Circa 2005
Making the American Dream Available to All by U.S. Senator Chuck Grassley of Iowa Chairman, Senate Committee on Finance
Despite regional, political and socio-economic differences, Americans are nonetheless more alike than we are different. The great melting pot continues to lure newcomers. People from around the world have long been attracted to the land of opportunity.
Opportunity. That’s the built-in promise of the American dream. Each successive generation can live better than the last. And that goes for every person in America, no matter one’s race, ethnicity, gender or creed. Roughly 300 million U.S. citizens with all ranges of human ability, from all walks of life, are entitled to live and enjoy the American way of life.
And that goes for the 54 million citizens living with disabilities. Whether facing mobility impairments or intellectual disabilities, Americans living with disabilities essentially want what mainstream America wants: a close-knit circle of friends and family, safe neighborhoods and good schools, a sense of community, home ownership, good jobs, quality health care and retirement security.
In their pursuit of happiness, able-bodied Americans sometimes take for granted their civil liberties, personal freedoms, careers and participation in society. Unless a family member, friend or neighbor lives with a disability, it may be difficult to empathize with those who work harder on a daily basis to integrate into community life.
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In his New Freedom Initiative announced shortly after taking office, President George Bush outlined a plan to tear down barriers preventing people with disabilities from fully participating in American society.
As chairman of the U.S. Senate Finance Committee, I have long worked on shaping public policy to empower individuals with disabilities. In large measure, that includes my legislative and oversight authority over the $300 billion per year Medicaid program.
From my positions on the Finance and Budget committees, I’m working with my fellow lawmakers and the nation’s governors to expand access to Medicaid and community-based care as well as working to enact some common-sense reforms. My efforts include identifying and closing down loopholes used by better-off Americans to tap Medicaid funds for their own longterm care; promoting the use of less expensive generic prescription drugs; curbing mismanagement; promoting cost-effective choices; and exposing fraud, waste and abuse in the system.
Medicaid spending is increasing faster than current budget limitations can afford. That’s why I’m working to find ways to capture savings that will allow us to rein in growth and still expand eligibility to those most in need.
The state-federal Medicaid program serves low-income families, uninsured children, individuals with disabilities and the frail elderly. It is often the lifeline that pays for access to health care, pharmaceuticals, medical equipment and other support services; this access saves lives and contributes tremendously to a better quality of life. Although not a perfect system—as mentioned earlier, I’d like to see Medicaid reverse course and promote more cost-effective, community-based care over more expensive institutional care—Medicaid still serves as the critical safety net for the most vulnerable among us.
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The president also endorses the idea of shifting Medicaid’s delivery system toward one that promotes costeffective, community-based care instead of one weighted so heavily toward institutional settings. The New Freedom Initiative continues the commitment by Congress and the Administration to create more options for people with disabilities. In 1999, Congress passed the Ticket to Work and Work Incentives Improvement Act, allowing people with disabilities the option to have jobs and engage more fully with their communities. The New Freedom Initiative builds off of these principles by identifying and eliminating barriers to community living.
Included as part of his New Freedom Initiative, the president proposed a policy in 2003 called the Money Follows the Person Rebalancing Demonstration. The demonstration program would encourage states to develop innovative alternatives to institutional care and help Americans with disabilities transition from nursing homes or other institutions to living in the community. This policy fits hand-in-glove with the Supreme Court’s landmark 1999 decision in Olmstead v. L.C., which affirmed the right of individuals with disabilities to live in the community rather than in institutions whenever possible.
I can say with confidence the high court’s decision squares well with Iowans, too. Having visited each of Iowa’s 99 counties at least once every year since 1981, I have yet to meet even one Iowan who has told me he or she wants to someday live in a nursing home. In fact, I’ve heard quite the contrary. People want to stay in the comfort and security of their own homes for as long as possible. That’s why I have long advocated for public policies that support family caregivers. At the same time, I use my oversight authority to keep close tabs on the nation’s nursing homes to ensure better enforcement of federal standards and arm consumers with good information. For those who do require the unique around-the-clock care provided by nursing homes, I want to make sure they get the quality care they deserve.
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But for those whose needs can be met at home or in community-based settings, I support improving the imbalanced federal policy that spends 70 percent of Medicaid dollars on institutional care and just 30 percent on community-based care. We should work to develop policies that would give the elderly and individuals with disabilities the opportunity to rejoin their communities and lead more active, productive lives.
For the last six years I have worked on bipartisan legislation with Sen. Ted Kennedy that would strengthen two other fundamental values in America: work and family. Our bill would bring new flexibility to the Medicaid system that would help middle-income parents who are raising children with disabilities. Loving parents will do whatever it takes to provide the best for their child. The natural instinct a parent feels to nurture, provide and protect grows even fiercer if a child is challenged by disability. Families raising children with disabilities confront many of the same stumbling blocks to child-rearing faced every day by parents across America, from handling picky eaters to refereeing horseplay among siblings. But the parents of a child with disabilities face additional layers of concern, from obtaining and paying for the necessary support services, therapies and health care treatments that will help the child achieve his or her fullest potential to worrying about their child’s integration in schools and socialization among peers.
Many of these families need Medicaid to obtain essential health care services for their children. As a result, many feel trapped into poverty just to retain Medicaid eligibility.
That’s where pro-family, pro-work legislation comes into play. The Family Opportunity Act of 2005 would empower families of modest means by allowing them to scale the economic ladder of opportunity. The bill would allow these parents to accept pay raises, work hard for job promotions and bring home bigger paychecks without fear of losing Medicaid coverage for their children—or worse. Some parents now face the unthinkable and are forced to give up custody or institutionalize their child to secure health care and other support services unavailable or unaffordable to them without Medicaid coverage.
Specifically, the Family Opportunity Act, S. 183, would amend Title XIX of the Social Security Act. It would allow states to offer middle-income families of children with disabilities the opportunity to buy into Medicaid. Families would be required to retain any private insurance coverage and pay a Medicaid premium not to exceed five percent of their adjusted gross income. Comprehensive Medicaid coverage would kick in for services not covered by private insurance.
Key provisions of the legislation I introduced at the beginning of this session of Congress include the following:
1) Medicaid buy in for families of children with disabilities income or resources are at or below 300 percent of the poverty level;
2) Funds for demonstration projects in 10 states to provide treatment at home, instead of in an institution, for Medicaid-enrolled children who need psychiatric care services;
3) Immediate access to Medicaid coverage for those children who are presumed eligible for Supplemental Security Income (SSI).
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Recognizing the tremendous value of connecting parents with other parents who are raising children with disabilities, my bill would also establish family-to-family health information centers. Families would have somewhere to turn for collaboration with other families and health care professionals to discuss successful health care delivery models and support services for children with disabilities.
With overwhelming co-sponsorship in the Senate, I’ll work hard to guide the Family Opportunity Act into law during the 109th Congress. After my 25 years in the U.S. Senate, folks know by now I don’t give up once I sink my teeth into something. And I can say the same for my friend from Massachusetts.
Now some might consider Sen. Kennedy and I an unlikely alliance. Just like other Americans, we bring to the table differences in regional, political and personal backgrounds. But we firmly believe in the American dream. And all law-abiding citizens ought to have the opportunity to live in their own communities, contribute to society and enjoy the American way of life.
Our bill would help strengthen families and build better communities by rewarding strong work ethics and helping families stay intact. The Family Opportunity Act is good public policy that will help open doors for parents who only want what’s best for their children.
Senator Grassley
