What does Medicaid have to do with independence? For millions of Americans with disabilities, the answer is clear. As the nation’s primary source of funding for the services that help people with disabilities stay in their own homes, Medicaid plays a vital role in protecting Americans with disabilities from institutionalization.
The disability community has long worked to ensure that people with disabilities can be included in mainstream American life rather than be forced into nursing homes and institutions.
In 1981, President Ronald Reagan signed the Home and Community-Based Services provisions within Medicaid. These provisions are a huge part of Medicaid and are rooted in a simple reality: People with disabilities are less safe, less happy and less free in institutional settings than they are in the community.
An overwhelming body of research and evidence shows that people with disabilities fare better in the community than in institutions, enjoying greater choice and control, better functional skills and an overall higher quality of life.
The Supreme Court agreed in the 1999 Olmstead decision saying that states must provide services in the most integrated setting appropriate to the needs of the individual. The court held that unnecessarily institutionalizing people segregates them, and that this violates the Americans with Disabilities Act signed into law by President George H.W. Bush in 1990.
It is Medicaid that provides the in-home aid who helps get an adult with quadriplegia out of bed, dressed and able to go to work in the morning. It is Medicaid that provides the in-home occupational therapist who works with the autistic child so she can live at home with her family — not be pushed into an institution. And, it is Medicaid that sends the home health nurse to check on the senior, who might otherwise have to leave the home where he lived for 30 years and raised a family to live in a single room of a nursing home.
So the Republicans’ proposal to defund and change Medicaid is the greatest threat the disability community has faced since the eugenics movement in the early 20th century.
Under the proposal passed by the House and currently before the Senate, the structure of Medicaid would change from a partnership between the federal government and state governments to a system of “per capita caps.” This means that the amount of money that the federal government provides to states would be capped, or limited, to a certain fixed amount per Medicaid recipient, based on 2016 spending levels.
The goal of these “per capita caps” is to save the federal government money — lots of money. An analysis from the Urban Institute suggests that almost half of the American Health Care Act’s $834 billion in cuts to Medicaid would come from per capita caps, devastating services to seniors, children and people with disabilities in my home state of Colorado.
The AHCA was supposed to be about solving problems believed to be caused by the Affordable Care Act. However, changing the financing will devastate programs that have successfully helped people with disabilities of all ages since the 80s.
The budget implications for states would be awful. States struggle to balance their budget each year. Colorado state legislators cannot simply add millions of dollars to the Medicaid program.
Nor should they have to.
It is an appropriate role of the federal government to partner with the states to provide Medicaid. There is no other source of long-term care funding since neither Medicare nor private insurance covers long-term care, such as home and community-based services.
Supporting people with disabilities, including elderly people with disabilities, has always enjoyed bipartisan support. Currently the most states pay is 50 percent, and states with more poverty pay less according to a match formula in current law. Forcing the states to shoulder all of the risk will create economic chaos for states, as well as American families and individuals, when the inevitable cuts are made.
Our country has had many years of slow but steady progress in expanding access to community life for people with disabilities. Slashing Medicaid funding threatens to send us back in time.
For the sake of the millions of Americans with disabilities — who want to stay in our communities with our neighbors, family and friends — we cannot let that happen. The United States is a proud leader and innovator on cost-effective services for people with disabilities — we can manage services at the state level, but federal funding must remain steady.
Senate Republicans, including my own Sen. Cory GardnerCory GardnerProtecting the outdoors: Three cheers for America's best idea Ex-Sen. Cory Gardner joins lobbying firm Biden administration reverses Trump changes it says 'undermined' conservation program MORE (R-Colo.), are now a part of critical deliberations among the GOP lawmakers. The livelihood of people with disabilities, our families and the many people that earn a living providing home and community-based services are at stake.
The Senate should stick to our American values, fight to defend Medicaid and reject per capita caps. The problems with the ACA can be fixed without destroying everything that matters to millions of Americans with disabilities.
Julie Reiskin is the Executive Director of the ColoradoCross Disability Coalition.
The views expressed by contributors are their own and are not the views of The Hill.