June 30, 2017
The Honorable Ben Sasse The Honorable Deb Fischer
136 Russell Senate Office Building 454 Russell Senate Office Building
Washington, DC 20510 Washington, DC 20510
Re: Concerns regarding the Better Care Reconciliation Act of 2017
We appreciate this opportunity to contract you regarding our concerns with the current proposal in the Senate to repeal and replace the Affordable Care Act. As the designated Protection and Advocacy organization for Nebraskans with disabilities we are committed to ensuring that “those who are most vulnerable, will be free from harm and able to exercise the same rights, opportunities and choices available to all citizens in order to live fully integrated and culturally valued lives.” As currently written, the proposed Better Care Reconciliation Act of 2017 will significantly frustrate efforts for Nebraskans with disabilities to achieve this vision and will have a negative impact on the ability of many Nebraskans with disabilities to acquire and/or continue to receive necessary health care through the private market, their employers, and especially Medicaid.
The United States Census Bureau’s 2015 American Community Survey, stated that approximately 11.2% of Nebraskans of all ages (209,300 people) report having a disability. The survey data shows that while 33.2% of working-age people with disabilities in Nebraska (34,400 people) reported Medicaid coverage (or other government-assistance plan for those with low incomes or a disability) as their primary insurer, only 4% of Nebraskans without disabilities (approximately 38,000 people) did. Although approximately 9.3% of Nebraskans with disabilities (9,600 people) reported being uninsured, approximately 40% reported receiving health insurance through either an employer or union (41,300 people) and approximately 14.1% purchased their own insurance (14,600 people).
Medicaid plays a vital role in the lives of thousands of Nebraskans with disabilities. According to the Nebraska Division of Medicaid and Long-Term Care, in 2016 the average monthly eligible persons for Medicaid in Nebraska totaled 232,795 people; of those 15.4% (35,937 people) were in the “Blind and Disabled” category and 67.1% were children (156,262 children). Nebraska Medicaid expended $1.96 billion in 2016; of this, funding for Nebraskans in the “Blind and Disabled” category totaled 45.2% ($888,535,550) and 27% for children ($531,482,950). Medicaid provides a wide-ranging array of services and supports for Nebraskans with disabilities, including inpatient/outpatient hospital services, nursing home care, medical supplies, durable medical equipment, prescription drugs, Intermediate Care Facilities for Intellectual/Developmental Disabilities, and home and community-based services.
We are particularly alarmed by the Congressional Budget Office score for the bill which portends a devastating impact on Nebraskans with disabilities, regardless of their insurer. The rollback of the actuarial value of plans from 70% to 58% naturally equates to increased personal cost for private health insurance. The consequent steep spike in insurance premiums, deductibles, and other cost-sharing devices, even when factoring in offsets to premium increases, will significantly restrict the ability of many Nebraskans with disabilities to afford health insurance, forcing them to remain uninsured, forgoing health insurance all together, or turning to Medicaid (if eligible).
Given the significant number of people with disabilities who rely on the Medicaid program for their health care, and the key role that Medicaid plays in maintaining or promoting the health of Nebraskans with disabilities of all ages, the proposed Better Care Reconciliation Act of 2017 would be disastrous—not only for individual Nebraskans with disabilities but also the state. Reducing Medicaid program funding through 2026 by $770 billion would result in the elimination or scaling back of essential services and supports that individuals with disabilities need:
“With less federal reimbursement for Medicaid, states would need to decide whether to commit more of their own resources to finance the program at current-law levels or to reduce spending by cutting payments to health care providers and health plans, eliminating optional services, restricting eligibility for enrollment through work requirements and other changes, or (to the extent feasible) arriving at more efficient methods for delivering services.”
Furthermore, the proposed Medicaid reimbursement cap and/or block grant are not only dangerous for Nebraskans with disabilities, they will place greater fiscal pressure on the State of Nebraska to make up for lost federal assistance. In the worst case, this could result in ineffective responses to epidemics or emerging health crises, and would assuredly result in decreased services/supports. As the National Council on Disability reports in 2013:
“If the federal share of Medicaid funding were capped, responsibility for making the tough calls on slicing benefits or trimming eligibility would be shifted to the states, which lack the fiscal resources to replace lost federal assistance. Instead of the Federal Government picking up half to three-quarters of the cost of future recessions, epidemics similar to the HIV/AIDS outbreak of the 1980s, and the introduction of new, high-cost pharmaceuticals and breakthrough treatments, states would be left to their own devices in coping with the financial uncertainties of the health care marketplace. Block grant funding would place states and program beneficiaries in a far more vulnerable financial position than they are today. Older Americans and people with disabilities would be at special risk.… States would face strong financial pressures to reduce services to low-income seniors and people with disabilities if federal Medicaid funding were to be capped.”
At this time we ask that you not support the Better Care Reconciliation Act of 2017 as currently written and work diligently to secure changes to this legislation so that it will not jeopardize the health of the most vulnerable people with disabilities in Nebraska. We stand ready to work with you to make those changes.
If you have any further questions or need more information, please do not hesitate to contact me at your earliest convenience.
Eric A. Evans, Ph.D.
Chief Executive Officer
 Erickson, W. Lee, C., & von Schrader, S. (2016). 2015 Disability Status Report: Nebraska. Ithaca, NY: Cornell University Yang Tan Institute on Employment and Disability (YTI). Available at http://www.disabilitystatistics.org
 Nebraska Medicaid Reform Annual Report for State Fiscal Year 2015-2016 December 1, 2016 available at http://dhhs.ne.gov/Reports/Medicaid%20Annual%20Report%20-%202016.pdf
 See Congressional Budget Office score analysis, www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf , at page 27.
 See Congressional Budget Office score analysis, www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf , at page 30
 See National Council on Disability, May 2013, A Medicaid Block Grant Program: Implications for People with Disabilities, at page 25, available at https://www.ncd.gov/publications/2013/0522201