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Community Choice Act
Gains
Momentum in the Senate
On September 25th, NCIL staff had the
opportunity to attend a hearing on long term care and the Community Choice Act
(H.R. 1621, S.799, formerly known as MiCASSA). It was a Senate Finance
Committee hearing, which focused on the fiscal aspects of this important
legislation the disability rights community has been pressing for years, which
would give individuals who are eligible for institutional care under Medicaid
equal access to community-based services, like per-sonal attendant services.
Senator Baucus opened the
Hearing by showing support for the Community Choice Act and respect for people
with disabilities. He stated, “In July of 1776, the bell of
Philadelphia’s Independence Hall rang to summon Americans to the birth of
an independent nation. On that bell were cast the words from Leviticus:
‘Proclaim Liberty throughout all the land unto all the inhabitants
thereof.’” He continued, “But not all Americans have the
freedom to live independently. People with disabilities and the elderly —
especially those who are also poor — face barriers to living
independently. They face barriers to living where they choose… Medicaid
pays for personal care assistance only when it is provided in an institutional
setting, like a nursing home. When people with disabilities need these
services, and cannot afford to pay for them, Medicaid pushes them into an
institution.”
There was a large push from the
grassroots community to Finance Committee Members' offices just before the
hearing, and the payoff was apparent. The room was packed with disability
rights activists who filled the seating area in a solid block of orange, with
t-shirts bearing the simple message, "COMMUNITY CHOICE ACT NOW!" Of twenty-one
Senate Finance Committee members, ten came to the hearing. This is a great
turnout, since the SCHIP bill was also being debated! The list of attending
Senators included:
Gordon Smith (R-OR), Ron Wyden (D-OR),
Max Baucus (D-MT), Olympia Snowe (R-ME), John Kerry (D-MA), Ken Salazar (D-CO),
Charles Schumer (D-NY), Chuck Grassley (R-IA), Blanche Lincoln (D-AR), and Jim
Bunning (R-KY).
Senators were attentive and asked
numerous questions of the witnesses.
Senator Harkin (D-IA), the author of
the Community Choice Act, spoke passionately about his family’s
experiences. Senator Harkin concluded by saying that, like his nephew
Kelly, a person with a significant service-related disability who received
a college degree and is able work everyday because of the personal attendant
services provided by the Veteran’s Administration, everyone should have a
choice in where they receive long term care.
Bob Liston, an advocate from Montana,
spoke about the need to end institutional bias, the human cost of living in
nursing homes and advantages to home and community based services.
Mitch LaPlante, of the University of
California, who spoke at NCIL’s Annual Conference this
year, estimates the cost of home and community based service to range
between $1.5 and $3.7 billion a year, which is much less than the $10-20
billion per year estimated for MiCASSA by the Congressional Budget Office in
1997.
The witness list also included two
Directors of Health and Human Services Agencies from Vermont and Iowa. Many
advocates were wary, unsure of whether they were present to show support or
opposition for the Community Choice Act. Surprisingly, their testimony was
overwhelmingly positive, focusing on the success of community-based services,
which brought huge savings to their states, allowing them to almost entirely
eradicate waiting lists and provide improved services. Every witness emphasized
that the Community Choice Act would not produce the “woodworking
effect,” supposed by the Congressional Budget Office. CBO postulated and
presented as fact the theory that if people were able to acquire services in
their own homes, the number of people requesting services would skyrocket,
bankrupting long term care funding. Senators seemed especially interested in
this and the issue of how states could effectively monitor quality of services
provided outside an institutional setting. The Senators seemed hardly able to
imagine people with significant disabilities managing their own services. They
directed questions on this issue to the representatives from HHS. As advocates
listened intently, both HHS Directors answered the question clearly: all you
have to do is ask them. The question was posed twice more during the hearing
and answered twice more in the same manner. In the end, the Senators seemed
satisfied, but advocates should be prepared for this to be a major issue should
the CCA make it to the full Senate. Every senator remarked that the bill seemed
to make sense, and seemed almost confused as to why the bill had not been
enacted years ago. Only John Kerry pointed out the immense influence of the
nursing home lobby, unfortunately only after the other Senators had left.
After the testimony and Q and A,
Finance Committee Chair Max Baucus called for a new Congressional Budget Office
(CBO) scoring of the Community Choice Act and asked Dr. LaPlante to work with
them to achieve proper re-scoring. This time we will have a fighting
chance and we will not let the opportunity pass. We will need the entire
strength of the disability community to pass CCA, the CLASS Act, and ADA
Restoration. This is our year!
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