What's Up in Washington: Sequestration, Budgets, and the Affordable Care Act

1. What's Up in Washington: Sequestration, Budgets, and the Affordable Care Act Robert Blancato Meredith Ponder Matz, Blancato and Associates June 3, 2013

2. What Is Sequestration? • Sequestration means automatic across the board spending cuts. • How did we get here? • Product of the Budget Control Act of 2011 debt ceiling agreement. Set caps on discretionary spending through 2021. • Created a so-called “super committee” (Select Committee on Deficit Reduction).

3. Sequestration: What Happened? • Failure of Committee to agree led to automatic spending cuts being a viable but last resort option. • Sequestration was delayed by two months late in 2012 by the “fiscal cliff 1” bill. • Cuts would have been closer to 8 percent across the board had it begun in January.

4. Exempted from Sequestration • Social Security • Supplemental Nutrition Assistance Program (SNAP) • Temporary Assistance for Needy Families (TANF) • Earned Income Tax Credit • Medicare benefits • Medicare cuts limited to 2 percent at provider level only • Medicaid

5. What Isn’t Exempt and Is Cut By 5% • Hundreds of important programs, including: • Low Income Home Energy Assistance Program (LIHEAP) • Social Service Block Grants and Community Service Block Grants • Older Americans Act programs • Section 202 Housing for the Elderly • Senior Corps (RSVP, Foster Grandparents) • Evidence-based health promotion and disease prevention programs

6. Sequestration Takes Effect • March 1 came and sequestration took effect. • Now in effect until September 30 as a result of the FY 2013 Continuing Resolution. Community health centers and food inspectors exempt as were some defense programs • Sequestration now three months old and impact being felt more each day. In programs of importance to AIRS • One revision made due to air traffic controllers. • More to come? Not likely

7. How Could Sequestration End? • Only possible exception would be if impact proves so significant as to warrant remedy. • Critical for people on ground to calculate impact in dollar and human terms. • Estimates we know: • LIHEAP loses $285 million (290,000 households). • SSBG/CSBG cuts services to 345,000 people. • OAA loses $121 million. Could include 4 million meals • Section 202 Housing loses $32 million (114,000 households). • Senior Corps loses 30,000 volunteers. • Evidence-based disease prevention programs cut 485,000 seniors.

8. Fiscal Year 2014 • Focus now on Fiscal Year 2014 (begins October 1, 2013) • Sequestration could last 10 years unless stopped. • The FY 2014 cuts could be worse. • Action has begun in Congress on 2014 budget.

9. What Would the FY 2014 Budgets Do? • House version would continue sequestration and maintain it for all 10 years. • Senate assumes end to sequestration. • President’s budget assumes end too. • Impact documented for this year will help determine if sequestration goes forward.

10. Older Americans Act Reauthorization • Two years late. • Action limited in last Congress to handful of Democratic Senators led by Sen. Bernie Sanders. • Comprehensive legislation to renew for 5 years just introduced by Sanders (S. 1028). • No support from Senate Republicans. • No action in House.

11. S.1028 – OAA Amendments of 2013 • Strengthens and reauthorizes core programs of the OAA. • Updates definitions of “greatest economic and social need.” • Addresses economic security. • Authorizes new demonstration projects. • Increases focus on elder abuse.

12. Chances for Reauthorization? • Prospects for action unclear. • Sanders pushing ahead. • Changes in Committees and Subcommittees could impact reauthorization. • Sen. Alexander (Tennessee) replaced Sen. Enzi as top Republican on full HELP Committee. • Sen. Burr (North Carolina) replaced Sen. Paul as top Republican on Subcommittee. • White House Conference on Aging.

13. Administration for Community Living • 2012: creation of Administration for Community Living (ACL) • Single biggest action taken on the OAA in 2012. • Created new structure blending existing AOA, Office of Disability and Office of Developmental Disability into new office. • Kathy Greenlee serves as both Administrator of ACL and Assistant Secretary of AOA.

14. About ACL • Mission: Maximize the independence, well-being, and health of older adults, people with disabilities across the lifespan, and their families and caregivers. • Increasing access to community supports. • Laws ACL administers: • Developmental Disabilities Assistance and Bill of Rights Act of 2000 (DD Act) • Older Americans Act • Alzheimer’s Disease Supportive Services Program (ADSSP) • Senior Medicare Patrol • Lifespan Respite Care Program • Help America Vote Act (HAVA)

15. Affordable Care Act and AIRS • 2013 is a pivotal year leading up to 2014 when full implementation of ACA will occur. • Big ticket issues, exchanges ( enrollment in October) and Medicaid expansion • News reports point to public being largely unaware of law and its benefits—the Washington Post reports that 78% of low and middle-class Americans are unaware of ACA’s benefits.

16. Upcoming Notifications and Events • Proposed rules on navigators for enrollment in online federal marketplaces (exchanges) also state partnerships • Some 850 letters of intent sent to HHS. Deadline June 7. $54 million • Separate in person assisters for state exchanges announced last week

17. HHS call center will launch in June. Intended to help applicants learn about exchanges and help insurers learn about the plans. • Web portal used for insurance enrollment will be tested in August. Open enrollment begins October 1

18. What Is the Goal? • To position AIRS and its members as viable resources to HHS/CMS as they move forward. • In communication with HHS: • State-by-state calls have been announced on this website, which has all the up-to-date news on exchange information/training: http://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/ODF_HealthInsuranceMarketplace.html

19. Conclusions • Important for AIRS members to know what is going on in their states on exchanges and Medicaid expansion. • Huge opportunity for AIRS members to become navigators for the exchanges because they have training and expertise in providing information. • Chance to bring visibility to importance of I&R services.

20. Resources • HHS/CMS Training and Announcements: http://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/ODF_HealthInsuranceMarketplace.html • HHS Regulations: http://www.hhs.gov/regulations/index.html • LCAO Issue Brief on Sequestration: http://www.lcao.org/files/2013/02/LCAO-Sequestration-Issue-Brief-Oct2012.pdf • ACL website: www.acl.gov • For additional information: • rblancato@matzblancato.com • mponder@matzblancato.com