Live from DC: Federal Aging
Policy Update
Sandy Markwood
National Association of Area Agencies
on Aging
State and Area Agency on Aging
Retreat, AIRS Conference
June 5, 2011
What is n4a?
• National membership association for Area
Agencies on Aging (AAAs) across the
country and a champion for Title VI
Native American aging programs in our
nation’s capital.
• We advocate on behalf of local aging
agencies to ensure that needed
resources and support services are
available to older Americans and their
caregivers.
n4a Public Policy and Legislative Affairs
– Board Public Policy Committee determines annual policy goals; Grassroots Committee promotes our agenda in the field
– In DC: Hill and coalition meetings, writing, advocacy
– To Field: Advocacy Alerts (to all), and Legislative Updates (to n4a members); special advocacy tools (Aging Policy Briefing, toolkits, postcards, etc.)
n4a’s 2011 Policy Priorities
• Reauthorization of the OAA
• Enhancing Health and Security
• Fiscal Year 2012 Appropriations
• Livable Communities for all Ages
• Senior Mobility Options
OAA Reauthorization • Strengthen the Aging Network’s role and
capacity in the coordination and
provision of long-term services and
supports
• Expand evidence-based health
promotion and disease prevention
• Improve community preparedness for an
aging population
• Set adequate authorization levels
Health and Security • CLASS Program
• Prevention and Wellness
• ADRCs
• Care Transitions
• Continue Medicaid HCBS
rebalancing efforts
FY 2012 Appropriations
• Sustain OAA programs
• Support the President’s FY 2012
Budget request for the “Caregiver
Initiative”
• Provide a down payment on the EJA
• Increase SHIP funding under the AoA
for Part D enrollment assistance
Livable Communities • Prepare America’s communities to
meet the needs of today and
tomorrow’s older Americans
• Support the Sustainable
Communities Initiative grant
programs through HUD, DOT and
EPA
Senior Mobility Options • Reauthorize senior transportation
programs to improve the availability
and accessibility transportation
services for older Americans
n4a Advocacy in Action
• 2011 Policy Priorities
• Advocacy leave-behind card
• OAA Reauthorization Recommendations
• LCAO OAA Reauth Recomms
A Tale of Two Budgets
• FY 2012 Appropriations
• Larger Budget/Debt Debates
Budget Storm Brewing
Challenges
• Real Fiscal Woes
• Entitlement Reform Mixed with
Deficit Reduction
• Policy Agenda Meets Political
Opportunity
• Potential to have long-term effects on federal policy and spending
Lightning = FY 2011
• Early Strikes During Elections
• Escalates in 2011
• Deeper cuts made in each CR, final
bill cut billions more
• Narrowly averted a gov’t shutdown
And so it flashes on….
So how did we get here?
• Last Congress didn’t pass any FY
2011 approps bills
• Politics Elections New Power
Dynamic of Republican House
• FY 2011 was the first skirmish, over
the leftovers
We can’t both drive the car!
Other (Air) Pressures (and Cold Winds)
• Growth in deficit spending
• President’s Deficit Commission
• Debt Ceiling Nearly Reached
• Intense Political Pressures all around
that could define the fate of both
parties for the next few cycles
And now cue the thunder!
FY 2012
Budget Begins
To Rumble
First Crack of Thunder = FY 2012 House Budget Resolution
• House Budget Comm Chair Paul
Ryan (R-WI) released FY 2012 budget
resolution first week in April
“Ryan Budget”
• Bold in scale, big in scope
• Cuts spending by $5.8 trillion
over 10 years
• Makes dramatic changes to
entitlement and discretionary
programs
“Ryan Budget”
• Block grants Medicaid, cuts it by almost
$1.4 trillion over 10 years. $600 billion from
repealing Medicaid improvements in
ACA (by 2021, these cuts equal about a one-
third reduction in federal support)
• Voucherizes Medicare (“coupon care”)
• Freezes discretionary spending for five
years at 2008 levels
• Lowers taxes on corporations and high
earners
“Ryan Budget”
• Medicare message was powerful and
used by Democrats over spring recess
• Passed House but not Senate
• Was the plan to beat in April, now focus
has shifted to less controversial, but
equally major proposals
• Remember, a budget resolution is not the
deficit reduction vehicle that will move
(just a blueprint)
Looming Flooding?
• Need to Raise the Debt Ceiling Limit this summer affecting the debate
and the course of events
So what happens next?
The Squall:
FY 2012 Appropriations Process
It all started with the
President’s Budget
• February release
• Congress was too
absorbed in FY
2011
• Not all good news,
but pockets of
great news
OAA FY 2012 President’s
Budget
Admin’s Caregiver Initiative • 25% Increase OAA Title III E, NFCSP
• 13% Increase OAA Title III B, Supportive Services
• 31%for Title VI Native American aging programs
• Increase Lifespan Respite from less than $3 million to $10 million(not OAA, but AoA)
OAA FY 2012 President’s
Budget
Other AoA Gains
• $5 million boost to ombudsman program ($26.8 mil) and $16.5 million for Adult Protective Services as down payment on EJA
• $47 million for SHIPs, move to AoA
• New line items (Title V, ADRC, Sr Medicare Patrol, etc.)
Other Programs That Didn’t Fare As Well…
• SCSEP, OAA Title V, would receive $450 million, a
major decrease of $375 million or 45 percent
over FY 2010
• LIHEAP would receive $2.5 billion less than FY
2010, returning to its FY 2008 spending level
• Section 202 Supportive Housing for the Elderly
Program would receive $757 million, a $68 million
cut from the FY 2010
• CSBG would be reduced by $305 million and
converted from a formula-based program into a
competitive grant program
Squall, Stage 2
• Appropriations process has begun
to move ahead
• Allocations Distressingly Low
(House Labor/HHS = 11.5 % less overall
than FY 2011)
• Larger budget debate will slow process, committees may wait to
act
Squall Forecast
• Gloomy!
• Virtually impossible to win increases.
• A win would be minor/no cut.
• Will be late – Nov/Dec. would be
reasonable.
What do we need to do?
• Step up our advocacy to protect
key programs
• Work in coalition on bigger
messages
• Push ourselves in advocacy (speak
up at town halls over recess)
The Monsoon
The Monsoon
• Congress and Administration
working to find agreement on a
legislative plan to reduce the deficit
(and ultimately the federal debt)
• It could be done right
• Or it could have drastic
consequences for immediate and
long-term national priorities and
programs
The Monsoon
• What are the risks?
– Medicare and Medicaid cuts never
before seen; fundamentally changing
the nature and scope of the programs
– Drastic cuts to discretionary spending
– Caps on future spending of all kinds, so
no chance for programs to respond to
future needs (say the aging of the
population!)
The Monsoon
• Deficit reduction in the short term
(cuts made in FY 2012 and shortly
thereafter)
• And deficit reduction in the long
term (control mechanisms on future
spending)
The Monsoon
Short-Term Cuts
• “Down Payment”
• Earns “scorable savings” (cuts to
programs now and in next few
years) • Example: Across-the-board cut to FY 2012
domestic discretionary spending or repealing
the ACA’s Medicaid MoE provision
The Monsoon
Long-Term Cuts
• “Control Mechanism”
• Spending cap (health care SC,
entitlement SC, global SC) (vs. debt cap)
• Has enforcement mechanism like a
trigger or sequester • For example, if in 2018, Congress doesn’t act to
respond to the trigger, cuts automatically
made to all programs
So what’s the big deal?
• If deficit reduction comes solely or
mostly from programs, where is the
shared sacrifice? (I.e., what should
the balance btwn spending and
revenues be in this equation?)
So what’s the big deal?
• If spending caps are triggered, it
doesn’t matter what the situation is
(need, population, economy) and if
cutting further is the most
appropriate response.
So what’s the big deal?
• Would force major changes to federal HC
programs without actually addressing the
underlying driver of costs (HC costs).
Instead, pushes those costs onto
individuals (and states).
• Could essentially shred the safety net for
low-income older adults and undermine
the economic security for millions of
middle class older adults.
What’s the real burden on the next
generation?
Next Steps
• “Biden Group”
• Debt Ceiling Pressure Provides the
Timeline (July/Early August) and the
Vehicle for the “Down Payment” if
not the whole thing
• That agreement will directly affect
FY 2012 numbers, too
OAA Reauthorization
OAA Reauthorization Timeline
• Groups Releasing Recommendations
(n4a’s recs are at www.n4a.org)
• Senate Spec Aging Comm Held May
26 Hearing
• Senate and House authorizing comms
still “staffing up” and planning
• We will need strong advocacy to make
Congress pay attention, get it right and
keep it moving!
Other Issues: Transportation
• Reauthorization of the Surface
Transportation Act
• Work on Senator Kohl’s “Senior
Transportation and Mobility
Improvement Act” continues
• Lobbying in support of Older Driver
and Pedestrian Roadway Safety
legislation
Other Issues: Livable
Communities
• Livable Communities Act has not
been reintroduced yet
• Efforts are being focused protecting
the Sustainable Communities
Initiative grants
• There is a real threat to the HUD grants programs as part of the
budget process
Grassroots Activities • Reach out to freshman MoCs to educate
them about your agencies and the work
you do
• Stay in regular contact with Members and
staff
• Invite your local congressional offices to
do site visits, attend events
• Attend the n4a Annual Conference in
Washington, DC and do a round
of Capitol Hill visits on July 20
Questions?
Call on n4a’s Public Policy and
Legislative Affairs Staff
Amy E. Gotwals, [email protected]
K.J. Hertz, [email protected]
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