From The Columbus Dispatch
Posted Jun 26, 2017 at 12:01 AM

What does Medicaid have to do with civil liberties? As the nation’s primary source of funding for the services that help people with disabilities stay in their own homes, Medicaid plays a vital role in protecting Americans with disabilities from institutionalization. The Center for Disability Empowerment provides support and resources to people of any age with any disability in order for them to be participants and contributors in their communities as they live, learn, worship, work and play alongside people who do not have disabilities.

Our efforts are rooted in a simple reality: People with disabilities are more safe, happy and free when they have the opportunity to receive services in the community. An overwhelming body of research and evidence shows that people with disabilities fare better in the community than in institutions. To protect that right, the center has been working with partners like the American Civil Liberties Union and the Arc of Ohio, an advocacy group for people with intellectual and developmental disabilities, to defend the Medicaid program.

It is Medicaid that provides the in-home aide who helps get an adult with a mobility impairment out of bed, dressed, and able to go to work in the morning. And, it is Medicaid that sends the home health-nurse to check on the senior citizen, who might otherwise have to leave the home where he or she spent decades with family, to instead experience the isolation of a single room in a nursing home.

So, the Republican proposals to defund and change Medicaid represent the greatest threats the disability community has faced in decades. Under both the House American Health Care Act and the Senate Better Care Reconciliation Act, the structure of Medicaid would change from a partnership between the federal government and Ohio to a system of “per capita caps.” This means that the amount of money that the federal government provides to states would be capped, or limited, to a certain fixed amount per Medicaid recipient, based on Ohio’s prior spending levels as of 2016. According to a recent analysis from Ohio’s Center for Community Solutions, per capita caps would take between $16.3 and $22.3 billion from Ohio’s Medicaid program between Fiscal Years 2019 and 2025. Under the Senate legislation, the cap would become even more severe after 2025, forcing the state to make further cuts.

Some have suggested that the impact of per capita caps won’t be as dire because Congress can later add additional funding. Yet recent events have demonstrated the naiveté of this approach. The Trump administration’s FY2018 budget request to Congress proposed further reducing the per capita cap growth rate reflected in the House bill. If passed into law, Trump’s budget would cut another $610 billion from Medicaid. All told, the AHCA and the Trump budget together would lead to $1.3 trillion in cuts to Medicaid funding over the next 10 years, resulting in a 45 percent cut to the program by 2026. The Senate legislation looks likely to result in even deeper Medicaid cuts than the House. Once the federal government’s financial commitment to the Medicaid program is capped, Congress is likely to deepen cuts, not mitigate them.

The budget implications for Ohio would be devastating, forcing state legislators to choose between a horrifying rollback in services and supports to people with disabilities or a dramatic and immediate need for new taxes to replace the lost federal funds. Tragically, under current law, Medicaid must pay for nursing-home care, but paying for in-home services is optional. As Ohio receives fewer and fewer Medicaid dollars, our legislators will be forced to choose between raising taxes, or pushing more of our residents into more-costly nursing homes and institutions.

Our country has had many years of slow-but-steady progress in expanding access to community life for people with disabilities. Medicaid per capita caps threaten to send us back in time.

Sen. Rob Portman is now tasked to either stand by Ohioans with disabilities by voting no or betray them by ratifying this awful bill. According to news reports, he is one of a select few Senate Republican swing votes capable of defeating this legislation. For the sake of people with disabilities throughout Ohio, Portman should fight to defend Medicaid and reject per capita caps.

Susan Hetrick is executive director of the Center for Disability Empowerment.