LEGISLATIVE ALERT
Action Needed Now on Budget Reconciliation Bill
July 1, 1997
HOUSE-SENATE CONFERENCE TO BEGIN JULY 8, 1997
ISSUES: Medicare, Medicaid, Children’s Health, and Welfare.
BACKGROUND: The House and Senate passed different versions of the spending portion of the budget reconciliation bill (H.R. 2015 and S. 947) the week of June 23. Both bills contain numerous provisions in the areas of health and welfare that could have a significant impact on social workers and the people we serve. Negotiations on reconciling the differences in the two bills are expected to begin the week of July 8. To affect the outcome of those negotiations, it is important that all Members of Congress receive the NASW message.
ACTION NEEDED: Fax, e-mail, or mail the enclosed sample letter and attachment to your Senators and Representative(s).
By Mail: Senate: The Honorable (first name, last name); U.S. Senate; Washington,
DC 20510.
House: The Honorable (first name, last name); U.S. House of Representatives; Washington, DC 20515.
By E-Mail: Call individual congressional offices for e-mail addresses or check the Internet for direct access. Internet address: http://www.visi.com/juan/congress/
By Fax: Call individual congressional offices for fax numbers or check Internet for numbers. Use Internet address above.
TIMING: The sooner your letters are sent, the more effective they will be. Congressional leaders expect to pass a final compromise version of the bill prior to the August recess which is scheduled to begin August 2, 1997.
NASW CONTACTS: Medicare/Medicaid: Sandy Harding, (800) 638-8799, ext. 261; Children’s Health: Madeleine Golde, ext. 237; Welfare: Cynthia Woodside, ext. 324.
Please mail, fax, or e-mail copies of letters. Mail: NASW, Office of Government Relations, 750 First Street, NE, Suite 700, Washington, DC 20002. Fax: Office of Government Relations, (202)336-8311. E-Mail: pransome@naswdc.org.
SAMPLE LETTER
July 1, 1997
Honorable ________ ________
US Senate (US House of Representatives)
Washington, DC 20510 (20515)Dear Senator (Representative) ________:
As a professional social worker, I am very concerned with H.R. 2015 and S. 947, the spending-related bills of this year’s budget reconciliation process that will soon be considered by a House-Senate conference committee. Both the House and Senate bills contain numerous provisions in the areas of health and welfare that could have a significant impact on the social work profession and the people we serve. However, this year’s budget reconciliation process seems to have been designed to pass these laws as quickly as possible, providing little opportunity for meaningful public knowledge, scrutiny, or feedback on the complex changes contained in the legislation.
I am pleased that the reconciliation bills assume spending to correct some of the more egregious problems that resulted from the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 and provide for expanding health care coverage for uninsured children. Nonetheless, I am dismayed that the overwhelming majority of spending reductions that will be used to balance the federal budget by 2002 are derived from the Medicare and Medicaid programs. I am very concerned that the spending reductions in Medicare and Medicaid will require profound structural changes in the programs that will erode the guarantee of basic health and mental health coverage for seniors and for low-income women, children, and disabled persons.
Attached are my recommendations on selected House and Senate reconciliation provisions that are related to Medicare, Medicaid, Children’s Health, and Welfare. I urge you to work with the conference committee to support these recommendations during negotiations on the budget reconciliation bill.
Sincerely,
cc: Attachment
State Consumer Protections
State Insurance Regulation. Reject the House provision to expand the Employee Retirement Income Security Act (ERISA) preemption from state health insurance regulation to health plans categorized as multiple employer welfare arrangements (MEWAs ).
Medicare
Age of Eligibility/ Cost-Sharing. Reject Senate provisions to raise the age of Medicare eligibility from 65 to 67 years, to means-test Medicare premiums, and to charge a $5.00 copayment for home health services under Medicare. Structural changes of this magnitude require extensive debate outside of the budget reconciliation process.
Medical Savings Accounts (MSAs). MSAs are not good for the Medicare trust fund, nor for beneficiaries with health costs. However, the Senate’s provision on MSAs, which limits the size of the demonstration project and contains limits on deductibles and out-of-pocket costs, is preferable.
Private Fee-for-Service Option. Reject the Senate provision to provide a Medicare opt-out for beneficiaries, a measure that further segments the Medicare risk pool and leads toward increased privatization of the program.
Balance Billing. Prohibit the return of balance billing that is allowed through the House’s Medical Savings Account option.
Quality Protections. Ensure quality standards for beneficiaries enrolled in managed care plans and require provider sponsored organizations to comply with existing state laws that offer consumer quality protections.
Appeals. Retain existing appeal rights in Medicare. Amend current proposal to apply the Part A appeals process to all home health services whether provided under Part A or Part B.
Medical Malpractice. Reject the House provision to place a cap on non-economic medical malpractice damages of $250,000.
Medicaid
SSI Kids. Honor the budget agreement to continue Medicaid eligibility for children who lost SSI benefits as a result of the tighter definition of disability in last year’s welfare bill.
Consumer Protections. Ensure federal quality and consumer protections for Medicaid beneficiaries that are enrolled in managed care plans. At a minimum, accept the Senate’s protections for beneficiaries enrolled in managed care. Require managed care plans to be monitored by an independent, quality review organization. Accept the House Commerce Committee provision that defines "medical necessity" according to the judgment of the attending health care professional. Retain House and Senate provisions that prohibit mandatory enrollment of disabled children in managed care plans.
Appeals. Preserve existing appeal rights in Medicaid.
Cost-Sharing. Reject the Senate bill’s new provisions that give States added flexibility to impose cost-sharing on Medicaid beneficiaries. Retain current cost-sharing limitations.
Disproportionate Share Hospital (DSH) Savings. Establish a federal DSH targeting standard to protect the continued viability of public and children’s hospitals that serve low-income beneficiaries.
Children’s Health
Delivery System. Support the Senate version of the children’s health initiative requiring states to use the $24 billion of new money ($8 billion of this money would come from a 20 cent per pack increase in the tobacco tax) to provide health insurance for uninsured children either through Medicaid expansion or as a block grant. When purchasing children’s health insurance, the Senate bill requires that the benefits package be equivalent to the federal employees’ Blue Cross/Blue Shield standard plan, with additional vision and hearing services.
Mental Health Parity. Support the inclusion of the Domenici-Wellstone mental health parity provision passed by the Senate Finance Committee. The provision would prohibit participating health plans that offer mental health benefits from imposing arbitrary day and visit limits or discriminatory copayments on mental health services.
Welfare
Immigrants. Support the Senate provision maintaining SSI coverage for all immigrants on the rolls as of August 22, 1996 and for those residing in the country as of that date who become disabled in the future.
Immigrants. Support the Senate provision exempting "legal" immigrant children from the five year ban on Medicaid eligibility.
Immigrants. Support the Senate provision extending eligibility for SSI and Medicaid to "legal" immigrants who are too disabled to complete the naturalization process.
Immigrants. Maintain provisions in both the House and Senate bills extending program eligibility for refugees and asylees from five to seven years.
Domestic Violence. Support the Senate provisions clarifying that the TANF exemptions for victims of domestic violence are in addition to the 20 percent hardship exemption and extending exemptions to child support enforcement.
Vocational Education. Support the Senate provision maintaining the limit of 20 percent of the caseload for participating in vocational education while exempting teens in school from the 20 percent.
Privatization. Reject the House provision permitting states to privatize the food stamp and Medicaid programs.
Worker Protections. Reject the House provisions limiting worker protections for welfare recipients making the transition from welfare to work.
Welfare-to-Work. Support the House provision splitting the $3 billion for the welfare-to-work program 50 percent to the states and 50 percent to localities.
Food Stamps. Maintain provisions in both the House and Senate bills restoring $1.5 billion for the food stamp program, exempting 15 percent of the 18-50 year old single, childless adults from the three-month limit on assistance and increasing the number of food stamp work slots.
Please mail, fax, or e-mail copies of letters. Mail: NASW, Office of Government Relations, 750 First Street, NE, Suite 700, Washington, DC 20002. Fax: Office of Government Relations, (202)336-8311. E-Mail: pransome@naswdc.org.