Additional Health Care Position Statements for 2017
ASHA has taken a position on the following issues related to health care.
Oppose block-granting proposals that would limit federal matching funds to set amounts without regard for changes in enrollment, medical needs, economic downturn, or other variable criteria.
Rationale: Block-granting proposals are estimated to potentially reduce federal and state expenditures on health care through the Medicaid program by up to $450 billion over 10 years. Block granting and per capita caps based on federal poverty census data within states as commonly proposed would dramatically affect members and consumers in states where Medicaid has expanded and where optional populations are covered. Block grants and caps disincentivize enrollment and comprehensive coverage while promoting more restrictive coverage and eligibility criteria. This is a result of capped funding and proposed elimination of federal dollars to support additional enrollment or eligibility.
School-Based Medicaid Reimbursement
Protect school-based Medicaid reimbursement for medically necessary services that are also educationally relevant.
Rationale: School-based reimbursement from Medicaid for medically necessary services that are also educationally relevant would be threatened because the state Medicaid agency would have limited funds and be disincentivized to provide coverage for school-based services. School districts would continue to have to comply with the Individuals With Disabilities Education (IDEA) law and ensure a free and appropriate public education. However, without the support of Medicaid funding, the amount of services available for eligible children would significantly decrease, threatening students’ access to essential services. Employment of members would be negatively affected because of potentially reduced student eligibility for services, resulting from increasingly restrictive standards driven by reduced funding.
Federal Medicaid Early Periodic, Screening, Diagnosis and Treatment (EPSDT) Mandates
Protect the EPSDT mandates.
Rationale: Under the proposed block grants, concerns have been raised regarding the federal government’s need to eliminate or relax federal mandates for Medicaid coverage and allow the states increased flexibility to make their own coverage determinations. The EPSDT mandate could be threatened with elimination or weakening of federal standards. There has been some deterioration of
the mandate because of varying interpretations of EPSDT by managed care organizations contracted to operate Medicaid in multiple states.
Enact consumer protections for access to affordable, quality care, including ensuring access to habilitation services, before repealing the Affordable Care Act (ACA).
Rationale: Repeal of the ACA prior to an agreement on a replacement strategy that continues to ensure access to quality health care is a threat to the country’s entire health care system. Congressional partisanship threatens action on a compromise plan, and Congress should not repeal the ACA until a compromise on replacement legislation is agreed upon.
Recent discussions to trim the essential health benefits places habilitation at particular risk moving forward, as it was not a commonly covered service under private health plans prior to passage of the ACA.
Habilitation provides critical access to medically necessary services for children with developmental delays, congenital disorders, impairments, and conditions that require the skilled services of audiologists and speech-language pathologists, among a host of other professionals. Habilitation services help maximize an individual’s (most commonly, a child’s) ability to function as independently as possible, greatly enhancing educational performance, employment independence, and quality-of-life outcomes. Access to habilitation services must be preserved.
ASHA also recommends reauthorization of the Children’s Health Insurance Program (CHIP) to ensure that children who intended to transition to ACA plans do not lose coverage if the ACA is repealed without specific provisions being in place to ensure continued access to care for those children.
Sale of Interstate Health Plans
Oppose the sale of interstate health plans that threaten consumer protections and ASHA-supported state mandates for coverage of services provided by audiologists and speech-language pathologists.
Rationale: Although commonly discussed as a means to increase competition and reduce costs, the reality of interstate health plans has proven the opposite, with larger entities crowding out smaller plans and reducing overall consumer choice. In addition, current proposals to allow interstate health plans would propose a threat to consumer protection and access to services—including audiology and speech-language pathology—for a variety of reasons.
First, interstate sale of private health plans would reduce the ability of state insurance commissioners to fully engage in their consumer protection oversight role and would not allow them the ability to fully enforce the laws within their state to ensure appropriate access to care by qualified, licensed health care professionals.
Second, interstate sale of private health plans would allow establishment of health plans in states with low coverage criteria and consumer protections and would provide those plans for sales in states with more comprehensive requirements. This would essentially undermine the hard-fought state mandates that we and other health professionals have achieved for autism coverage, habilitation, hearing health, telepractice recognition, and co-payment parity.
It is in ASHA’s interests to continue building our relationships with the National Association of Insurance Commissioners (NAIC), as well as with individual state commissioners, and join them in opposition to interstate health plan sales. The NAIC has laid out plans for improving competition among health plans to improve consumer access and choice founded on the concept of interstate compacts. Such a proposal dovetails nicely with ASHA’s recent efforts toward developing interstate compacts for licensure of audiologists and speech-language pathologists.
Medicare Vouchers, Tax Credits, and Premium Support
Oppose Medicare vouchers, tax credits, and premium support to protect the affordability of care for older Americans and for people with disabilities.
Rationale: Recent discussions of privatizing Medicare, providing vouchers for consumer choice, and establishing tax credits for seniors to purchase health care of their choice ignore the reality that many senior citizens face. Too many seniors live in or near poverty or on limited fixed incomes and do not have the resources to buy health insurance on the open market because of pre-existing conditions. The actuarial impact of their age on health risks and premium costs, particularly without Affordable Care Act (ACA) protections, would make coverage unaffordable.
Even more concerning is the concept of providing tax credits to seniors and individuals with disabilities in order to purchase private health care. An overwhelming number of retired Americans and individuals with chronic conditions and disability determinations do not earn enough income to pay any amount of federal taxes. The concept of tax credits as a viable option for the majority of seniors and individuals with disabilities is reckless and undermines the foundational nature of Medicare as an entitlement funded by each individual through payroll taxes over the course of their employment careers.
Medicaid Cost Sharing and Implementation of High-Deductible Health Plans
Oppose increased Medicaid cost sharing and implementation of high-deductible health plans for low-income Medicaid beneficiaries.
Rationale: Similar to concerns about Medicare premium support proposals, Medicaid initiatives like those implemented in Indiana and elsewhere to increase co-payments and co-insurance for Medicaid beneficiaries fail to recognize the limited financial capacity of many individuals and families enrolled in the Medicaid program. Although health savings accounts and high-deductible plans have a significant role to play in increasing consumer attention and focus on health care costs, quality, and effectiveness, applying them to individuals who cannot afford the co-payments results in delaying and avoiding health care services that often help manage and prevent progression to more serious and costly conditions.