by: Myrna Mandlawitz, LDA Policy Director

The Administration’s stated intention to repeal and replace the Affordable Care Act (ACA) prompted swift action from LDA, as the organization engaged with a broad array of national organizations, including disability, education, civil rights, and health care advocates. With the introduction of the American Health Care Act (AHCA) in March, LDA and its partners engaged in direct advocacy on Capitol Hill and mobilized grassroots advocates, ultimately succeeding in defeating a bill that would have caused serious negative impacts on individuals with learning disabilities.

LDA had several significant concerns about the AHCA.  First and foremost were the proposed changes to the Medicaid program, upon which many children and adults with disabilities and low-income individuals rely for their health coverage. Currently, the federal government matches State funds for qualified Medicaid costs.  States receive at least one dollar in federal funds for every State dollar spent.  This funding mechanism allows federal funds to go to States based on actual costs and needs.  The ACA allowed States also to opt for a Medicaid “expansion” plan that provides an enhanced match rate.  Under the Medicaid expansion, States were guaranteed 100 percent reimbursement for Medicaid costs for newly eligible recipients from 2014 to 2016, with a gradual phase-down to 90 percent in 2020.

The AHCA included a change in the Medicaid funding mechanism to a per capita cap, with the late addition of an option for States to receive their Medicaid funds in a block grant.  LDA strongly opposed both alternatives.

LDA was also deeply concerned about the effects of per capita caps and block grants on services delivered in schools to children with learning disabilities.  Approximately $4-5 billion currently flow to schools through the Medicaid program for low-income children and children with disabilities.  Those dollars pay for EPSDT (Early Periodic Screening Diagnostic, and Treatment”) services, which include important vision and hearing screenings and provide early identification of other health problems that impede learning.  Medicaid dollars also are used to reimburse for critical specialized instructional support services for children with disabilities, including speech-language, occupational and physical therapies, mental and behavioral health services, and school nurse services, especially for children with chronic health conditions.

The Congressional Budget Office (CBO), a non-partisan, non-political agency, issued a report on the potential effects of the AHCA shortly before the House was ready to vote on the bill.  The CBO reported that 14 million Americans could lose their health coverage under the AHCA this year alone and 24 million over the next decade.

Ultimately the Speaker of the House assessed that there were not sufficient votes to pass the AHCA.  The bill was pulled at the very last minute, and currently there are no plans to bring the bill up again.

LDA, with a broad array of national partners, will continue to educate congressional staff about the potential harms of changes in the health care system, especially for children with learning disabilities.  The national organization reached out to its State affiliates to contact all members of Congress to expand this education process.  In addition, LDA was pleased to have a number of members from across the country participate in visits to their congressional delegations in Washington as part of this year’s national LDA conference. These efforts will continue, as LDA continues to monitor any efforts to impact health care for its members.


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