What’s Up on Capitol Hill? An Aging Policy Perspective

1. What’s Up on Capitol Hill? An Aging Policy Perspective Amy Gotwals, Director K.J. Hertz, Deputy Director n4a Public Policy and Legislative Affairs n4a Answers on Aging Annual Conference July 18, 2011

2. n4a Public Policy and Legislative Affairs Board Public Policy Committee determines annual policy goals; Grassroots Committee promotes our agenda in the field In DC: Hill and coalition meetings, advocacy, analysis To Field: Advocacy Alerts (to all), and Legislative Updates (to n4a members); special advocacy tools (Aging Policy Briefing, toolkits, postcards, etc.)

3. n4a’s 2011 Policy Priorities • Reauthorization of the OAA • Enhancing Health and Security • Fiscal Year 2012 Appropriations • Livable Communities for all Ages • Senior Mobility Options

4. OAA Reauthorization • Strengthen the Aging Network’s role and capacity in the coordination and provision of long-term services and supports • Expand evidence-based health promotion and disease prevention • Improve community preparedness for an aging population • Set adequate authorization levels

5. Health and Security • CLASS Program • Prevention and Wellness • ADRCs • Care Transitions • Continue Medicaid HCBS rebalancing efforts

6. FY 2012 Appropriations • Sustain OAA programs • Support the President’s FY 2012 Budget request for the “Caregiver Initiative” • Provide a down payment on the EJA • Increase SHIP funding under the AoA for Part D enrollment assistance

7. Livable Communities • Prepare America’s communities to meet the needs of today and tomorrow’s older Americans • Support the Sustainable Communities Initiative grant programs through HUD, DOT and EPA

8. Senior Mobility Options • Reauthorize senior transportation programs to improve the availability and accessibility transportation services for older Americans

9. Budget Battles • Deficit Reduction • Need to Increase the Debt Ceiling • FY 2012 Appropriations

10. Challenges • Real Fiscal Woes (Economy, Deficit and Debt) • One deal has the potential to have major long-term effect on federal policy and spending

11. Forces At Play • Philosophical Forces • Policy Agenda (Reduce Govt Spending Dramatically) Meets Political Opportunity • Discretionary and Entitlement Cuts Seen as Necessary and Worthy

12. Forces At Play • Policy Reform Forces (practical and philosophical) • Medicare vouchers • Medicaid block grants • Balanced budget amendment

13. Forces at Play • Congress must raise the debt ceiling in order to avoid default, which would • Lower the country’s bond credit rating • Chain effect on financial markets, interest rates, international implications • If govt stop paying its’ bills, the pain trickles down… • “This is how a default gets into the rest of the economy: it destroys the fundamental trust that allows the financial markets to operate.” – Washington Post, 7.16.11

14. Key Deadlines • August 2: Debt ceiling reached • July 22: Deal would need to be struck

15. So how did we get here? • Last Congress didn’t pass any FY 2011 approps bills • Elections  New Power Dynamic of Republican House • FY 2011 was the first skirmish, over the leftovers

16. FY 2011 • Deeper cuts made in each CR, final bill cut billions more, narrowly averting gov’t shutdown in April • All programs at least 0.2% reduction, AoA another $16 mil, and major 45% cut to OAA Title V

17. So how did we get here? • Growth in deficit, esp. due to reduced revenues from economic downturn and increased stimulus spending • Increase in national debt

19. FY 2012Budget

20. Round One = FY 2012 House Budget Resolution • House Budget Comm Chair Paul Ryan (R-WI) released FY 2012 budget resolution first week in April • Makes dramatic changes to entitlement and discretionary programs

21. “Ryan Budget” • Block grants Medicaid, cuts it by almost $1.4 trillion over 10 years. $600 billion from repealing Medicaid improvements in ACA (by 2021, these cuts equal about a one-third reduction in federal support) • Voucherizes Medicare (“coupon care”) • Freezes discretionary spending for five years at 2008 levels • Lowers taxes on corporations and high earners

22. “Ryan Budget” • Medicare message was powerful and used by Democrats over spring recess • Passed House but not Senate • Was the plan to beat in April, now focus has shifted to less controversial, but equally major proposals • Remember, a budget resolution is not the deficit reduction vehicle that will move (just a blueprint)

23. Round Two: White House Negotiations • Biden Group • Obama Negotiations Past Two Weeks • Grand Deal $4 trillion • Openess to a smaller package -- $2 trillion?

24. Meanwhile in Congress… • McConnell fallback plan (gives Pres. limited authority to raise debt ceiling if cuts made) • McConnell-Reid $1.5 trillion plan? • House to take up “Cut, Cap and Balance” bill this week

25. Budget Deal • What are the risks? • Medicare and Medicaid cuts never before seen; fundamentally changing the nature and scope of the programs • Drastic cuts to discretionary spending • Caps on future spending of all kinds, so no chance for programs to respond to future needs (say the aging of the population!)

26. Budget Deal • Deficit reduction in the short term (cuts made in FY 2012 and shortly thereafter) • And deficit reduction in the long term (control mechanisms on future spending)

27. Budget Deal Short-Term Cuts “Down Payment” • Earns “scorable savings” (cuts to programs now and in next few years) • Example: Across-the-board cut to FY 2012 domestic discretionary spending or repealing the ACA’s Medicaid MoE provision

28. Budget Deal Long-Term Cuts “Control Mechanisms” • Spending cap (health care SC, entitlement SC, global SC) (vs. debt cap) • Has enforcement mechanism like a trigger or sequester • For example, if in 2018, Congress doesn’t act to respond to the trigger, cuts automatically made to all programs

29. So what’s the big deal? • If deficit reduction comes solely or mostly from programs, where is the shared sacrifice? (I.e., what should the balance btwn spending and revenues be in this equation?)

30. So what’s the big deal? • If spending caps are triggered, it doesn’t matter what the situation is (need, population, economy) and if cutting further is the most appropriate response.

31. So what’s the big deal? • Would force major changes to federal HC programs without actually addressing the underlying driver of costs (HC costs). Instead, pushes those costs onto individuals (and states). • Could essentially shred the safety net for low-income older adults and undermine the economic security for millions of middle class older adults.

32. So what happens next? FY 2012 Appropriations Process

33. It all started with the President’s Budget • February release • Congress was too absorbed in FY 2011 • Not all good news, but pockets of great news

34. OAA FY 2012 President’s Budget Admin’s Caregiver Initiative • 25% Increase OAA Title III E, NFCSP • 13% Increase OAA Title III B, Supportive Services • 31%for Title VI Native American aging programs • Increase Lifespan Respite from less than $3 million to $10 million(not OAA, but AoA)

35. OAA FY 2012 President’s Budget Other AoA Gains • $5 million boost to ombudsman program ($26.8 mil) and $16.5 million for Adult Protective Services as down payment on EJA • $47 million for SHIPs, move to AoA • New line items (Title V, ADRC, Sr Medicare Patrol, etc.)

36. Other Programs That Didn’t Fare As Well… • SCSEP, OAA Title V, would receive $450 million, a major decrease of $375 million or 45 percent over FY 2010 • LIHEAP would receive $2.5 billion less than FY 2010, returning to its FY 2008 spending level • Section 202 Supportive Housing for the Elderly Program would receive $757 million, a $68 million cut from the FY 2010 • CSBG would be reduced by $305 million and converted from a formula-based program into a competitive grant program

37. FY 2012 Appropriations • Appropriations process has begun to move ahead in the House • House Allocations Distressingly Low (House Labor/HHS = 11.5 % less overall than FY 2011) • House Subcomm markup ~ July 26 • Senate: no overall number, so slower to develop specifics. Waiting on larger budget deal.

38. Forecast • Gloomy! • Virtually impossible to win increases. • A win would be minor/no cut. • Will be late – Nov/Dec.

39. What do we need to do? • Step up our advocacy to protect key programs • Work in coalition on bigger messages • Push ourselves in advocacy (speak up at town halls over August recess)

40. OAA Reauthorization

41. OAA Reauthorization Timeline • Groups Released Recommendations (n4a’s recs are at www.n4a.org) • Senate Spec Aging Comm Held May 26 Hearing • Senate HELP Subcomm Hearing on June 21 • We will need strong advocacy to make Congress pay attention, get it right and keep it moving!

42. Other Issues: Transportation • Reauthorization of the Surface Transportation Act bogged down with revenue and Trust Fund solvency issues • House & Senate differences over size and scope

43. Senior Transportation • Continue to work on senior mobility marker bill • Lobbying in support of Older Driver and Pedestrian Roadway Safety legislation

44. Other Issues: Livable Communities • 2nd Anniversary of Partnership for Sustainable Communities • Livable Communities Act has not been reintroduced yet (Menendez) • Round two: HUD FY 2011, $67 million for Sustainable Communities Initiative grants

45. Grassroots Activities • Reach out to freshman MoCs to educate them about your agencies and the work you do • Stay in regular contact with Members and staff • Invite your local congressional offices to do site visits, attend events • Come back to DC in April. Aging Policy Briefing, April 16-17, 2012.

46. Questions? Call on n4a’s Public Policy and Legislative Affairs Staff Amy E. Gotwals, agotwals@n4a.orgK.J. Hertz, khertz@n4a.org www.n4a.org