What Wasn’t in the Healthcare Bill that Could Have Been

Whether you agree or disagree with the legislation that was voted upon by Congress and signed into law by the President this week, there’s one thing clear to me.  Healthcare for the developmentally disabled is not going to change for the better nor has it even been discussed! 

First of all, allow me to step on my political soapbox for just a moment.  The heavily touted healthcare bill isn’t going to give healthcare to everyone in America.  It’s going to give health INSURANCE to everyone in America or force it on them even if they don’t want it.  Healthcare and the health insurance that sometimes funds it are privileges to everyone in this great country, and now they are going to become unfunded mandates by the federal government.  

Unfunded mandates are nothing new to us.  We in the nonprofit world of serving those with developmental and intellectual disabilities understand unfunded mandates quite well.  Take for example the eight hours of mandatory annual training on top of the initial 16 hours of training that all employees have to go through simply for working with special needs individuals.  When ARC Marion gives employee training, there are NO dollars coming into the facility as the clients must all stay home for the day.  For those 50 clients that live in ARC Marion group homes, that’s a full day that has to have staffing in the group home whereas usually there’s an 8 am- 3 pm window with no staffing. 

What about the client to staff ratios that are mandated per client?  While the funding continues to decrease, the ratios aren’t changing.  It’s not like all of a sudden Johnny can be put in a classroom with six other clients if he is funded for 1:2 ratio of staffing simply for us to help save on costs.  Or what about the annual medication validation that is $6 per employee that ARC Marion pays plus the time it takes to recertify staff annually so that they can assist clients taking self-administered medication.  Those are things done at ARC Marion that we have to do and will never have funding to pay for them.  I digress.

The real thing that I haven’t heard discussed in the bill is a change to medical coverage for those who are developmentally and intellectually disabled.  You see, the lawmakers keep comparing this wonderful new system to that of Medicare that is allegedly working well for senior adults.  So the new law is going to put even more low income families into the Medicaid system to help them receive healthcare as well.  Then there’s the Medicaid Waiver system that all developmentally disabled individuals are in (not mentioned in the 2,000+ page healthcare bill at all to my knowledge) that sort of puts people at the bottom of the healthcare totem pole.  Yes, these special people have the ability to receive healthcare that is “paid for,” however, finding physicians who are willing to accept the payouts is another thing all together.  Doctors by the droves simply don’t take Medicaid much less Medicaid waiver due to the low payouts and amount of time it takes to get paid.  So, unless the healthcare bill includes mandates that private doctors have to take Medicare and Medicaid in order to practice medicine (which seems a bit illegal to me), giving folks access to a payment plan will not solve the problem if there’s no one to willing to accept the pay.

As far as I’m concerned, there are a few items in the bill that are positive, but for the most part we are back to square one as funding is approved with limited numbers of  medical doctors available to take the payments.  And let’s not even mention dentists who take Medicaid as there are very few.  Then again, dental health isn’t part of the healthcare bill either.

It seems to me that there are a lot of people who need to receive healthcare coverage of some sort who have been unable to receive it for one reason or another.  Then there is a whole other group of individuals like the special people served at ARC Marion who will never be able to pay for, work for, or afford healthcare coverage to fully care for their every need.  Isn’t that something we should be spending long hours on a Sunday night talking about?