Summary
For the fourth year in a row, ASAN opposes the President’s annual budget request. This cruel proposal would once again make deep cuts to vital programs such as the Supplemental Nutrition Assistance Program (SNAP), eliminate critical housing supports, cut spending on Medicaid and the Affordable Care Act (ACA) by approximately $1 trillion over the next ten years, make it harder for students with disabilities to access public education, add onerous work requirements to nearly every social safety net program, and reduce funding for numerous disability-related programs at the Administration for Community Living.
It is important to understand that the President’s budget request is unlikely to be fully enacted into law. As our budget toolkit explains, this is just the first step in the federal budget process. However, as a disability rights organization, ASAN has a responsibility to highlight the consequences of implementing this proposal: the loss of economic and social opportunity for millions of Americans, particularly Americans with disabilities. Minor concessions–such as the creation of a permanent Money Follows the Person state plan option in Medicaid, or maintaining level or increased funding for parts of the IDEA–cannot make up for the danger posed by this budget. ASAN calls upon Congress to reject these grim cuts and instead to invest in the social services that allow people with disabilities to live in and contribute to our communities.
Analysis
The budget makes cuts that affect people with disabilities primarily in three areas: healthcare, education, and social safety net programs. It forces ill-fitting work requirements onto virtually all of our social services along with onerous new eligibility and procedural hurdles. It consolidates viable, effective programs into one-size-fits-all block grants which make it much more difficult for our state and local governments to offer targeted aid to specific populations. In general, the budget purports to offer “choice” to States while in fact drastically limiting choice through draconian funding cuts. Here is our detailed breakdown on how the President’s budget would impact Americans with disabilities:
Health Care
The President’s budget proposes drastic reductions in Medicaid and Affordable Care Act spending over ten years, from 2021-2030. The proposed reductions total approximately $1 trillion dollars over ten years, including an alarmingly vague and unexplained $844 billion devoted to an “allowance for the President’s health reform vision.”
- The President’s budget once again imposes work requirements throughout Medicaid, specifically for working-age adults “without disabilities” — in short, the Medicaid expansion population. In reality, we know that many people with disabilities are in the Medicaid Expansion population and will be hurt by work requirements, especially autistic adults, people with mental health disabilities, and people with chronic illness. Furthermore, as we have stated elsewhere, work requirements don’t work. In Arkansas, more than 1 in 4 people subject to the policy lost their health care coverage, even though the vast majority were in compliance.
- The budget allows states to increase copayments for individuals using the emergency room for “non-emergency purposes.” This discourages people, including people with disabilities, from seeking necessary care, and has a disproportionate impact on low-income people who lack a primary care provider.
- The budget allows Medicaid to make Non-Emergency Medical Transportation (NEMT) optional, which would make it more difficult for many people with disabilities to reliably obtain transportation to doctors’ appointments and other forms of critical medical care.
The budget also calls for significant cuts to a number of vital agencies run by the Department for Health and Human Services (DHHS), along with an overall 10 percent cut to DHHS’ budget. The budget calls for a $143 million dollar cut to the Administration for Community Living, a subagency that oversees essential disability-specific federal programs:
- Funding for Projects of National Significance would be gutted by 11.25 million dollars compared to 2020 funding levels, and would retain a budget of only $1 million.
- The budget would significantly reduce funding for the University Centers for Excellence in Developmental Disabilities (UCEDDs), by some $8.7 million dollars. UCEDDs provide invaluable training to professionals who work with people with I/DD and support us in reaching our health and educational goals.
- Funding for the National Institute on Disability, Independent Living, and Rehabilitative Research (NIDILRR) would be cut by $22 million. NIDILRR focuses on applied research to improve community living–it is one of the most important federal research programs for the disability community.
- Funding for Independent Living would be cut by $2 million.
- Funding for Intellectual and Developmental Disabilities programs generally would be cut by $44-45 million dollars. These programs include among others the Protection and Advocacy organizations (P&As), which help people with disabilities acquire much-needed legal aid, and State Councils on Developmental Disabilities.
The budget cuts more than $700 million dollars from the Health Resources and Services Administration (HRSA), cuts which include the complete elimination of funding for Autism and Other Developmental Disabilities. These programs include the Leadership in Neurodevelopmental and Related Disabilities (LEND) program, a highly effective program which trains healthcare practitioners in how to provide disability-competent healthcare for people with developmental disabilities. The budget proposes to compensate for the loss of targeted funding by adding an additional $60 million to the Maternal and Child Health Block Grant. This would in no way would make up for the loss of targeted funds that directly serve our community.
Education and Employment
The budget would cut overall Department of Education funding by nearly $5.6 billion dollars, or a 7.8 percent decrease compared to 2020 enacted levels. With respect to public education, the budget makes apparent its obsession with school choice in ways that enrich private schools and diminish public schools’ ability to serve all students.
- The budget proposes consolidating nearly 29 different public school programs serving different subsets of low-income students and students of color into a single, one-size-fits-all $19.4 billion dollar “Elementary and Secondary Education for the Disadvantaged” block grant for schools. Some of the consolidated programs include programs specifically for disadvantaged populations including Native Hawaiian, homeless, and migrant students, as well as funding specifically for rural education and community schools. The new block grant offers $4.7 billion dollars less than the combined funding of all 29 programs.
- By contrast, the budget proposes that $5 billion annually be devoted to its “Education Freedom Scholarships” initiative, which allows businesses to donate to State-sponsored scholarship funds for private schools, career and technical education, and special education. This is a transparent attempt to expand school voucher programs while public school programs face block grants for their targeted programs and decreased funding.
In terms of employment, the budget once again proposes to eliminate state supported employment grants, which help vocational rehabilitation agencies get people with disabilities supported employment. The budget additionally cuts $11.4 million from the Office of Disability Employment Policy (ODEP). ODEP provides valuable support to American Job Centers and the Department of Labor’s Employment First initiative for people with disabilities, as well as the Job Accommodation Network, which provides guidance to people with disabilities and employers about disability employment and workplace accommodations. Last week, the President boasted that the unemployment rate for people with disabilities is lower than ever before–but his budget proposal would gut the programs responsible for that progress.
Social Safety Net
The President’s budget outright eliminates and guts social safety net programs that provide millions of low-income Americans with food, shelter, and financial support, preventing them from becoming homeless or institutionalized. People with disabilities are disproportionately likely to be low-income and are disproportionately impacted by these egregious cuts.
- The budget proposes to cut the Supplemental Nutrition Assistance Program (SNAP) program by an absurd $185 billion dollars over ten years. It proposes to do so by limiting the number of people who can maintain benefits by imposing additional work requirements on SNAP program beneficiaries. It also once again contains the “Harvest Box” proposal, which would give low-income families pre-packaged goods as SNAP benefits instead of allowing them to choose what to eat for themselves–a regressive practice that would threaten the health and safety of many people with disabilities.
- The budget cuts the Temporary Assistance for Needy Families (TANF) program by $20 billion over ten years. It also proposes to impose work requirements on TANF beneficiaries.
- The budget cuts $5 billion from the Department of Housing and Urban Development (HUD)’s housing voucher program, which includes the Section 8 housing vouchers that make housing in the community affordable for many people with disabilities. It proposes imposing work requirements on non-elderly tenants without disabilities receiving housing assistance. Nonetheless, as we have seen in other work requirement proposals, a number of tenants with disabilities would likely be subject to work requirements due to an inability to complete the procedural hurdles required to “prove” they have a disability.
- The budget once again eliminates the Low Income Home Energy Assistance (LIHEAP) program, which helps low-income families and people with disabilities pay their energy bills.
- The budget eliminates the Community Development Block Grant and HOME Investment Partnerships Program – both programs that help struggling communities develop and enhance affordable accessible housing.
- The budget eliminates Social Services Block Grant (SSBG) funding, which funds a variety of different services including child care, foster care, and services for people with disabilities.
The budget also takes aim at programs run by the Social Security Administration (SSA) that support people with disabilities, such as Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). It anticipates a $75 billion dollar deficit reduction from its efforts to “reform Federal disability programs and improve payment integrity” — a grandiose euphemism for reducing disability benefits and trying to force SSI and SSDI beneficiaries back to work without providing them with sufficient support. The bipartisan Committee for a Responsible Federal Budget estimates that $35 billion in reductions will come from direct changes to SSI and SSDI, some of which are outlined below:
- The budget proposes to move the Ticket to Work (TTW) program — a highly effective SSA program that allows beneficiaries to slowly transition into the workforce where and when they are able to — to the Department of Labor and to replace the voucher and payment model with performance-based grants.
- The budget proposes to collect fees for replacement Social Security cards, which will impose further unnecessary costs on people with cognitive disabilities.
- It reduces the retroactive benefits provided to workers after they qualify for Social Security Disability Insurance (SSDI) from 12 months of benefits to only 6, doing great harm to the financial stability of families who have members with newly acquired disabilities.
- The budget would reduce benefits to families on what it refers to as a “sliding scale” when more than one member qualifies for SSI, leading to significant benefit reductions for families with more than one member who has a disability. The budget states that this will “save” 8.1 billion dollars over ten years — which it will do by depriving struggling families of financial security.
A $46.5 billion dollar reduction over ten years will supposedly occur from “testing new approaches to increase labor force participation.” This apparently consists of expanding SSA’s demonstration authority for testing new program rules that get more people with disabilities into the workforce and “reduce participation on disability programs.” While we agree that people with disabilities should have greater opportunities for employment, previous Social Security demonstrations that have attempted to improve labor force participation have not worked. Improving the number of people with disabilities in the labor force will likely require greater up-front financial investment in the services and supports we need to participate, rather than less.
Conclusion
The President’s FY2021 Budget makes deep cuts to vital programs that support the disability community while imposing work requirements for the express purpose of taking services away from millions. It consolidates funding targeted to specific populations into one-size-fits-all block grants that will likely lead to a loss in services and support for many communities. It specifically targets disability-related programs in many HHS agencies, and broadly harms people with disabilities who are low-income, people of color, and otherwise multiply marginalized. We call upon Congress to reject this budget and make real investments in our communities. People with disabilities need more funding for home and community-based services, real access to equitable and inclusive public education, expanded employment services, affordable and accessible housing, and economic security. We deserve better than this.
The Autistic Self Advocacy Network is a 501(c)(3) nonprofit organization run by and for autistic people. ASAN was created to serve as a national grassroots disability rights organization for the autistic community run by and for autistic Americans, advocating for systems change and ensuring that the voices of autistic people are heard in policy debates and the halls of power. Our staff work to educate communities, support self-advocacy in all its forms, and improve public perceptions of autism. ASAN’s members and supporters include autistic adults and youth, cross-disability advocates, and non-autistic family members, professionals, educators, and friends.