Last Friday, a Federal District Court in Texas issued a decision declaring the Affordable Care Act (ACA) in its entirety unconstitutional. The judge’s reasoning has been widely criticized and legal scholars contend that it is unlikely the decision will be upheld on appeal. Nevertheless, the ruling sowed confusion and uncertainty on the eve of the ACA Marketplace enrollment deadline and furthers the harm caused by the Trump Administration’s and Congress’s actions to undermine the ACA.
If the ruling were to stand, the implications for older adults would be catastrophic. Over 4.5 million older adults age 55-64 who have coverage through the Marketplaces and Medicaid expansion would lose access to health care. For millions more, health care would become either unaffordable or unattainable because health insurance companies would again be permitted to charge older adults more based on age and deny coverage to the 8 out of 10 older adults with a preexisting condition.
The ACA’s Medicare provisions would also be rolled back. Medicare enrollees would face higher prescription drug costs and out-of-pocket spending on preventive services that are currently free pursuant to the ACA. Further, the savings from the ACA that extended the life of the Medicare trust fund would be eliminated, placing Medicare at risk for dramatic cuts through the budget, vouchers, and privatization. These are costs that seniors simply cannot afford.
Despite the judge’s ruling, the ACA remains the law today and older Americans can continue to rely on the ACA’s protections and coverage. By joining together, we have successfully prevented previous attempts strike down the ACA. That fight continues to ensure older adults have access to affordable and quality health care as they age.
A class action lawsuit filed today against Florida’s Agency for Health Care Administration asserts that the state’s management of its Medicaid long-term care system violates Title II of the Americans with Disabilities Act. By perpetuating the institutionalization and segregation of older adults and people with disabilities and severely limiting their access to community-based services, the state forces people to unnecessarily enter nursing facilities to get care.
Justice in Aging, a national non-profit legal advocacy organization that fights senior poverty, and Southern Legal Counsel, a Gainesville, Florida-based, statewide nonprofit law firm, filed the suit on behalf of their clients, who are on the state’s waiting list for home-based long-term-care services and are currently at risk of unnecessary and unwanted institutionalization. Disability Rights Florida, private attorney Nancy Wright, and lawyers from the firm of Cozen O’Connor are co-counsel.
“The Americans with Disabilities Act provides that people with disabilities are entitled to receive needed health care in the most integrated setting. Yet in Florida, many older adults and adults with disabilities are stuck on a wait list, unable to get the care they need to stay in their homes, and face having to go into a nursing facility to get that care. This case seeks an expansion of lower-cost home and community-based services and a rebalancing of the long-term care system so people can avoid institutionalization,” said Regan Bailey, litigation director for Justice in Aging.
Florida’s Long-Term Care Medicaid Waiver program provides in-home services and supports for frail older adults and persons with disabilities. Many of these Floridians prefer to remain at home and in their communities and receive help at home with daily activities like eating, bathing, and cooking. But the state prioritizes funding institutional care, and there are currently thousands of people on the wait list for home-based services. As a result, many eligible applicants will die or be forced to move to a nursing home before they get off the waiting list.
“Home and community-based services allow individuals with disabilities to stay in their homes, with or near their families, and remain a part of their community. Such services are integral to maintaining the dignity and humanity of older adults and people with disabilities. It’s no wonder there is such a great demand for these services,” said Amanda Heystek, director of systems reform for Disability Rights Florida.
Lengthy wait times for essential care put lives at risks and cause families to make impossible choices between institutionalizing their loved ones and bankrupting themselves paying out-of-pocket for care. The vast majority of those on the waiting list are over 60, more than half are over 74, and a quarter are 85 or older. Depending on the level of need and existing support, these individuals could wait up to three and a half years before getting the care at home that they need. Between July 1, 2016, and March 8, 2018, more than 1,400 people on the wait list had to move to nursing facilities. In this same period, more than 8,600 people died while on the wait list.
“The state can’t say it’s limiting home-based care services because of a lack of funding, because it actually saves the state money for people to receive care at home,” said Southern Legal Counsel Executive Director Jodi Siegel. “Florida’s administration of its Medicaid Long-Term Care Waiver program is therefore not only in violation of the ADA, but also fiscally irresponsible.”
About Justice in Aging
Justice in Aging is a national non-profit legal advocacy organization that fights senior poverty through law. Since 1972 we’ve worked for access to affordable health care and economic security for older adults with limited resources, focusing especially on populations that have traditionally lacked legal protection such as women, people of color, LGBT individuals, and people with limited English proficiency. Through targeted advocacy, litigation, and the trainings and resources we provide to local advocates, we ensure access to the social safety net programs that poor seniors depend on, including Medicare, Medicaid, Social Security, and Supplemental Security Income (SSI).
About Cozen O’Connor
Established in 1970, Cozen O’Connor has more than 700 attorneys who help clients manage risk and make better business decisions. The firm counsels clients on their most sophisticated legal matters in all areas of the law, including litigation, corporate, and regulatory law. Representing a broad array of leading global corporations and middle market companies, Cozen O’Connor services its clients’ needs through 28 offices across two continents.
About Disability Rights Florida
Disability Rights Florida was founded in 1977 as the statewide designated protection and advocacy system for individuals with disabilities in the State of Florida. We provide free legal and advocacy services to people with disabilities through the authority and responsibility of nine federal grants. Our mission is to advance the quality of life, dignity, equality, self-determination, and freedom of choice for people with disabilities.
About Southern Legal Counsel
Southern Legal Counsel is a statewide, nonprofit law firm that works proactively to ensure fairness, social justice and government accountability for Floridians through focused, high-impact initiatives, policy advocacy and civil litigation.
Governing Magazine: Assisted Living: A $10 Billion Industry with Little Oversight (April 2018) A February report from the Government Accountability Office (GAO), which found significant shortcomings in oversight of assisted living facilities across the country. It found significant shortcomings in oversight of assisted living facilities across the country, but “barely scratches the surface” of the problem, said Eric Carlson when interviewed for the piece.
U.S News and World Report: How Medicaid Work Requirements Could Hurt Older Americans. (April 20, 2018) Since the Centers for Medicare and Medicaid Services opened the door to state waivers that would impose work requirements on many Medicaid recipients, some states have requested and been approved such wages. In this article, Justice in Aging attorney, Eric Carlson talks about the amicus brief we filed to block Kentucky’s waiver.
President Trump’s proposed FY 2019 Budget is yet another attack on the health and economic security of older adults and people with disabilities. After using the latest tax bill to give away trillions of dollars in tax cuts to America’s wealthiest, the Administration is attempting to pay for those tax cuts by slashing critical programs that keep older adults in their homes, allow them to visit their doctors, and ensure they can meet their basic needs.
This budget would take us backwards by increasing poverty and making it harder for people to get the health care they need. It goes against what Congress wants and what the public wants. In its 2018 budget, Congress recently increased spending for important and popular programs. Those gains would disappear in 2019 under this budget.
The American people do not want cuts to Medicaid or the repeal of the ACA, yet this budget renews calls for slashing Medicaid by more than $1.4 trillion over the next decade through block grants and per capita caps, as well as repealing and replacing the Affordable Care Act (ACA). As we have explained, such cuts would be devastating to low-income older adults who rely on Medicaid to support their health care needs and ability to stay in their homes, leave millions without coverage, and weaken consumer protections.
The President promised the American people he wouldn’t touch Medicare, yet his proposed budget for the next ten years calls for over $490 billion in cuts to a program that every American will need.
The budget also would make it harder for older adults to pay rent, put food on the table, and meet their basic needs. The budget proposes significant cuts of over $83 billion to Social Security, primarily through cuts to Social Disability Insurance (SSDI) and the Supplemental Security Income (SSI) programs. These programs are there for people who have no or little income and are the difference between home and a life on the streets for many.
Additionally, the budget proposes dramatic cuts to nutrition assistance, eliminates funding for home heating and cooling assistance for about 6 million low-income households, and calls for the complete elimination of the Legal Services Corporation, which provides vital legal help for low-income older adults and their families.
This budget is a true window into the misplaced priorities of this President and his Administration. On the heels of a massive tax cut that will increase income inequality, this budget proposes to make life even more difficult for America’s poor older adults and people with disabilities.
By joining together we have fought back successfully against previous attempts to cut the programs older adults and their families rely on, and we will continue to fight for justice for us all as we age.
Read our joint statement with Medicare Rights Center, and the Center for Medicare Advocacy
Washington, DC—The President’s annual budget request is, at its core, a statement of values. It is incredibly troubling then, that President Trump’s budget blueprint for FY 2019, submitted this week, again prioritizes deep cuts to programs on which older adults and people with disabilities rely, including Medicare, Medicaid, and the Affordable Care Act.
(January 12, 2018) Yesterday, the Centers for Medicare & Medicaid (CMS) issued guidance to states that would allow them to condition Medicaid eligibility on fulfilling work and “community engagement” requirements. This represents an unprecedented change to Medicaid eligibility that threatens healthcare for millions of low-income persons, including older adults who are not yet eligible for Medicare, people with disabilities and chronic health conditions, and family caregivers.
Not only have punitive work requirements been proven ineffective at lifting people out of poverty or improving health outcomes, they are also extremely burdensome for beneficiaries to navigate and for states to administer. Requiring people to verify that they are either working or exempt from the requirement will inevitably lead to Medicaid-eligible people falling through the cracks simply because the process is too complicated, onerous or doesn’t work correctly.
CMS intends to allow states broad leeway in determining who would be subject to work requirements and what activities would satisfy those requirements. For example, while CMS recognizes that Medicaid beneficiaries may be caregiving for elderly family members, there are no required protections for caregivers. As a result, depending on how the state defines “work,” family caregivers, who are more likely to be women, risk losing their health coverage. Similarly, many people with chronic health conditions and disabilities that limit their ability to work could be excluded from coverage or face onerous verification processes to be exempted from a work requirement.
We strongly oppose this change in longstanding policy as defying the objectives of the Medicaid program and endangering the lives and well-being of those who rely on it. We urge CMS to reconsider this policy and call on states to maintain the purpose of Medicaid, protect the health of their residents, and not impose work requirements.
December 20, 2017-Today, the House and Senate passed their destructive tax bill on a purely partisan basis. The tax bill provides an enormous tax break to wealthy individuals and big corporations at the expense of the well-being of millions of others, including older adults. The Joint Committee on Taxation estimates that the bill’s tax breaks for the wealthy will slash federal revenue by over $1 trillion, directly undermining critical programs that older adults rely on, such as Medicare, Medicaid, Supplemental Security Income, and Supplemental Nutrition Assistance Program (SNAP).
This bill threatens the health and economic security of older adults and their families in other ways as well. By repealing the Affordable Care Act’s individual mandate, the tax bill will leave 13 million Americans without health care, including older adults, people with disabilities and 5 million Medicaid-eligible individuals. The tax cuts will not provide financial relief to most older adults. The Institute on Taxation and Economic Policy finds that by 2027 the bottom three-fifths of Americans will see their tax bills rise, as temporary tax cuts for individuals expire and corporate tax cuts remain permanent. Further, under sequestration, the bill also triggers automatic cuts to certain federal programs, including $25 billion from Medicare in 2018 alone.
The fight is not over. Now that Congress has passed the tax bill, we must hold them accountable, and let them know that they can’t pay for tax cuts for the wealthy by slashing Medicare, Medicaid, Supplemental Security Income, SNAP, and many other programs that older adults depend on.
We will be here in the New Year ready to fight back and provide you with the information you need to do your jobs. Thank you for everything you do. Together we will protect older adults, people with disabilities, and their families from harm, and work to strengthen the programs they rely on.
The revised Senate health care bill brings an idea that should be a hard sell for the over 3 million older adults and people with disabilities who rely on Medicaid for in-home care. On top of a massive almost $800 billion cut to Medicaid that guarantees shrunken programs and eliminated services, the Senate bill kills CFC and replaces it with an inferior version that provides fewer services for a limited time only.