Print Friendly and PDFPrinter Friendly Version

Wednesday, December 5, 2012

Budget Diagnosis, Part 5: People with disabilities have much at stake

This is the fifth in Budget Diagnosis, a series on the coming major decisions in Congress that could affect your health care. This series explains, simply, what advocates need to know, features special guests writing about different groups and populations that will be especially vulnerable, and provides you with updates from D.C. This post is a guest blog by David Heymsfeld from the American Association of People with Disabilities. Check out our first four posts here.

People with disabilities have much at stake in the on-going efforts to reduce the deficit in the federal budget. Deficit reduction threatens to reduce vital government services that give many people with disabilities the opportunity to live healthy, independent, and productive lives in their communities.

Medicaid is of great importance to our community. Medicaid now serves as a lifeline for more than 8 million people with disabilities, giving them the health care and the long-term services and supports they need.

  • For people with a variety of physical disabilities, such as spinal cord injuries, traumatic brain injuries, cerebral palsy, or amputations, Medicaid provides access to wheelchairs, prosthetic devices, and assistive technology.
  • For people with epilepsy, mental illness, HIV, and a variety of other conditions, Medicaid is often the only source of access to essential prescription drug coverage.
  • For many people with cognitive and other disabilities, Medicaid is an important source of long-term services and supports, which are tools that enable them to live and work in the community and to avoid costly, segregated nursing homes and institutions.
  • For children with disabilities, Medicaid provides access to the Early and Periodic Screening Diagnosis and Treatment benefit, which requires screening for, and treatment of developmental, vision, dental, mental health, and other medical problems.

In deficit reduction talks, cuts in entitlement programs, such as Medicaid, are on the table. There have been “block grant” and “per capita” proposals that would make substantial cuts in Medicaid funding over the next ten years.      

These proposals are of great concern because they merely cut funding without making reforms that would increase the efficiency of the program. Medicaid already provides services at a lower cost per beneficiary than private insurance. Merely waiving a magic wand of arbitrary limits on spending will not reduce the costs of the needed services Medicaid provides. The needs will remain. The inevitable result of arbitrary spending cuts, not based on reforms that improve quality and increase efficiency, will be a reduction in the number of people served by Medicaid or the services they receive.

There are opportunities to make reforms that will make the program more efficient and less costly. One promising approach is to continue to reduce the number of persons receiving long-term care and services in institutions, instead providing these services in less costly home- or community-based settings. People with disabilities welcome the opportunity to live and work in their communities.

In addition to Medicaid, people with disabilities are concerned with proposals to impose across-the-board cuts that would reduce the funds for important programs that help people with disabilities live and work in their communities. These include programs providing assistance in employment, education, housing, and transportation. These programs have already been subject to the major cuts that were imposed by the across-the-board reductions in the 2011 deficit reduction package. Further cuts would impair services substantially.

Finally, there are concerns with ensuring that there is a balanced approach to deficit reduction. A position letter of the Consortium for Citizens with Disabilities (a coalition of more than 100 organizations) states that “deficit reduction strategies must reflect a thoughtful, balanced approach and include all aspects of the federal budget in order to protect people with disabilities.” On this point, Mark Perriello, CEO of the American Association of People with Disabilities, the nation’s largest cross-disability organization, recently stated:

  Any common sense solution needs to prioritize the needs of the most vulnerable Americans. We should not cut benefits to millions of Americans and deprive them of health care and community supports, to facilitate tax breaks to those who don’t want to pay their fair share. Making cuts to benefits is not the answer.

 We must not make cuts in spending that would reduce services to Americans with disabilities and we cannot accept a solution that prioritizes tax cuts over the health of millions of individuals.

The disability community will be actively involved in the debate over deficit reduction to help ensure that the solutions developed do not do serious harm to our most vulnerable citizens.

David Heymsfeld is the policy advisor for the American Association of People with Disabilities. For more information, visit