Reflect and Reset: What’s Ahead?

Let’s reflect on the last few months – what a rollercoaster, to put it mildly! As Than Johnson, member of the ANCOR Board of Directors and Government Relation Committee Chair Emeritus, points out, for ANCOR members, and other Medicaid funded providers, the incredibly sobering aspect about the rise and fall of the American Health Care Act was how close Congress got to dramatically restructuring Medicaid. Consider that – relative to the media attention to the proposed changes to the Affordable Care Act (ACA), remarkably little attention was paid to the consequences of converting the uncapped federal entitlement to a per capita capped or block grant program.

I tuned into the morning political TV talks shows the Sunday before the House was set to vote on the bill – I think Senator Susan Collins (R-ME) may have been the only guest that listed the restructure as one of the three reasons why she was opposed to the bill pending before the House. She referenced the impact on the hospitals in her state, and on individuals. Yes, there were newspaper articles and other media note,  but not on the scale that such a dramatic public policy shift deserves. Don’t misunderstand – the Medicaid expansion that was key to the original ACA certainly garnered its share of major media focus (and vastly complicated the attempt to roll President Obama’s signature legislation back) but the proposals to alter the fundamental structure of Medicaid, established over a half a century ago, were barely discussed. Why was that?

The reasons were partly obvious and not so obvious. The legislative process was expedited, the actual text of the bill and its price tag not available until late in the game, the changes to the ACA insurance requirements were more immediate to the American public, and then of course the “repeal and replace” bill was not the only issue of the President’s first 100 days grabbing headlines.

But there was another reason, one that ANCOR and other national associations need to constantly address – Medicaid is complicated, and far too Americans aren’t fully aware of how directly they benefit from the social program that got its start at the same time as Medicare. It further challenges the brand when it is known by a different name in many states. People all too often don’t make the connection that the government program that is paying for their mother’s or grandmother’s nursing homes bills in Maine is MaineCare or in Tennessee TennCare or, as it’s known in California, Medi-Cal.

We obviously focused on the proposal like a laser beam, as did other associations representing beneficiaries, advocates, providers, payers and other stakeholders. National think tanks pumped out numerous analyses to inform both sides of the debate. Avalere, the health care data analysis firm ANCOR contracted with last year to assess the fiscal impact of the DOL Overtime rule, produced a significant analysis for the National Governor’s Association.

We were enormously encouraged that thousands of people, ANCOR members, individuals and families , responded to our action alerts, and communicated the message that the bill as proposed would have further deepened the workforce crisis and harmed, rather than strengthened, Medicaid funded services for people with intellectual disabilities. Thank you to all who took action, and who shared the alerts across your constituencies. It mattered. Together with all of our brother and sister national associations we collectively raised up our voices, and the bill was withdrawn. Significantly, we are now hearing that the workforce crisis message was gaining traction, and that some ANCOR members who visited congressional offices two days before the bill was set to be voted were greeted by staff that had heard about the urgency of the crisis.

That was music to my ears – but we can not and will not stop there. All of us have an obligation to educate public policy makers, elected officials, the media and the general public about the challenges confronting the IDD service delivery system, but we also need to do a far better job telling our positive story of how Medicaid transforms people’s lives every single day.  We’ll continue to hyper focus on the Direct Support Professional workforce crisis, and educating the public about the value of the work of provider agencies is a top ANCOR’s priority. But, back to Than’s observation, we must heed last month’s lesson of how narrowly the Medicaid program came to being dramatically restructured because the successes of the program all too often fly under the radar. Let’s change that.

Barbara Merrill is CEO of ANCOR. She can be reached at [email protected].