Senate Health Care Repeal -- NASN Advocacy Education Brief

By NASN Profile, RN, BSN, NCSN posted 06-23-2017 20:09


The Senate has introduced its own version of a healthcare bill, the Better Care Reconciliation Act (repeal of the Affordable Care Act or ACA) as a parallel bill to the House bill, the American Health Care Act (AHCA). While it is similar to the House bill in terms of fully changing the way that Medicaid is structured - turning Medicaid into a block grant or per capita cap, there are subtle differences. Previously Medicaid was a federal-state partnership with the federal government committing to covering a certain amount of a states’ Medicaid costs. Now with both the House and Senate bills, that federal commitment to Medicaid is in jeopardy.

A vote could come as soon as next week, prior to the July 4th recess, on the Senate bill!

What You Need to Know

Schools are part of the safety net for children and Medicaid plays a significant role, particularly in the funding of needed medical services for children in special education under IDEA through their IEP, but also for those students without IEPs who are eligible for Medicaid. Medicaid reimbursement to schools for the healthcare of children generates between $4 -5 billion a year or approximately one percent of all Medicaid funds. Yet that one percent is threatened.

These changes will impact the ability of students with disabilities and students in poverty to receive many critical health services in schools that enable them to learn. This includes services provided by the school nurse for example, vision and hearing screenings and management for students with diabetes and asthma. The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Programs are paid for by Medicaid and ensure that children receive the check-ups and treatment that they need and that preventable conditions are treated. Schools are able to provide these professional services because Medicaid covers the majority of the costs. Get more information.

Medicaid covers nearly 36 million children today. Lower income children are disproportionately affected by health conditions. Children must be healthy and safe to be ready to learn. This is why these cuts to Medicaid are so dire!

Medicaid Provision

House Bill
Under the House bill, states are given a block grant or per capita cap, determined by how much each state is currently spending dependent on 2016 numbers. Based on the CBO over ten years Medicaid would be cut $834 billion.

Senate Bill
Under the Senate bill it would enact a per capita caps or block grant beginning in 2021. However, starting in 2025 the rate of increase would slow (or in other words, the cuts would be deeper). Many have predicted that it would make it more difficult for states to keep their commitments to Medicaid. There is not yet a CBO score for the Senate bill.

Senate Republicans are attempting to exempt children who are eligible for Social Security Insurance (SSI). This is not an easy bar to meet for children with disabilities. Approximately 1.2 million kids under the age of 18 currently qualify for SSI. There are 6.5 million children with disabilities in schools, so the vast majority would not be eligible for this carve-out.

Any per capita cap would force states to balance their budgets with much less federal Medicaid funding over time. This growing strain would likely prompt states to cut Medicaid across the board, threatening care for all beneficiaries, including the children with disabilities who wouldn’t be covered by the state’s cap. As a result, children meeting SSI disability standards would still be subject to Medicaid cuts, as would the hospitals, physicians, and other providers that serve them. And of course, the tens of millions of other children, including children with disabilities and special health care needs, would be at severe risk of ending up uninsured or going without needed care.

What You Need to Do

Please speak up and use your voice! Call or email your Senators. Tell your story about your students that rely on Medicaid. The number to the Senator Switchboard is 202-224-3121. Time is of the essence!