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, agotwals@n4a.org

K.J. Hertz, khertz@n4a.org