Understanding the AHCA (from a disability perspective)
I try to keep this blog pretty neutral on political issues, however I am also becoming increasingly aware of the general public’s gross misunderstanding of why ADAPT and other disability groups are protesting so prominently against the senate’s healthcare bill- and it’s a lot more complicated than preexisting conditions and losing insurance.
If you can make it through this, there are cute puppy photos of VSEPR at the end (from when he was an 8 week old ball of fluff).
I will start by saying I, like everyone, am quite biased on this subject. I am disabled, I am involved with several disability advocacy groups, disability activism groups, and disability coalitions. I am close to people with all sorts of disabilities. And many of them are a part of the community doing wonderful work because of medicaid.
There’s a perception that institutionalizing people with disabilities (physical and mental) is a thing of the past. And that institutions and nursing homes are significantly safer and more dignified than they were “way back when”. Neither of these are true, and a big part of whether someone who is disabled is a part of the community or is locked away in an institution has to do with where you live and your access to medicaid.
Medicaid is the primary insurer of low income individuals and individuals with disabilities, and almost half of children born in the US. Without the Affordable Care Act (ACA/Obamacare), it is often the only insurer for people with disabilities.
On a federal level, medicaid must cover the cost of a nursing home, but individual states can elect to offer what are called waivers for home-care for “non-skilled” and “skilled” medical care. “Non-skilled” is typically an aide who helps an elderly person or person with a disability function in the community but not providing skilled nursing. This can look like anything from helping someone with a physical disability dress and feed themselves to transporting someone to community events to attending doctors appointments to simply using the bathroom. “Skilled” care might be an in home nurse for maintaining IVs and IV medication or nutrition, in home physical therapy, helping with feeding tubes, or any number of other things an individual may not be able to do effectively by themselves. These services are what allow many disabled people and elderly people to stay in their homes and a part of their community. Private insurers generally do not pay for these services long term. Disabilities, however, exist long term.
Without medicaid waivers, becoming significantly disabled and not having access to a very dedicated family or an enormous amount of money to pay for these services means you are sentenced to live in an institution, away from the community.
The federal government is not saying “no” to waivers with the AHCA, they are restructuring the way they pay for medicaid. Rather than reimbursing states for how much medical care actually costs, the federal government would only pay a set amount per person (like a block grant). So, states that currently offer waivers would no longer be reimbursed for those waivers and often don’t have the budgetary means to offer them. This means that more and more people with disabilities will likely lose their access to the community and ability to live independent, dignified lives if the AHCA is passed. I, and most of the protesters, believe the right to get dressed and go to work, use the restroom, and be bathed without being institutionalized is a basic right that should be protected by the federal government. The AHCA deeply threatens that.
This is just one aspect of why this bill scares me and so many other people with disabilities. The bill and the issues surrounding it are complex and take years to understand. There are many problems with insurance and our healthcare system and medicaid is no exception, but in my opinion, gutting medicaid is not the right answer.
Help us be a part of society and contribute by educating yourself on this and expressing to your representatives how you think they need to vote to protect your community’s needs.
And as promised, puppy pictures: