Model law for guardianship restricts guardian rights to act on behalf of incapacitated individuals: Part 2

Monday, July 24th, 2017

See Part 1 for VOR’s comments included in a cover letter to the Uniform Law Commission (ULC) committee on guardianship.

Below are additional comments that VOR sent to the ULC committee. VOR’s concerns are summarized in this paragraph: 

“VOR is deeply concerned about any effort to weaken the protections of guardianship. Attempts to replace guardianship with technology or Supported Decision-making affect not only those with severe intellectual disabilities but also people with I/DD who are vulnerable to manipulation and coercion by others as well as individuals who lack awareness of the consequences of their own actions which may cause harm to themselves or others.”

To better understand the comments... 

The term “ward” refers to an incapacitated person who has a guardian who has been appointed through state court guardianship procedures.

The “petitioner” is the person in a guardianship procedure who is asking to be appointed guardian for an individual who is unable to make or communicate decisions in some or all aspects of his or her life. The vast majority of guardians are family members or close friends of the incapacitated person.

The “respondent” is the individual for whom a guardianship is under consideration by the state court. Here is a link to the draft proposal from the ULC "Committee on Uniform Guardianship, Conservatorship, and Other Protective Arrangements Act". The VOR comments reference sections of this document.

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VOR Comments to Proposed Guardianship, Conservatorship, and Other Protective Arrangements Act

Supported Decision making (SDM), Guardianship, and the Least Restrictive Standard The Prefatory Note and Section 314 speak in favor of the “least restrictive means” of serving the ward with a bias toward Supported Decision-making [SDM]. [We refer you to VOR’s Position Paper on SDM.] SDM does not offer a “least restrictive” means of providing support to an individual. For individuals who are incapable of participating in the decision making process due to their intellectual disabilities, the SDM team would be engaging in the substitute decision-making that SDM allegedly prevents. How is the substitute decision-making of the SDM team “less restrictive” than the decision-making of a guardian, especially when that guardian is a family member with intimate knowledge of the ward and motivated by unconditional love?

The term “least restrictive” should be defined in the Act. The “least restrictive means” should be defined in terms of what is actually least restrictive for the individual based on that person’s needs and preferences to the extent that the preferences are actually known or reasonably ascertainable by the guardian and the court.

Residential Choice The “least restrictive means” also entails a bias against congregate residential facilities. The Americans with Disabilities Act (ADA) and the U.S. Supreme Court Olmstead decision, which interpreted the ADA, recognize the unique needs of the individual with disabilities and their right of choice in accessing public accommodations for disabilities, such as residential services. In Olmstead, the justices affirmed the “States’ need to maintain a range of facilities for the care and treatment of persons with diverse mental disabilities,” Olmstead v. LC 527 US 581, 597 and stated,

“We emphasize that nothing in the ADA or its implementing regulations condones termination of institutional settings for persons unable to handle and benefit from community settings...Nor is there any federal requirement that community-based treatment be imposed on patients who do not desire it.” Olmstead at 601-602

Furthermore, the Developmental Disabilities Assistance and Bill of Rights Act of 2000 supports individual choice among residential options and recognizes families as the primary decision-makers,

“Individuals with developmental disabilities and their families are the primary decision-makers regarding the services and supports such individuals and their families receive, including regarding choosing where the individuals live from available options, and play decision-making roles in policies and programs that affect the lives of such individuals and their families.” DD Act, 42 U.S.C. 15001(c)(3)(2000).

Section 314 (c)(4) and Section 317 (a)(7) of the draft act requires guardians to take additional steps and to provide increased reporting should they choose an “institution,” “nursing home,” or “facility” as a residential placement for a ward. The language in these sections instills a bias against such settings. As these settings serve individuals requiring higher levels of care, the language works against the most severely and profoundly disabled individuals needing guardianship. Additionally, this language infringes on the right of choice of individuals and their guardians and flies in the face of the second prong of Olmstead which confirms the individual’s right “to oppose” placement in the community. Parents and guardians are the most knowledgeable about a ward’s overall needs, and therefore, their decision-making with respect to residential choice should be respected..

Sensitivity to certain terms (e.g., “ward”) The Prefatory Note speaks about the drafts’ updated terminology. The draft does not use the terms “ward,” “incapacitated,” and “incompetent”. These terms define why guardianship is needed, and as such, serve as protections for the individuals affected. The descriptive nature of the terms alert others to the fact that the affected individuals need additional assistance, and thus, stimulates compassion in others. “Person subject to guardianship” is non-descriptive and could actually cause confusion as to the degree of disability at hand.

Excessive Reporting VOR believes that responsible and caring individuals wanting to serve as guardian for an incompetent person should be encouraged, especially when those individuals are family members and close lifelong friends of the individual. We are concerned that the Guardian Plan required in Section 316 could discourage guardianship by adding unnecessary burdens. Given that a Guardianship Report is already required, a Plan in addition seems excessive and could be intimidating for some caring and loving people who would make excellent guardians, but are not comfortable with bureaucratic and legalistic-sounding paperwork. The Guardian Plan is likely to be redundant for individuals with I/DD who are receiving services. Most states require service plans that guardians and other family members participate in. These could easily be included as part of the evaluation of an individual for guardianship.

Visitor In Section 304, the addition of the visitor into the guardianship process adds a third party between the petitioner, the respondent, and the court. The visitor is given the responsibility to investigate, look into medical history, and make a recommendation to the court as to the appropriateness of guardianship. It raises many concerns including, what qualifications does the visitor have and how are they chosen? Do they have expertise in the myriad co-morbidities which may exist? The visitor’s feedback is purely substitute feedback, and as such, infringes upon the decision-making authority of the court and the vital and caring role the petitioner plays in the life of the respondent, especially when the petitioner is a family member and close friend.

Appointment of an Attorney Section 305, Alternative A and Alternative B, require the appointment of an attorney for the respondent, in some or all proceedings, whom the respondent must compensate. If the respondent is incapacitated, he or she is not in a position to provide direction to an attorney. The attorney would be engaging in substitute decision-making and could manipulate the respondent and work against a well-meaning and knowledgeable family guardian or close friend. Additionally, paying an attorney is a significant financial responsibility, especially for an incompetent person with limited income which in many cases may consist only of Social Security income.

Who Should Be Guardian Section 309 of the draft prioritizes the parties that can be guardian, placing family members last. A family member should be given the highest priority given their intimate knowledge of the individual and their having the greatest motivation to act in the best interest of the individual. Indeed, this is no different than the way most Americans lead their lives. When competent adults prepare their wills and estates or engage in personal and financial planning, most look to family members for advice and to help them protect their interests. Why should an incapacitated person not enjoy this same privilege? How can a law that is to protect vulnerable people be credible if it severs these individuals from their most loyal support systems? Section 310 compounds this insult by placing the “least restrictive means” to meet a respondents’ needs ahead of family members, putting technology and supported decision-making teams ahead of familial bonds. It should be noted, an incapacitated individual often requires assistance with technology, and therefore, the technology itself is subject to manipulation, and as such, so is the incapacitated individual.

When public or professional guardians are needed to protect vulnerable individuals, they must act with independence when they make decisions on behalf of their ward. For public guardians financed by the government, conflicts of interest arise. These guardians must not be pressured to make decisions that fulfill the agendas of government agencies rather than protect the interests of their wards, nor should they be pressured to adhere to an ideology that does not accept that there are individuals who cannot make decisions. VOR members have seen the adverse affects of conflicts of interests with public guardians. Model law and state courts should protect the right of all people with intellectual disabilities to be treated as individuals and not make presumptions based on their status as part of a class; nor should model law or state courts which address guardianship be unduly swayed by an ideology that does not respect the inability of some in their charge to engage in decision-making.

Termination or Modification of Guardianship Section 311 and Section 319 allows for the “adult subject to guardianship” to petition to have guardianship removed and an attorney provided. How is the incapacitated adult able to make such a determination? Such a provision potentially undermines the ability of the guardian to act in the ward’s best interest when the ward does not understand or accept the reasons for the guardians’ decisions.

Restrictions on Ability of Guardian to Protect the Ward Section 311 requires court authorization in order for a guardian to restrict communications and visitors with the ward. As the responsible party who could be held accountable if the ward is harmed, such a requirement unduly inhibits the guardian from carrying out his or her duty to protect the ward. To require the guardian to petition the court to exclude certain individuals from interacting with or visiting the ward fails to allow the guardian to use his or her best judgment in subsequent instances where contact may harm the ward. Delays caused by having to petition the court could place the ward in serious jeopardy.

In conclusion, Supported Decision-making as an alternative to guardianship does not live up to the standards for accountability and monitoring that is required in guardianship procedures. Discouraging families and close friends from taking on the responsibility of guardianship does a disservice to people with profound and severe cognitive disabilities who are not capable of speaking on their own behalf, or to individuals with mild or moderate
cognitive disabilities who are easily manipulated. Without the ability to give informed consent, these persons are unable to provide advance directives for their care or to designate a person with the authority to act on their behalf. When there is no guardian, service providers are left to make decisions that are most convenient for themselves without the oversight and protection of a caring third party without a conflict of interest.

VOR is deeply concerned about any effort to weaken the protections of guardianship. Attempts to replace guardianship with technology or Supported Decision-making affect not only those with severe intellectual disabilities but also people with I/DD who are vulnerable to manipulation and coercion by others as well as individuals who lack awareness of the consequences of their own actions which may cause harm to themselves or others.

Model Law for guardianship restricts guardian rights to act on behalf of incapacitated individuals: Part 1

The Uniform Law Commission (ULC) proposes model laws that promote consistency and uniformity in certain areas of the law among the states. A ULC committee on the “Guardianship, Conservatorship, and Other Protective Arrangements Act” has drafted a model guardianship law that, if approved by the Commission, would recommend to states extensive changes in guardianship procedures.

The proposed law embraces a controversial movement that has emerged in recent years to limit the use of guardianship and to replace it with alternatives to “substitute” decision making. Substitute decision-making occurs when a person lacks the capacity to make or communicate decisions on their own behalf, in some or all aspects of their lives, and a guardian is appointed by a state court with authority to make those decisions. Supported Decision-Making (SDM) for individuals with intellectual and developmental disabilities (I/DD) and other disabilities, promotes the idea that an informal network of advisors should be made available to the individual for support and that guardianship should be avoided at all costs. Proponents of SDM believe that all persons with disabilities, with almost no exceptions, have the ability to make decisions for themselves when given the support they need to do so.

[Read more about the Uniform Law Commission and Guardianship vs. Supported Decision-Making. Here is the draft of the proposed guardianship law.]

VOR, a national non-profit organization advocating for high quality care and human rights for people with intellectual and developmental disabilities, has submitted comments to the ULC committee on guardianship. The comments are the work of the VOR Issues Oversight Committee of which I am a member.

The Comments consist of a letter to David English, the chair of the ULC guardianship committee (Part 1) followed by specific comments on the text of the draft model guardianship law (Part 2). 

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Letter to David English, the chair of the Committee on Guardianship, Conservatorship, and Other Protective Arrangements Act

Dear Mr. English:

VOR is a national advocacy organization working to protect high quality care and the human rights of all individuals with intellectual and developmental disabilities (I/DD). We support a full range of services and residential options to meet the needs of this diverse population.

VOR’s membership consists of family members and guardians of individuals with intellectual and developmental disabilities (I/DD). We understand the importance of families and guardians in helping to ensure that individuals with I/DD have choices available to them that optimize needed services and supports and honor their unique personhood.

VOR has a responsibility to its members to advocate for guardianship policies and procedures that protect the health and safety of people with I/DD and respect their civil rights. We understand that the ULC Committee on Uniform Guardianship, Conservatorship, and Other Protective Arrangements Act, chaired by David M. English, JD, is finalizing its model act. We also understand that, Uniform Acts are model statutes produced by nongovernmental bodies that may become law if they are independently adopted, in whole or in part, by state legislatures. Because of the potentially broad affect of this Act on guardianship policy, VOR is concerned with some of the proposed changes.

Specifically, we are concerned with changes that would incorporate the principles of “Supported Decision-Making” (SDM) into guardianship law and promote its use as a substitute for guardianship. SDM, as it is promoted by organizations that receive funding from the federal Administration for Community Living, is based on a belief that everyone with a disability can make his or her own decisions with almost no exceptions. Our families know better from their experiences of living with disabled family members who have complex cognitive, physical, and behavioral disabilities. Some function at the level of infants or young children or have intellectual and behavioral disabilities that prevent them from understanding the ramifications of their decisions. Although some people with less severe intellectual disabilities may find that SDM gives them the tools they need to make decisions, there are others who do not recognize or appreciate risky or dangerous situations and need guardianship to prevent them from being harmed by the consequences of their decisions.

Although SDM is meant to be an alternative to substitute decision-making, we believe that SDM is another form of substitute decision making, but without the accountability of guardianship. These concerns are outlined in VOR’s attached Position Paper on Guardianship and Supported Decision-making.

We are providing comments on the “Guardianship, Conservatorship, and Other Protective Arrangements Act.” VOR members who serve as guardians for their intellectually disabled family members consider guardianship to be an honor, a privilege, and a labor of love. Our members are representative of the people who must live up to and implement the standards and policies of this proposed model law, and as such, our input is crucial to help ensure that the model legislation reflects the real world demands and needs of individuals with intellectual disabilities in relation to guardianship. We welcome your sincere consideration of our comments and look forward to your response.

Sincerely,

Caroline Lahrmann
VOR President

Charlie Gard: Who decides when there are no right answers?

It goes against my bleeding-heart liberal tendencies to praise an article by a well-known conservative commentator like Charles Krauthammer, but the issues he writes about in this instance rise above the usual party politics and left-right positions on medical care and morality. Krauthammer’s background and life experiences give him unusual insight into the dilemma facing the family of the infant Charlie Gard whose parents are fighting a London hospital to release him so that he can undergo experimental medical treatment that may or may not save his life.

Charles Krauthammer graduated from Harvard medical school in 1975 and became a psychiatrist before taking up a career as a columnist and TV commentator. He is also physically disabled from a diving accident that occurred during his first year of medical school.

In his Washington Post opinion column, “What to do for little Charlie Gard”, 7/20/17, Krauthammer summarizes the case of the eleven-month old infant:

“One cannot imagine a more wrenching moral dilemma than the case of little Charlie Gard. He is a beautiful 11-month-old boy with an incurable genetic disease. It depletes his cells’ energy-producing structures (the mitochondria), thereby progressively ravaging his organs. He cannot hear, he cannot see, he can barely open his eyes. He cannot swallow, he cannot move, he cannot breathe on his own. He suffers from severe epilepsy, and his brain is seriously damaged. Doctors aren’t even sure whether he can feel pain.

“For months he’s been at the Great Ormond Street Hospital in London. His doctors have recommended removing him from life support.

“His parents are deeply opposed. They have repeatedly petitioned the courts to allow them to take Charlie for experimental treatment in the United States.”

The issue here is that under British law, when doctors and parents disagree on treatment for a child in such dire circumstances, the court becomes the arbiter of the best interests of the child and may overrule the parents right to make medical decisions. In this case there are no accusations that the parents are incapable of making such decisions or that they have in any way mistreated or neglected their infant son. The parents have raised funds and others have agreed to provide treatment for free if it has any chance of helping the child, so the cost of treating Charlie is not an issue.

Krauthammer concludes that the parents are wrong and the doctors and judges are right, but “despite all these considerations, I would nevertheless let the parents take their boy where they wish.” I agree with almost all of what he says, except for this: “Charlie’s suffering is literally unimaginable and we are simply prolonging it.” Because it is “unimaginable”, the parents are in the best position to determine whether the child is suffering and to what extent.

My son Danny, who is 40 years old and has profound physical and cognitive disabilities, is obviously not in the same situation as Charlie Gard except in the respect that Danny has no way of communicating specifically about his condition and what he is experiencing. As his parents, my husband and I know how he looks when he is unhappy, uncomfortable, or in pain. Sometimes we are wrong, but mostly we know better than anyone else.

In recent months, Danny has had many trips to the emergency room for seizures and two hospitalizations for pneumonia. I can say without a doubt that he has never been more miserable than when he was in the ER having trouble breathing with a temperature of 103 degrees and waiting for the diagnosis of pneumonia so that he could start on antibiotics that would relieve his misery over the course of the next day. As for his seizures, his normal (for him) movements are often mistaken as seizure activity by the experts when he is just expressing his exuberance for something he finds highly entertaining, such as the beeping of alarms going off in the ER. He also sometimes appears to be grimacing in a way that most people would interpret as pain, when we know he is expressing extreme happiness and amusement. We don’t want Danny to suffer, but sometimes suffering is more in the eyes of the beholder who cannot fathom what it is like to be Danny and assumes that suffering is part of his condition when it is not.

Krauthammer acknowledges the exceptions for when parental decisions should be overruled as well as the ulterior motives of the state, when it gives priority to cost savings over the welfare of an individual child. He is also skeptical of miracle cures. Nevertheless, he says, “...there’s a reason why, despite these exceptions, all societies grant parents sovereignty over their children until they reach maturity. Parents are simply more likely than anyone else to act in the best interest of the child.”

A final ruling on the case of Charlie Gard is expected on July 25th, 2017.

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Here is another Washington Post article on the Charlie Gard case,“The dying child who became an ideological football” by Ruth Marcus, 7/6/17:

“…as tends to happen in these circumstances, individual tragedy is susceptible to being hijacked in service of a larger, sometimes misleading point. So the terrible case of Charlie Gard serves both to raise difficult and important questions about the proper contours of parental rights — and to sound unwarranted alarms about the horrors of socialized medicine and the insidious arrival of death panels. Charlie is at once a dying child and an ideological football.”

...and another Washington Post article, "Who gets to decide if Charlie Gard's life is worth living? It shouldn't be his doctors" by Charles Camosy, 7/13/17:

"...The values of the parents should be the ones used when making the decision, especially when they do not require the use of shared community resources. There is no basis for arbitrarily substituting the moral judgment of a physician — and plenty of reasons not to."

Senate Bill to "Repeal and Replace" Obamacare targets Medicaid expenditures to reduce federal spending

According to the federal Medicaid website, “Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.” As of April 2017, it provides health care coverage to 69 million people.

The purpose of the GOP plan to repeal and replace Obamacare appears be to be to reduce federal expenditures so that Congress can afford to give tax cuts to mostly wealthy citizens. Whether you agree with this assessment or not, the plan will have that effect.

People with disabilities rely on Medicaid for their health care coverage as well as for services they need to live safely in settings appropriate to their needs. Here are excerpts from two articles, that explain proposals to place caps on federal Medicaid spending.

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From Disability Scoop, “Caps Would Pinch Medicaid For Decades To Come” by Michelle Diament, 6/30/17:

“The Republican proposal under consideration in the Senate would convert Medicaid to a per-capita cap system, much like a version of the legislation passed by the House of Representatives in May.

“Currently, Medicaid operates as an entitlement program meaning that services are provided to anyone who meets eligibility requirements. The federal government provides matching grants to states to help cover the cost.

“Under a per-capita cap system, however, the federal government would chip in a fixed amount for each beneficiary regardless of the true cost of their care and leave states to make up any difference.

"The budget office previously projected that the Senate plan would mean $772 billion less in federal Medicaid spending over the next decade, a drop of 26 percent.” 

...

“Individuals with disabilities represent just 15 percent of Medicaid beneficiaries, but account for 42 percent of the program’s costs, according to the Kaiser Family Foundation.” [emphasis added]

Read the full article here

From Together by Choice, “The Impact of the Proposed Medicaid Cap on Individuals with Intellectual and Developmental Disabilities” by Scott Mendel, 6/22/17:

“…The details of the bill were released today. It seeks to cap the federal portion of Medicaid at each state’s current per capita Medicaid expenditure. In addition, the federal portion of Medicaid would increase by the rate of inflation as measured by the consumer price index. Historically, the per capita cost of Medicaid has increased at a faster rate than the consumer price index.

"The Effect of a Medicaid Cap on Individuals with Intellectual and Developmental Disabilities

“Capping the federal portion of Medicaid will have a serious detrimental effect on individuals with intellectual and developmental disabilities. Individuals with intellectual disabilities suffer from a wide range of disabilities, from autism to down syndrome to cerebral palsy. The common feature is that individuals with intellectual disabilities do not function at an adult level. Many function at the level of a three or five year old and are in need of 24 hour care. For these individuals, Medicaid is the only option available to them to cover the cost of the intensive 24 hour care they need. Most individuals with intellectual disabilities will never have full-time employment, will never receive health insurance coverage through a job, and do not have income sufficient to purchase private health insurance. They are totally reliant on Medicaid.

“Capping the federal portion of Medicaid means that the portion of the cost of meeting the needs of individuals with intellectual disabilities that will be picked up by the federal government will shrink…[costs] will be shifted to the states or to the individuals. Neither can afford to pick up the portion that the federal government will no longer cover. In many states, services for individuals with intellectual disabilities are already under funded…These most vulnerable members of our society have nowhere else to turn to receive the services they need."


Read more  to see the “Call to Action” from Together for Choice with specific recommendations on how to contact Senators to voice your opinion on how these proposals will affect your disabled family member.

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More resources from the Kaiser Family Foundation, Medicaid's Future

Is this any way to reform health care?

The U.S. Senate has taken up consideration of a hugely unpopular House bill to repeal and reform Obamacare. Senate leadership plans to hold a vote on the Senate version of the bill by Friday, June 30, 2017. No debate, no hearings, no amendments. And you won't have time enough to read and understand the bill to know how it will affect you and your DD family member. Here is an Action Alert from ACCSES:

June 20, 2017 

ACTION ALERT

Senate Vote on Health Care 

This Action Alert Requires Your Immediate Action!

The Senate health care bill is expected to come to the floor for a vote by next Friday, June 30, with NO debate, NO amendments, and NO committee hearings. While no one has seen the bill, which is being drafted under the guidance of just 13 Republican Senators, it is believed to include cuts to Medicaid spending that are even more extreme than the House-passed American Health Care Act.

We are at the critical stage. It is on all of us to push back and demand that the Senate do its job in the daylight and reject any health care bill that has not been fully vetted. Reach out to your Senator(s) and tell them to vote NO.

Go to the ACCSES Action Center now! Call your Senators’ offices. E-mail them. This is serious.

Kind regards,

Kate McSweeny
Vice President of Government Affairs &
General Counsel
ACCSES

Will Michigan legislators listen to constituents on mental health funding proposals?

Michigan Public Radio aired an interview on 6/7/2017 with Gail Marsh, the mother of an adult daughter with Down Syndrome, and Bob White, the father of two adult sons on the autism spectrum. Both parents have been involved in “Section 298” workgroups and affinity groups for more than a year. These groups were formed after the Governor’s budget proposed to shift mental health Medicaid funding from public Community Mental Health (CMH) agencies to private health plans that currently administer Medicaid medical health plans. They were a response to the strong opposition that met the Governor's proposal. 

People with developmental disabilities are one of the populations served by the mental health system in local Community Mental Health (CMH) agencies.

From the Michigan Radio website, "Parents 'afraid to die' because of fear mental health care system won’t take care of their children" by Stateside staff and Josh Hakala, 6/7/17:

“Tomorrow, state lawmakers are expected to release their final budget for fiscal year 2017-18 for the Department of Health and Human Services.

“That budget will reveal if Republicans have chosen to shift control of mental health funding – which amounts to nearly $2.5 billion in annual Medicaid payments – away from public mental health organizations, and transfer it to private insurers.
...
"Listen to the full interview … to hear more about their children and how they rely on mental health services as well as Marsh's examples of how privatizing ‘doesn't work’ and why White describes it as a form of ‘outsourcing.’"

Here is part of the interview with Gail Marsh on how the legislature has so far ignored much of the public input from the “Section 298 Initiative”. Start listening at about 12 minutes and 30 seconds into the interview. [Note that in this discussion, “integration” of care is about integrating funding for medical and behavioral health services under one administrative roof - the private Medicaid health plans.] The stakeholder workgroups and affinity groups overwhelmingly supported maintaining a public system to provide behavioral health services which include the social services and supports necessary to maintain people served in community settings.

Gail Marsh recently testified at a Michigan House appropriations subcommittee where she heard references to a State Senator’s comment that, “We’ve been dancing around the concept of integration for too long and the legislature needs to force things to happen.”

Here is her response in the interview:

“…I told them, the reason we’ve been dancing around total integration for so long is because it’s not what people want …The job they’ve been hired to do …is not to force unwanted things on their constituents, but to listen to the people who elected them. So, both the House and the Senate…have dismissed the recommendations of the workgroup and the stakeholder affinity groups, which were to maintain a public behavioral healthcare system.”

• Listen to the whole interview here.
• Link to  background information on “Section 298 Initiative” 
• Minding Michigan, is Stateside’s ongoing series about mental health issues is Michigan.
• So far, I have not seen news on whether the budget proposals for MI Health and Human Services have been acted on.

The GOP race to advance repeal-and-replace of Obamacare by July 4th, 2017

If you thought the Republican plan to repeal-and-replace Obamacare was dead on arrival in the U.S. Senate, think again. The House of Representatives passed an extremely harsh and unpopular bill last May that has been heavily criticized. Nevertheless, Senate plans to usher through healthcare reform are underway.

According to Politico, “McConnell whips Senate GOP back in line in Obamacare repeal” by Burgess Everett, Jennifer Haberkorn, and Adam Cancryn, 6/6/2017, Republicans have emerged from meetings this week with increasing optimism that they can pass a bill by the end of June, before the July 4th recess. If and when it is voted on, you may not know what is in it and there will be no public hearings on the bill. There is no legislation written yet for you to look at, but McConnell (R-KY) says that “failure is not an option”. 

Or as Senator Pat Roberts (R-Kan.) puts it,

“We’re in the back seat with Thelma and Louise and we need to get out of the car. So details matter, but we need to get out of the car. That was the pre-eminent message…The upshot is: This has to happen.”

What will happen? No one can say exactly, but here is what might happen:

“Senate Republicans expect their bill to be more generous than the House-passed measure in almost every way: A longer runway for ending the Medicaid expansion, more money for insurance market stabilization to lower premiums and beefed up tax credits for Americans of lower income, senators said. But no decisions have been made on some key policy questions, including on handling Medicaid. Still, it’s almost impossible for the public to assess what precisely Republicans are working on — the GOP is writing the bill behind closed doors and with no committee hearings.” [emphasis added]

If a bill is passed, it will have to be done through Reconciliation. According to the Tax Policy Center, “Congressional budget committees use the reconciliation process to ensure tax laws and mandatory spending programs are revised according to the budget resolution’s revenue and spending targets. The reconciliation process is a way to fast-track revenue and spending legislation into becoming law.” For a fuller explanation, see this from the Tax Policy Center.

The bill will have to go through a number of steps described in the article, though none of them include hearings or sober consideration of a huge change to our health care system with multiple effects on our economy and health.