Welcome to the New Mobilizer! Now back in circulation after a brief hiatus, our monthly Mobilizer will keep you up to speed on national policy and provide you with concrete opportunities to further advocacy for the Health Care for the Homeless community. We welcome your submissions, questions, or suggestions for content—simply contact Regina Reed, National Health Policy Organizer.
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December Roundup The 114th Congress convened for the last time this month, but not before passing some major health policy legislation and setting the budget through April. After his historic election, President-elect Donald Trump went to work naming new cabinet secretaries.
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New Appointees - Tom Price as Secretary of HHS. Price is an orthopedic surgeon from Atlanta, a six-term Republican Congressman, and chair of the House budget committee. He is a long-time ACA critic and introduced ACA replacement bills including the recent Empowering Patients First Act. Many of his ideas are included in Speaker Paul Ryan’s replacement plan “A Better Way”. HHS is a large federal agency with a $1 trillion budget and approximately 80,000 employees. As Secretary, Price will oversee any changes to the ACA, as well as multiple social service agencies including the FDA and CDC.
- Seema Verma as Director of the Centers for Medicare & Medicaid Services (CMS). Verma is a health care consultant who helped design Indiana Governor Mike Pence’s Medicaid expansion using a federal waiver that included lockouts from coverage for those who missed payments. Her consulting firm worked on Medicaid waivers in other states (IA, OH, and KY) that included work requirements and other conservative provisions.
- Ben Carson as Secretary of HUD. Carson is a neurosurgeon and a former GOP Presidential candidate who has no housing policy background. He removed himself from consideration for Secretary of HHS because, he said, he didn’t have the experience to run a large federal agency, and has described the Obama administration’s fair housing standards as a “social engineering scheme.” If confirmed, he will run a $49 billion department that provides assistance to more than 5 million low-income Americans.
- Mick Mulvaney as the Director of the Office of Management and Budget (OMB), the agency that directs the Administration’s funding priorities and approves rules and regulations. Mulvaney is an outspoken fiscal conservative and founding member of the Freedom Caucus. In this role he will work with President Trump on overhauling the tax code, creating the budget, and repealing the ACA.
All four of these positions require Senate confirmation (learn about the process). Hearings will commence soon after Congress convenes in early January, but confirmations will not happen until after Trump’s inauguration on January 20th. Do you have questions that you want asked at these hearings? Let us know!
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21st Century Cures Act On December 13th, President Obama signed the 21st Century Cures Act, a mix of several pieces of legislation pending in the House and Senate. One of these pieces included $1 billion in state grants to help fight the opioid crisis, which has been appropriated through the Continuing Resolution (described below). The act also included major mental health reforms reauthorizing crucial grants, allowing for same-day Medicaid billing, encouraging parity, training law enforcement on mental health, outlining funds for Assertive Community Treatment and Early Prevention Funding, and creating a new Assistant Secretary for Mental Health, among other reforms. The law also includes controversial, and potentially detrimental, changes that impact public health. The law loosens the drug approval process through the FDA—allowing drugs to hit the market more quickly. It also cuts $3.5 billion over 10 years from the Prevention and Public Health Fund, established under the ACA.
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Fiscal Year 2017 Budget Congress passed a temporary spending bill called a Continuing Resolution (CR) which will continue to fund programs at a rate consistent with Fiscal Year 2016 rates through April 28, 2017. Congress has until April 28th to pass a budget for the rest of 2017. The CR includes a 0.19% decrease across the board to all programs. This is particularly concerning regarding housing vouchers, which would need around $1 billion more in funding to maintain current levels. Learn more about the CR’s impact on housing vouchers.
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On the Horizon We’re gearing up for a busy winter in Washington. A new Congress reconvenes on January 3, and Donald Trump will be inaugurated on January 20. Since the issuing of our Post-Election FAQ, the specifics of what will happen in January are still largely speculative (check out “What We’re Reading” for some reliable information). With repeal of the ACA looming, and uncertainty about whether a replacement will come sooner or later, the Council will continue to advocate for any change in health policy that ensures high-quality, affordable, and accessible health care coverage for very low-income people. Here's what we do know:
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Congressional leaders want to move fast: Repealing the ACA will require 60 votes in the Senate, which Republicans do not have (Senate makeup: R: 52, D: 46, I: 2). Congressional leadership indicated they will, instead, repeal pieces of the ACA through a process called budget reconciliation, which only requires 51 votes to pass and allows for changes to spending and revenues. This could include overturning ACA subsides, Medicaid expansion, and the individual mandate—all changes that were included in Congress’s reconciliation bill from earlier this year, which President Obama vetoed. We expect this process to begin in early January and finish by late January/early February. The changes won’t legally begin for 2 or 3 years, in which time Congress will need to pass a replacement plan. Learn more about the budget reconciliation process and the dangerous impact of "repeal without replace."
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Republicans favor per capita caps and block grants: Proposed replacement plans, along with statements from President-elect Trump and Vice President-elect Pence, indicate that the Republican replacement plan will favor per capita caps, block grants, and work requirements. These replacements would unravel the safety net and reduce funding for Medicaid. Learn more about what this might mean for the HCH community on our Post-Election FAQ.
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Advocates are fighting for Medicaid, and we need your help: Lawmakers in Washington are proposing changes that will alter the way state Medicaid programs are managed and financed--and they are looking to the states for feedback. More now than ever, it’s important to let your state know why Medicaid is important. Learn what you can do under Take Action.
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Share your Medicaid Stories! We need your stories for our advocacy work to let lawmakers know what Medicaid really means to us. Sharing your perspective is quick and easy.
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Local Features- "Homeless Aren't Going Away:" learn about the limitations of HUD's point-in-time count and what it takes to truly end homelessness in this op-ed co-authored by Kevin Lindamood, President and CEO of Health Care for the Homeless, Baltimore, MD.
- "What It Would Take to Keep Terry... Off the Street:" this editorial from Brandon Clark, CEO of Circle the City in Phoenix, AZ, illustrates the importance of medical respite care, enhanced collaboration between service providers, a critical need to expand permanent supportive housing, and the need for empathy and compassion to address homeless health care and hospitalization discharge practices.
- Homeless Persons' Memorial Day: view our resources and information about recent ceremonies honoring this critical day of remembrance for our friends who have passed while experiencing homelessness.
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This publication and all HCH advocacy are funded by dues from Organizational Members of the Council. Consider joining the Council to support this work.
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