and health care providers
   The ACHA repeals many of the tax provisions that are used to help finance the ACA. Millions of low and moderate income people would lose their health insurance to pay for $600 billion in tax cuts for the rich and the insurance, drug, and medical device industries. This includes $285 billion in taxes for the top 2% of earners and the elimination of the cap that insurance companies can deduct from their taxes for executives making over $500,000 per year.

5. Prevention Takes a Hit
   The Prevention and Public Health Fund, which provides crucial financial support for public health and other services that assist people with disabilities. would be gone in 2018. According to analysis by the Trust for America’s Health, the U.S. Centers for Disease Control and Prevention would lose 12 percent of its annual budget if the Prevention and Public Health Fund is repealed.