We’re deep into performance evaluations here at ANCOR. Every year I think that perhaps I ought to change up when we do it, conducting them during the holiday season may verge on passive aggressiveness. I’m especially guilty this year, I think I have two employee reviews scheduled for directly after our staff holiday lunch. But the year-end timing just makes sense as we look toward 2018, reflect on what we’ve done well, and how and where we can improve. And so with a line from one of my all-time favorite Christmas songs playing in my head as I write this - And so this is Christmas, and what have you done? – indulge me for not your usual CEO Perspective column.
I write this as LINKS goes to press – the Senate just secured the votes to pass the tax reform package late Friday night, and barring an unexpected roadblock during the reconciliation process to align the House and Senate versions, the Republicans are poised to secure their first major victory. The Senate bill is a slight improvement over the House bill, but bottom line, it is likely no coincidence that the next item on Congress’ and the White House’s docket is entitlement reform, i.e., cutting Medicaid, Social Security and other safety net programs. The tax bill almost didn’t pass because it balloons the federal budget deficit – providing even greater impetus for the Republican-controlled Congress to find the big cuts that'll deliver on the party’s commitment to fiscal conservatism and take control of the national debt. That puts us squarely in the crosshairs.
Back to evaluations. I don’t love doing my own self-evaluation. Doubt I’m alone on this. What a rollercoaster ride we’ve been on this year; a year where the stakes have been higher than we’ve encountered since the Clinton/Gingrich block grant years; a year where finding the moderate middle ground has been elusive; a year where as soon as we thought we were out of the woods we were proven wrong.
As Esmé Grant Grewal, our Vice President of Government Relations, pointed out in an email forwarded from a member angry that we urged our members to oppose the Republican tax reform package as currently proposed, these issues are emotional. I’d second that in spades. The country is polarized, Congress is polarized, but we can’t afford to be. I’m a broken record on this point, but I believe it needs repeating. Our strength comes from honoring the diversity of opinions within our membership, our strength comes from reflecting the constructive middle in our policy positions whenever possible, our strength comes from our unity. Always a tall order, this year proved even more so.
So as I reflect on what we have done well over the last year, and what we need to do if we are to continue to be successful, not only in protecting Medicaid but in building momentum to improve the policy and funding environment, I am mindful that if we do not work hard to listen to all of our members, our unity could prove to be an illusion. Equally important is to ensure that we constantly communicate to all of our audiences that ANCOR is nonpartisan, and our positions are guided by analysis of how any given issue will impact community services funded overwhelming by Medicaid – not which political party is pushing the proposal.
Last month I listened to an insightful and entertaining panel discussion of national health care reporters reflecting on this year’s attempts to repeal and replace the Affordable Care Act. Misery loves company: it felt good to laugh about everyone’s collective PTSD caused by the bill dubbed the zombie bill because of how often it came back from the dead. And now we think it will come back again. But here’s what encourages me enormously: to quote Julie Rovner, former New York Times health reporter and current editor of Kaiser Health News, the “shining moment for 2017 was that the country finally figured out what Medicaid is and what it does.”
Let’s put this current environment in perspective. It hasn’t just been this year that has been challenging on the federal level, 2015 and 2016 forced us to do battle to mitigate the impact of the Obama Administration’s proposed DOL Exempt Employee rule. That was painful; lobbying against a rule to improve wages seemed to run counter to our years of advocating for higher wages for DSPs. But we found common ground in supporting a much more moderate salary threshold increase, and obtained the nonenforcement policy through effective lobbying to educate Democratic members of Congress and the DOL about how Medicaid works for our members.
I vividly remember the meeting in which a senior DOL policy advisor finally grasped the fact that our members are price takers, not price setters. That lightbulb moment, coupled with our relentless lobbying for them to understand our workforce crisis and costs of complying with the HCBS rule, was what got us that special accommodation. To paraphrase Rovner, that was the shining moment that DOL finally figured out how Medicaid funded providers would be hurt by a large federal mandate.
We are an association of providers. It’s not enough for us to simply try to stop cuts with slogans and rallying cries – those tactics generally do not work with Republicans. We never would have convinced the Democrats and achieved the DOL accommodation had we made the same arguments as other employers. We distinguished ourselves with the Democrats, and we must do that again with the Republicans. We can never forget that the bulk of disability policies, including the ADA, have been achieved only by both Democratic AND Republican support. Republicans have traditionally been strong supporters of disability services, if we are going to protect our services moving forward we need to do an even better job of educating them about the unique challenges IDD providers face on a daily basis.
So amidst a truly trying year, the silver lining was the broader public awareness of what Medicaid is and what it does. Let’s build on it!
Barbara Merrill is CEO of ANCOR. She can be reached at firstname.lastname@example.org.