The Affordable Care Act Is More Important Now Than Ever

There is clear evidence that the Affordable Care Act (ACA) is making a tremendous difference in the lives of tens of millions of Americans who are unemployed and in need of accessible quality health care during the COVID-19 pandemic.

In March the number of unemployed individuals rose sharply from 5.7 million to 23.1 million[1] and 17.1 million Americans filed for unemployment benefits[2] as state and local officials ordered bars and restaurants, offices, manufacturing plants, schools, gyms, and other public and private facilities to shut down in the wake of the sudden spread of the novel coronavirus. 

By May 2, more than 33 million people had filed for unemployment insurance.[3]  Of those, the Kaiser Family Foundation (KFF) estimated that as many as 27 million unemployed workers had lost their health insurance.[4]  For many of those individuals, the only accessible or affordable health insurance was available through two federal programs: Medicaid (including Medicaid Expansion) and the ACA’s insurance marketplaces. 

According to KFF, more than 21 million, or 77 percent of all Americans who were laid off, were eligible for either Medicaid (12.7 million) or an ACA insurance plan (8.4 million). Without these programs, millions of Americans would have had no way of paying for or accessing quality healthcare.

Unfortunately, six million Americans are not able to access either no cost or low-cost health insurance, and there appears to be no easy fix. This gap was created by states that chose not to take advantage of the ACA’s Medicaid Expansion program, even though their share of the cost would be low. Under Medicare Expansion the federal government paid 100 percent of the cost of coverage from 2014 to 2016, 95 percent in 2017, 94 percent in 2018, and 90 percent in 2020 and every year thereafter.[5]

The Medicaid Expansion was designed to fill the gap between regular Medicaid and ACA marketplace insurance programs. This ongoing gap in coverage — especially for lower income individuals and their households — required a fix, according to Democrats. In late June the House of Representatives adopted H.R. 1425, the “Patient Protection and Affordable Care Enhancement Act of 2020,” to help address this issue. 

If H.R. 1425 were to become law, it would address the Medicaid/ACA gap in coverage by making subsidized or free health insurance and care available to those who currently cannot obtain coverage through Medicaid, Medicaid Expansion, or the ACA marketplaces. However, the chances of that happening are next to nil. 

Republicans opposed the bill as another tax and spend effort by Democrats. Senate Republican leadership has indicated that they will not allow the bill to come to the Senate floor, while the White House issued a veto threat should the bill reach the president’s desk. Rep. Virginia Foxx (R-NC), the ranking member of the House Education and Labor Committee, called the bill “misguided” and argued that it would “contribute to already skyrocketing healthcare costs, and double down on the many failures of the Affordable Care Act or ACA.”[6]

At the same time, the administration has asked the Supreme Court to strike down the ACA as unconstitutional. If the Supreme Court agrees with the administration, the 28 million Americans who are covered by Medicare, Medicare Expansion, and the ACA would lose their benefits.

Without the ACA, 28 million Americans would have to rely on emergency rooms and other urgent healthcare facilities that are extremely expensive and are generally not able to address their individual, long-term healthcare needs. States and counties, generally the healthcare providers of last resort, would be saddled with the cost of healthcare for these 28 million Americans, placing further financial burdens state and local budgets that are already stretched thin due to the pandemic. Additionally, the loss of these health insurance programs would have the most negative impact Black and Latinx communities. It would substantially increase the healthcare disparities that already exist between people of color and their white counterparts. It would also contribute directly to the disproportionate number of coronavirus cases and deaths among people of color because of their more limited access to healthcare options. 

Without the Affordable Care Act and its related programs, including Medicaid Expansion and health insurance through marketplaces, tens of millions of Americans would be without access to affordable insurance and quality healthcare. The failure to maintain or expand the ACA could have very negative consequences for all our communities.


[1] Bureau of Labor Statistics, February through July, 2020.

[2] Washington Post, U.S. now has 22 million unemployed, wiping out a decade of job gains, April 16, 2020.

[3] ABC News, 3.2 million more people file for unemployment, bringing coronavirus crisis total to over 33 million, May 7, 2020.

[4] Kaiser Family Foundation, Eligibility for ACA Health Coverage Following Job Losses, May 19, 2020.

[5] Center on Budget and Policy Priorities, Medicaid Expansion Continues to Benefit State Budgets, Contrary to Critics’ Claims, October 9, 2018.

[6] Committee on Education and Labor Republicans, Press Release:  “Foxx Opposes Democrats’ Socialist Health Care Scheme,” June 29, 2020.

Take Action Now: Support House Funding Levels for Health and Human Services Programs

Over the next several weeks, the House and Senate will be working on drafting a final fiscal year (FY) 2020 omnibus appropriations bill in hopes of meeting the November 21 continuing resolution deadline. As is so often the case, the House and Senate Labor-Health and Human Services-Education (Labor/H) appropriations bills differ. 

Overall, the House FY 2020 Labor/H appropriations bill – passed through the chamber as a part of the H.R. 2740 legislative minibus package – offers more favorable funding levels for the Older Americans Act (OAA) and other key health and human services programs. It would increase funding for a wide range of human services programs important to regions, especially those regions that are also designated as the Area Agency on Aging (AAA). In contrast, the draft fiscal year 2020 Senate Labor/H bill would maintain funding at current levels. 

The proposed Senate Labor/H appropriations bill would level fund Title III of the Older Americans Act (OAA). The House, in contrast, would increase overall funding by $151 million – a 10 percent increase over fiscal year 2019. The same is true for Title V programs. The Senior Community Service Employment Program (SCSEP), a program operated by the Department of Labor, would be level funded. By contract, SCSEP funding would increase by approximately 15 percent if the House funding proposal is adopted. 

Other HHS programs such as the Community Services Block Grant and the Low-Income Home Energy Assistance Program would also see a funding increase if the House Labor/H appropriations bill becomes law. While none of the proposed increases are large, all represent movement away from last year’s appropriations amounts that either level funded or reduced funding to these important programs.

A current appropriations chart developed by the National Association of Area Agencies on Aging (n4a) is available here.

Here are some ways you can take action now:

  1. Send a letter to your Members of Congress. Use this template to send your own messages to you members of Congress about the importance of a long-term funding bill and funding increases for OAA and health and human services programs.
  2. Does Your representative or senator serve on an Appropriations Committee? Advocacy with Members on the House and Senate Appropriations Committees is especially important. If your representative or senator serves on one of these key committees, your letter should request that they share your messages with their committee leaders. At this point, many funding decisions are being made at a leadership level, and the more they hear from their committee colleagues, the more seriously they will consider these requests. You may wish to add: As a member of the {SENATE/HOUSE] Appropriations Committee, I urge you to work with your fellow committee members to ensure that the House language is adopted.
  3. Engage your grassroots. Using n4a’s toolkit or your own approach, get the word out in your networks that action is needed now! Here are some approaches you could take:
    • Ask your grantees to email or post a short note to lawmakers on social media. Members monitor their email/website/social media traffic for constituent correspondence, and personal messages resonate most. Ask your advocates to share why the OAA is important to them. 
    • Ask local advocates to call Congress. Included in the n4a toolkit’s grassroots template alert are instructions on calling lawmakers and a short sample script that constituents can use.
    • Share stories in person. Encourage your advocacy stakeholders to attend the next town hall your federal representatives have in the region to share the importance of funding for OAA. Invite your senators and member(s) of Congress to come see your agency in action and meet some of their constituents receiving OAA and other senior services.

NARC would like to thank n4a and Sandy Markwood, n4a’s Chief Executive Officer, and Autumn Campbell, n4a’s Senior Director, Public Policy and Advocacy, for their assistance and support addressing OAA, AAA, and other programs for seniors, as well as permission to use their funding documents and draft templates. 

This Month in Photos: July – August 2019

This Month in Photos: July – August 2019

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Welcome to the latest edition of Regional Councils: This Month in Photos!  June – July 2019 (PDF)

Each month, NARC publishes Regional Councils: This Month in Photos to highlight events and activities taking place in regions around the nation. 

We feature regional council meetings, board retreats, meetings with state or federal elected officials, the opening of new facilities, special programs, awards, and anything else you view as important or fun to share with your colleagues.

If you would like your region included in Regional Councils: This Month in Photos, please send your photos and a brief description to Neil Bomberg at neil@narc.org.

This Month in Photos: June – July 2019

This Month in Photos: June – July 2019

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Welcome to the latest edition of Regional Councils: This Month in Photos!  June – July 2019 (PDF)

Each month, NARC publishes Regional Councils: This Month in Photos to highlight events and activities taking place in regions around the nation. 

We feature regional council meetings, board retreats, meetings with state or federal elected officials, the opening of new facilities, special programs, awards, and anything else you view as important or fun to share with your colleagues.

If you would like your region included in Regional Councils: This Month in Photos, please send your photos and a brief description to Neil Bomberg at neil@narc.org.

The Argument for Regionally Based Job Training Programs

Prior
to passage of the Comprehensive Employment and Training Act (CETA) in 1973, job
training programs were largely federally operated.  Moreover, they were very fragmented and there
seemed to be no rhyme or reason to the way the programs were organized.  CETA changed all that. Though it remained
federally funded, all funds were passed through to states and localities, and
for the first time the job training system was locally operated through a
system of “prime sponsors” – units of general purpose government such as cities
or counties.

President
Richard Nixon underscored this point when he signed CETA into law.  He said,  

“For the first time, [funds will] be made available to State and local governments without any Federal strings as to what kind of services or how much of those services should be provided. From now on, State and local governments will be the decision makers concerning the mix of manpower services, which they make available.”

Over
the next 40 years, the nation’s job training system was transformed from one
that began as city- or county-based to one that required a regional response to
the workforce needs of business, industry, and workers.[1]

This
transformation was not always without controversy.  States sought to control the program and
deliver services statewide, and individual cities and counties sought to
maintain their control over the funds and the program. Yet time and time again
policymakers decided that America’s federally funded job training system should
be delivered locally through a system of regionally based workforce programs
that were multi-jurisdictional and reflected labor markets, economic development
areas, and regional economies.

Why?  Regions, rather than individual cities or
counties, are more likely to reflect the true labor market of an area.  Workers of course will cross governmental boundaries
to get to work, employers will draw upon workers from a wide area and not just
the municipality or county in which they are located, and wage rates are likely
to be similar across these areas, thereby ensuring that individual workers
would consider a variety of locations for work. 

Regions,
rather than individual cities or counties, are more likely to be able to
generate successful economic development strategies.  The many jurisdictions within a region are
better able to develop effective land use and tax policies, make better use of
the human capital throughout the region, and generate business and industrial
development and jobs.

With
passage of the Workforce Innovation and Opportunity Act in 2014, policymakers finally
made it clear that workforce development and job training programs must be
regionally based. 

The
law states that each state when drawing up its workforce development areas shall
develop planning regions that consist of labor market areas, economic
development regions, and other “contiguous sub-areas” of the states.  And as part of the identification process,
the state will use the following regional criteria:

What began as a single city- or county-based job training system some 45 years ago has morphed into a robust, multi-jurisdictional job training system that reflects how and why economies emerge. Going beyond governmental boundaries, this system provides workforce development based on labor markets, economic development areas, local economies, industrial composition, labor force conditions and participation, and much more. 


[1] The Job
Training Partnership Act (JTPA) in 1983, the Workforce Investment Act (WIA) in
1988, and the Workforce Innovation and Opportunity Act (WIOA) in 2014 succeeded
CETA. 

The Ongoing Debate Over Disaster Relief and Climate Change Collide

After more than a year of negotiations, the Senate appears to have moved closer to an agreement on disaster funding for Puerto Rico, Florida, and California. 

According to Politico, Senators Richard Shelby (R-AL) and Patrick Leahy (D-VT), the chair and ranking member of the Senate Appropriations Committee, respectively, and the President are near an agreement that will provide $17 billion in assistance to communities recently impacted by disasters, though the amount going directly to Puerto Rico remains under discussion.  

Sadly, it is likely that the debate around how much the federal government should spend to respond to the impacts of disasters on states, counties, cities, and regions will continue as more and more data suggest that climate change and weather-related disasters are likely to be on-going and have more severe consequences than previously thought. 

Early Monday, hundreds of scientists, working under the auspices of the United Nations, gathered in Paris for the release of a summary report that was approved by 132 nations, including the United States.  The report focuses on the unanticipated impact that climate change and weather-related disasters are likely to have.  New and profoundly significant impacts on plants and animals and the ecosystems in which they live, and upon which humans are dependent, are now predicted.  

The report states that changes in weather patterns such as those being experienced in the Midwest and Mississippi and Missouri River Basins right now, the severity of storms and sea level rise, the elimination of coastal wetlands and inundation of fresh water supplies by salt water, and continued melting of the polar ice caps, will result in the extinction of a million plant and animal species. The report adds that once flourishing ecosystems are likely to all but disappear because humans are transforming the earth’s natural landscapes so dramatically.

While short term political battles, such as the one we are seeing over disaster relief for Puerto Rico and some states, are likely to continue, there can be no doubt, given the most recent reports on climate change, that funding for disaster relief will continue into the foreseeable future as we face an increasing number of climate change and weather-related disasters.

The Importance of a Federally-funded Job Training System

Workforce development programs – whether the Comprehensive Employment and Training Act, the Job Training Partnership Act, the Workforce Investment Act or the current Workforce Innovation and Opportunity Act – have a long history in this nation, and have always had bipartisan support.

The problem is that at a time of very low unemployment, the need for an effective and well-funded federal job training system may be greatest.  

More recently, however, budget constraints at the federal level have kept funding for workforce development programs well below what most job training experts believe is necessary, and historically low unemployment rates have been used as an excuse to recommend that workforce development funding be cut each fiscal year.

The problem is that at a time of very low unemployment, the need for an effective and well-funded federal job training system may be greatest.  

Here’s why.  

First, the federal government is the most effective distributor of funding for programs like the Workforce Innovation and Opportunity Act (WIOA). Every state and every workforce development area is assured of receiving funds that reflect the numbers of unemployed adults, dislocated workers, and youth in need of job training assistance. Left to be funded by the states or localities, there is a significant chance that the funding of these programs will be less likely, and even if states choose to fund the program, the funding will prove irregular at best with some states making substantial investments while others may make no investments at all.

Second, while unemployment is at record lows, underemployment is at record highs:

  • Approximately 21 million or 14 percent of all working Americans are at a job for which they are overqualified.
  • An estimated 4.5 million or three percent of all Americans are working part-time but would prefer to work full-time.
  • Eighteen million, or 12 percent, of all Americans are working two or more jobs in order to make ends meet.

Third, the workplace and the nature of work are evolving rapidly. In the last few years we have seen a substantial increase in the use of robotics, artificial intelligence, and autonomous systems.  More progress has been made in the past five to eight years than in all the previous 50 years and the changes that are occurring today are very different than the automation cycles that occurred in the 1950s, 1980s, and 1990s. During those cycles the perception was that we were automating mechanical, clerical and routine work, and that automation in those cycles was designed to help workers be more productive and to reduce some of the hard physical labor often required in manufacturing, construction and related types of jobs.

The fact is that our nation suffers from a skills shortage.

Today, however, the machines we are building seem capable of doing wholly new things. They appear to have their own cognitive and knowledge skills, and are capable of machine learning.

The fact is that our nation suffers from a skills shortage. Yes, we have more college graduates than ever. Yes, we have more community college graduates than ever. But all too often, key industries in our country are unable to find enough sufficiently trained workers to perform the jobs they have because there is a mismatch between the skills workers have and the skills employers need. And this gap is likely to grow over time unless we make the right kinds of investments in workforce training that address the problem.

According to the National Skills Coalition, we can close this gap by “adopting policies that support sector partnerships and career pathways, and by making job-driven investments [and using] data to better align workforce and education investments with employer skill needs.”

To that end, a workforce development system that is funded at the federal level to meet these needs can help address this ongoing problem, and ultimately remedy it.  

Next week:  Why a Regional Job Training System Makes the Most Sense

Regions and the Aging of America

According to the Population Reference Bureau,[1] the number and characteristics of America’s older residents is shifting dramatically. Here are some basic facts:

  • The number of older Americans (those age 60 and older) will double from 46 million to more than 98 million by 2060;
  • Older Americans by mid-century will make up nearly one-quarter of the population;
  • The number of older Americans is becoming more racially and ethnically diverse;
  • Older adults are working longer. By 2022 27 percent of older men and 20 percent of older women are expected to continue to be working beyond the age of 65; and
  • The rural Midwest is becoming disproportionately older as young people move elsewhere.

And while many of the changes are positive – education levels are increasing; life expectancy is increasing; the gender gap in life expectancy is narrowing; and the poverty rate has dropped sharply – many of the changes are negative and are of concern:

  • Obesity rates are increasing substantially among older adults;
  • Economic disparities across different subgroups are becoming very dramatic with more than twice the number of older Americans of color living in poverty than non-Hispanic whites;
  • Divorce is on the upswing and more than 25 percent of older Americans live alone;
  • The need for nursing homes is increasing as more and more older Americans require long-term care;
  • Diseases associated with older adults – Alzheimer’s and dementia – are rising; and
  • Social Security and Medicare expenditures are rapidly increasing.

Federal, state, and local governments need to better plan for an aging America. Older Americans will be both more dependent and independent, healthier but in need of more long-term care, and capable of aging in place but desiring new kinds of multi-generational and livable communities. These needs are growing and will require greater resources each year. 

What is also becoming increasingly clear is that local solutions will need to become more regional in focus as planning for an older America becomes less about specific cities or counties and more about the regions in which older Americans live.

For this reason, regions throughout the United States have become active partners in the development of plans and the implementation of solutions that address an aging population. Many now function not only as the regional planning entity, but as the Area Agency on Aging (AAA) and are direct service providers and grantors. While others may not be the AAA, they are very involved in the planning and development of programs that create more livable, diverse, and comfortable communities for older adults.

Here are just a few examples of regional councils that also serve as the AAA and the work they are doing to address the needs of their older residents.

  • The Denver Regional Council of Governments (DRCOG) has developed programs specifically designed to address the needs of elder refugees and has implemented accountable health communities throughout the region. 
  • The Atlanta Regional Commission (ARC) has developed a regional strategic plan entitled Live Beyond Expectations that is designed to address the changing demographics of the Atlanta region in a way that delivers more supports and provides greater impacts, with fewer resources.

Check back with Regions Lead in the upcoming months for additional discussions about older Americans and reauthorization of the Older Americans Act (OAA), the federal government’s principal funding stream for local services to older Americans.


[1] https://www.prb.org/aging-unitedstates-fact-sheet/

This Month in Photos: February 2019

This Month in Photos: February 2019

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Welcome to the latest edition of Regional Councils: This Month in Photos!  February 2019 (PDF)

Each month, NARC publishes Regional Councils: This Month in Photos to highlight events and activities taking place in regions around the nation. 

We feature regional council meetings, board retreats, meetings with state or federal elected officials, the opening of new facilities, special programs, awards, and anything else you view as important or fun to share with your colleagues.

If you would like your region included in Regional Councils: This Month in Photos, please send your photos and a brief description to Neil Bomberg at neil@narc.org.