House Vote on Budget Reconciliation:
The Strategy - Hold Targeted House Members Accountable for Disability Programs/Services

One of the most important public policy votes that will affect people with disabilities, their families and the poorest, most vulnerable Americans is scheduled to take place on February 1, 2006. The U.S. House of Representatives must vote again on the Budget Reconciliation Conference Report, which includes almost $40 billion in cuts over five years in entitlement programs and services, such as Medicaid, TANF, SSI and others.

You may recall that the House already approved the conference report by a 212-206 vote that occurred early in the morning (6:00 a.m.) on December 19, just hours after the more than 700-page bill was finalized. However, the Senate’s vote, which happened on December 21, amended the final report and now forces the House to reconsider the conference report, giving disability community and other advocates for human services programs one last opportunity to kill this extraordinarily bad bill.

We need your help and we must act quickly!

WHY IS THE BUDGET RECONCILIATION CONFERENCE REPORT SO HARMFUL?

The overall Budget Reconciliation Conference Report seriously erodes decades of progress made in creating and expanding policies and programs that improve the lives of people with disabilities nationwide. Attached are more details about what provisions in this conference report will truly harm our constituencies.

WHAT IS THE STRATEGY?

The Arc and United Cerebral Palsy have joined with the Emergency Campaign for America’s Priorities (ECAP), http://www.actnow.org/, and other human service program advocates in a national campaign to hold key Members of the House of Representatives accountable for their upcoming vote on the Budget Reconciliation Conference Report.

Our strategy is simple and we look to the following leaders of The Arc and United Cerebral Palsy for assistance:

• Affiliate/Chapter Board Presidents and Chairs of Public Policy Committees
• Affiliate/ Chapter Board Members who have good relationships with the key House Member(s)
• State/Local Chapter Executive Directors
• CEOs/Affiliate Executive Directors

TOP PRIORITY


1. Schedule Meeting(s) with Targeted House Member(s)
   

   Time is of the essence. Many Members are now back in their Congressional Districts meeting with constituents and others on a range of issues. The Budget Reconciliation Conference Report may or may not be top-of-mind with the Member. We need to ensure that this is most prominent on their mind and hold the Member(s) accountable for his/her vote, scheduled for February 1.

   Contact the Member’s district office scheduler and request an immediate meeting with the Member. If that is not possible, meet with the District Office Chief of Staff. The subject of this meeting should be the Budget Reconciliation Conference Report and its impact on our constituency. Bring key members of your chapter/affiliate as well as other grass-tops leaders in your community who care about disability policy issues to the meeting.

   Attached is a list of the Members of the House of Representatives that are our primary and secondary targets.

   Primary Targets –

   1. These House Members voted against the original Budget Reconciliation Conference Report back in December. Their “No” vote must be maintained, despite the pressure that the White House and House Republican leadership are putting on them to change their votes.
   2. These Members voted against the House Budget Reconciliation bill, but voted for the Conference Report or they missed the conference report vote all together. These Members could be persuaded to vote against the report and it is imperative that we attempt to change their votes.

   Secondary Targets – It is reported that these Members have concerns about provisions in the Conference Report that affect low-income individuals. These Members could also be persuaded to vote against the report, now that the details of the report are apparent.

   After your visit, please notify the DPC at (202) 783-2229 ext. 15 and/or e-mail Richard Price at price@thedpc.org of the position your Member(s) of the House will take on this vote.
   
   

OTHER PRIORITY STRATEGIES



2. Actively Participate in (and Help Organize) Town Hall Meetings Focused on Budget Reconciliation and its impact on Human Services

   Keeping with the theme of holding key House Members accountable, ECAP is also planning to sponsor town hall meetings in the districts of these key House Members. The meetings will allow House Members to answer their constituents’ questions/concerns about the Budget Reconciliation Conference Report and its impact on human services programs, like Medicaid, TANF, SSI, etc.

   A list of ECAP coordinators will be published and we will distribute that information to all leaders, chapters and affiliates as it becomes available. We encourage you to contact these coordinators to ensure that the disability community is properly represented at the town hall meetings. Extensive local media coverage is expected.
   
   

3. Encourage Grassroots Calls to Key House Targets

   The American Friends Service Committee has generously provided the human services community with a toll-free number for contacting Members of Congress in Washington, DC. We need chapters and affiliates to encourage their own grassroots networks to be actively calling their House Member.

   Feel free to distribute the toll-free number (1-800-426-8073) and the talking points (see below for more details) to your grassroots networks, and we encourage following up with your network about the results of their calls.
   
   

4. Participate in Vigils at Members of Congress’s Offices

   Religious groups, unions, and other organizations with a stake in human service programs are planning vigils nationwide that target these key House Members. Again, it is vital that the disability community’s presence is apparent at these vigils.

   ECAP will be coordinating these vigils and publishing the date(s), time(s) and location(s) shortly. Once that information becomes available, we will distribute it to chapters and affiliates. The vigils, beginning 72 hours prior to the February 1 vote, will be held in front of the Members’ main district office.

   Please encourage as many of your constituents to participate in the vigils.

WHAT SHOULD I SAY? SUGGESTED TALKING POINTS

Many Members of the House of Representatives had practically no time to read the Budget Reconciliation Conference Report, let alone understand exactly what they were voting on. The details of the bill, however, are now very well known.

Since all House Members are up for election this year, voting for this politically divisive Budget Reconciliation Conference Report will be difficult, considering that Congress is sacrificing programs and services for America’s poorest and most vulnerable while cutting taxes for America’s wealthiest.

Attached is a more detailed outline and talking points about why this conference report is truly harmful for people with disabilities. These talking points should guide you and other advocates in your community through in-person meetings and discussions, phone conversations, questions, etc. about the impact the Budget Reconciliation Conference Report on our constituencies.

Much is at stake in the fight over the Budget Reconciliation Conference Report. Decades of progress advocating for the programs/services for our constituencies will be lost if House Members approve the conference report.

We need you to coordinate and advocate like never before. Our constituents and their programs/services are in serious jeopardy. Thanks for your help and good luck!

We’ll be in touch with you periodically during the next two weeks to check on progress.

The Budget Reconciliation Conference Report
Erodes Decades Of Progress For Disability Policies And Programs

Why is the Budget Reconciliation Conference Report so bad for chapters of The Arc and affiliates of United Cerebral Palsy? The overall conference report seriously erodes decades of progress the disability community has made in creating and expanding for policies and programs that improve the lives of people with disabilities nationwide. The devil is in the details.

Talking Points on Key Bill Provisions

Home and Community Services

1. Section 6086 of the conference report sets back efforts to provide community services to people with disabilities.
   • Efforts to eliminate the institutional bias in the Medicaid program would be set back decades because the conference report would give states unprecedented leeway in limiting services to people in community-based settings.
     
2. Section 6086 has some provisions of a good bill, S. 1602, introduced by Senators Charles Grassley (R-IA), Evan Bayh (D-IN) and Hillary Clinton (D-NY) with the support of the disability community.
   • Section 6086 would establish a new option for states to provide home- and community-based services (HCBS) without needing to use a waiver process;
   • Section 6086 would allow states to provide any of the services now covered under HCBS waivers; and
   • States would also now be required to establish stricter eligibility (level of care) criteria for institutional services than for community-based services.
     
3. Overall, the good provisions are far outweighed by the new state flexibility provisions included in Section 6086 of the conference report. In fact, it will undermine the home and community services program as well as other services in Medicaid.
   • This establishes a harmful precedent in the basic Medicaid program;
   • Section 6086 would allow states to cap the number of people to be served under the new home and community services Medicaid option;
   • It would allow states to provide these services in limited areas of the state;
   • It would explicitly allow states to maintain waiting lists for these services; and
   • It would allow states to grandfather current HCBS users for as little as one year.
     
4. Section 6086 of the Budget Reconciliation Conference Report will tear at the basic fabric of the Medicaid program. You should reject the conference report because it will:
   • Undermine beneficiary protections through introduction of caps and waiting lists into the basic Medicaid program and through offering services in limited areas of the state;
   • Undermine state advocacy efforts to move people out of institutions based on the U.S. Supreme Court’s decision in Olmstead, which required that waiting lists at least move at a reasonable pace; and
   • Cap the number of eligible beneficiaries and maintaining waiting lists for services now covered under the state Medicaid plan, such as personal care services and rehabilitation services, by moving them into the new home- and community-based services option.

Cost sharing

• The Budget Reconciliation Conference Report contains new Medicaid beneficiary cost sharing provisions that will likely result in many beneficiaries forgoing health care because they have no money to pay for their share of the cost.
  • The bill has no limits on cost sharing for Medicaid beneficiaries below 100 percent of the federal poverty level (approximately $800 per month for an individual). This means that SSI beneficiaries with disabilities could be required to pay any level of cost sharing their Governor chooses.
    
    For example, a SSI beneficiary with a developmental disability, living in a group home, could have their entire monthly personal needs allowance depleted by co-pays for Medicaid services (e.g. doctor’s visits, prescription drugs, therapy services, wheelchairs). This would make it far more difficult for them to meet their basic needs (e.g. dental care, eyeglasses, hearing aids that Medicaid may not cover, toiletries, and transportation) and virtually impossible to afford any type of leisure activity – like tickets to a movie.
  • Medicaid beneficiaries with incomes from 100 – 150 percent of the Federal Poverty Level (approximately $800 – $1200 for an individual monthly) could be required to pay up to five percent of their monthly income for co-pays for all Medicaid services. This would impact Many Disabled Adult Children (“DACs”) with developmental disabilities; and
  • Unlike current Medicaid law, cost sharing is enforceable under this bill, meaning that the provision of a Medicaid service will be conditioned on the receipt of the co-pay.
    
    For example, a pharmacist can refuse to dispense a prescription drug if the beneficiary fails to pay the co-pay.

Temporary Assistance for Needy Families (TANF) - Title VII Subtitle A

• The Budget Reconciliation Conference Report reauthorizes TANF with onerous work requirements that make it almost impossible for TANF recipients with disabilities or those caring for family members with disabilities to meet these requirements.
  • States would be mandated to have at least 50 percent of the people receiving assistance from TANF working. States would also no longer be allowed any credit for individuals they had previously assisted in finding employment. Together these changes will result in a 69 percent increase in the number of families that will have to participate in work-related activities.
  • The Secretary of Health and Human Services would be given much discretion to tighten regulations about what activities count as work and how to verify work activities. This could negatively impact people with disabilities who want to work but cannot meet more stringent requirements.
  
  Background - The General Accountability Office has determined that approximately 44 percent of TANF recipients receiving assistance have a disability or have a child or adult relative with a disability.

• The conference report does not include any of the disability provisions supported by The Arc and United Cerebral Palsy that would give states the flexibility to better serve people with disabilities by providing longer time frames for rehabilitative services and through the provision of other supports.
  • Despite these new requirements on the states, the final bill includes no new TANF funding and only $200 million more in child care funding; and
  • Because the resources available for child care are insufficient to meet the demand, states will likely be forced to cut child care funding for low income families who do not receive TANF. This will make it even more difficult for families who have children with disabilities that require child care to find appropriate and affordable care.
  • There is no safety net for TANF recipients who cannot meet the new work requirements. The recipients would be sanctioned off the program and left with no financial support to survive.

Budget Reconciliation House Targets

1. Designates a primary target
2. Designates a secondary target