HARRISBURG, Pa. – The GOP health bill now in the U.S. Senate would be especially harmful to seniors and people with disabilities, according to a new report.

With the per-capita cap on Medicaid spending that would be imposed under the American Health Care Act, states would be forced to make cuts.

And, according to Judy Solomon, the vice president for health care policy at the Center on Budget and Policy Priorities, Home- and Community-Based Services (HCBS), which allow seniors and people with disabilities to get the care they need in their homes, would be at the top of the list.

"Most HCBS are what Medicaid considers 'optional' services - in other words, states don't have to provide them, in contrast to care in a nursing home, which is mandatory and states must provide," she explains.

The report says more than 90,000 Pennsylvanians participate in Medicaid-funded HCBS, and capping Medicaid could force many into much more expensive nursing-home care.

Marty Ford, the senior executive officer for public policy of the Arc, says the impact of a cap on Medicaid would be devastating for people with intellectual and developmental disabilities.

She claims it would undo decades of work by states to move people out of institutions and into the community, as federal law requires.

"It would be a major step backward and a violation of the U.S. Supreme Court's decision in Olmstead. And based on the Americans with Disabilities Act, unnecessary segregation is discrimination."

In some states, people with disabilities already spend eight to 10 years on waiting lists for home- and community-based services," she says.

David Certner, legislative policy director for AARP notes that seniors and people with disabilities now account for 60-percent of Medicaid spending.

He says caps would shift costs to states, state taxpayers and to families who can't afford to pay for care without this additional support.

"The end result would be dramatic cuts to program eligibility, program services or both, ultimately harming some of our nation's most vulnerable citizens," Certner says.

Nationally, nearly three million people rely on HCBS to receive care at home instead of nursing homes or other institutions.


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House lawmakers have passed a bill advocates said will be harmful to nonprofits in New York and nationwide.

House Resolution 9495 passed with a 219-184 vote after failing to get a two-thirds majority in the chamber last week. The bill gives the Treasury Secretary power to rescind tax-exempt status for nonprofits considered "terrorist supporting organizations." On its first vote, it had strong bipartisan support.

Jeff Ordower, U.S. Lead for the group 350 Action, said President-elect Donald Trump's rhetoric about "the enemy within" makes this bill's return troubling.

"They are trying to consolidate the number of tools in their toolbox," Ordower contended. "So they can move quickly to call some people the enemy within and shut down organizations that are supporting causes that are unpopular, supporting causes that are fighting corporate power, fighting structural racism."

Voting in favor of the bill were 15 Democrats, including Rep. Tom Suozzi, D-N.Y. It could be due to its other provision giving tax breaks to Americans wrongfully imprisoned abroad or held hostage by terror groups. Ordower noted it is the result of a push by groups who want Israel and Gaza's status quo before Oct. 7 restored, which aid organizations could jeopardize.

Beyond public concern, some experts feel the bill's primary goal is helping President-elect Trump consolidate power within the Executive Branch. Ordower pointed out it is one of the many battles with the second Trump Administration about what defines a healthy and sustainable democracy.

"What we need in order to really have a good fight that defends civil society, that leads us towards and continues some of the ways that are flourishing democracy is to have lots and lots of groups that are able to push their agendas, and not just groups with particular ideologies or point of views doing that," Ordower stressed.

Ordower is surprised by lawmaker's persistence to pass this bill given wars occurring across the world, as well as ongoing economic, climate and immigration issues at home. Some 150 groups including the ACLU signed a letter to House lawmakers urging them to oppose the measure.

The Indiana Chamber of Commerce outlined six key priorities for lawmakers ahead of the legislative session in January.

Rather than releasing detailed policy positions, the Chamber emphasized broad focus areas, including workforce, education, economic growth, infrastructure, quality of place and community health.

Phil GiaQuinta, D-Fort Wayne, House Minority Leader, responded to the Chamber's priorities, highlighting the need to address child care as a factor in economic development.

"We talk about economic development with things that impact economic development here in the state. Child care is really one of those," GiaQuinta contended.

The organization stressed the critical role of affordable child care in workforce development, citing a report estimating Indiana loses $4.2 billion annually, including $1.7 billion in tax revenue due to child care challenges. High costs force some parents out of the workforce, straining the state's economy.

Statehouse leaders acknowledged the issue but differ on solutions. Democrats argued child care deserves more state investment, while Republican leaders believe the private sector should play a larger role.

Todd Huston, R-Fishers, Speaker of the House, said businesses should not expect the state to solve their child care problems entirely.

"They've done a lot of different things to try to support families and young families. We will continue to do that," Huston stated. "But I think we also have to set a level of expectations that we're not going to; the state's not going to be funding all universal pre-K."

The Chamber plans to release detailed policy proposals in January, aiming to guide lawmakers toward strategies to strengthen Indiana's economy and workforce.


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North Dakota is no stranger to public pension debates. States face pressure to keep retirement systems well-funded and new data show most Americans place great value on such benefits for both government and private-sector workers.

According to the National Institute on Retirement Security, 86% of Americans believe all workers, not just those employed by state and local governments, should have a pension. There are similar approval levels when asked how important public pensions are in recruiting teachers and public safety workers.

Dan Doonan, executive director of the institute, suggested it is not too surprising to see the results.

"Pensions, along with other benefits, are part of creating that culture of careers and not jobs," Doonan explained.

Starting in January, North Dakota will close its main public pension plan for new hires, who will instead be offered a 401(k)-style benefit. The move followed debate over whether it was the right way to address a $1.9 billion unfunded liability. Backers argued it protects benefits for existing workers and taxpayers but skeptics contended it makes it harder to attract workers to the public sector.

Doonan noted the survey results overlap with the idea maintaining an experienced public-sector workforce is a good thing for community members and not just the employee and employer.

"In general, when public services are done well, they're often invisible, right?" Doonan emphasized. "We want good roads, we want safe communities, and I think Americans understand the role of having career public servants in terms of delivering those outcomes."

The Bureau of Labor Statistics said state and local governments employ about 20 million workers, which represents about 13% of the U.S. workforce.