Access to comprehensive, affordable health care coverage can make or break the lives of any American, but particularly people with intellectual and developmental disabilities (I/DD). The Affordable Care Act (ACA), which Congress is working to repeal, included an option for states to expand Medicaid, which has helped millions of people, including individuals with I/DD. The key ingredient was the additional federal contribution to expand, which has helped more people access health care without harming the existing programs that provide supports and services to people with I/DD. Access to consistent and reliable health care is imperative for individuals with I/DD, and the ACA created much-needed reforms to health insurance, addressed systemic discrimination, and expanded coverage.
The ACA allowed states to extend their Medicaid programs to childless adults earning up to 138 percent of the federal poverty level. This change has provided coverage to millions of people, including individuals with I/DD and other disabilities who were not otherwise eligible for Medicaid.
Several provisions of the ACA were designed to assist states to rebalance their long term supports systems and invest in the community instead of costly and outdated institutions. These include the Community First Choice Option (CFC) and the State Plan Home and Community-Based Services Option (also known as 1915(k) and 1915(i). Iowa was among many of the states utilizing 1915(i).
In addition to expansions of health coverage, the ACA provided important insurance requirements, non-discrimination provisions, and long term supports and services expansions to ensure that everyone would have options for coverage. Non-discrimination provisions and health insurance reforms such as banning the exclusion of people from health insurance coverage based on pre-existing conditions, preventing insurers from charging people with disabilities and health conditions significantly more for health insurance coverage, and eliminating annual and lifetime caps on health coverage were included.
ACA improved affordability of health insurance through tax credits and cost-sharing assistance for low and moderate income individuals. ACA also requires a comprehensive benefit package which includes rehabilitative and habilitative services and devices, mental health and substance abuse disorder services including behavioral health treatment, and prescription drug coverage.
ACA expanded access to health insurance in a number of important ways including:
• Expanding mental health parity provisions
• Requiring coverage for dependents until age 26
• Improving accessibility of medical diagnostic equipment
ACA also expanded access to long term supports and services by:
• Creating the Community First Choice Option allowing states to provide participant-directed home and community based attendant services as part of their state Medicaid plan
• Extending the Money Follows the Person Rebalancing Demonstration
• Creating the Balancing Incentives Program to incentivize states to increase access to non-institutional LTSS.
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Repealing ACA would be devastating for all who have finally found coverage in the last seven years. It would also undermine the health and long term supports provided by the Medicaid program. If the additional Medicaid expansion funding is repealed it will destabilize the Medicaid program in the 32 states that have expanded Medicaid. It will force states to make tough choices about eligibility and access to services and could cause substantial competition between diverse groups (children, people with disabilities, the elderly) for scarce resources.
States would also be faced with how to finance the cost shift from the federal government to the states and may look to beneficiaries, family members, providers, and others to make up the difference. Significantly increased cost-sharing is not affordable for people with I/DD who receive Medicaid.
The ACA has unquestionably improved access to care for people with disabilities and chronic conditions to help them live healthy, independent, and fulfilling lives. To eliminate the ACA without simultaneously replacing it with a functionally equivalent alternative, jeopardizes this progress and puts consumers’ ongoing access to comprehensive, affordable coverage at risk. It is critical that the I/DD community is a part of any discussion about repeal and replace to ensure that any changes meet the needs of people with disabilities.
• David Thielen is the president and CEO of The Arc of East Central Iowa, a nonprofit agency in downtown Cedar Rapids. The Arc of East Central Iowa, a United Way agency established in 1953, serves over 800 individuals with intellectual and developmental disabilities in the immediate seven surrounding counties.