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Republicans in the Senate are struggling to agree on a plan to replace the Affordable Care Act, also known as Obamacare. One of the biggest sticking points is Medicaid. The bill that passed the House in May includes major cuts to the program. Republicans in the Senate, though, are hesitant to make such big cuts to services for the poor, disabled and elderly, the people that Medicaid helps. NPR's Alison Kodjak visited one program for disabled adults that could be at risk.
ALISON KODJAK, BYLINE: It's morning meeting time at Our Place Day services on Lover's Lane in Slinger, Wis.
UNIDENTIFIED CROWD: I pledge allegiance to the flag...
KODJAK: Our Place is a day center for adults with disabilities, and on this recent morning the clients were talking about their goals. Some have big dreams, like getting a job or their own apartment. Some are more modest, like going to a movie with a friend. Danielle Wirsbinski reads from her list.
DANIELLE WIRSBINSKI: To have a job.
DONNA ELLENBECKER: OK.
WIRSBINSKI: To do more volunteering, learn new skills and taking class, go to school, to live on my own.
KODJAK: This is a safe place for people with Down syndrome, say, or autism to spend their days while their family caregivers are at work. They can do art or go bowling. And they can work on specific skills like money management or cooking.
ELLENBECKER: We help men and women become the men and women they were meant to be.
KODJAK: That's Donna Ellenbecker, the director of Our Place.
ELLENBECKER: Many of our people are interested in becoming - having their own apartment someday and are living with their parents now and really need some help with the - just the everyday skills of cooking and cleaning and doing the things that everyone else does to be able to live independently.
KODJAK: Nearly all of Our Place's clients pay with money that comes from Wisconsin's Medicaid program. And that has Ellenbecker worried about the future. President Trump and Republicans in Congress want to restructure how Medicaid is funded. Instead of paying for all the medical care and services beneficiaries need, the health care bill House Republicans passed last month would grant each state a fixed sum per beneficiary based on what the state spent in the past.
That per capita allowance would rise over time, but at a slower rate than health care costs generally rise, so the Congressional Budget Office estimates that under that proposal Medicaid funding would be 25 percent less in 10 years than it would be under current law. White House budget director Mick Mulvaney said the administration wants to spend money more wisely.
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MICK MULVANEY: We're no longer going to measure compassion by the number of programs or the number of people on those programs, but by the number of people we help get off of those programs. We're not going to measure compassion by the amount of money that we spend, but by the number of people that we help.
KODJAK: But the people here at Our Place aren't likely to get off Medicaid. Instead, they'll probably need care and support for their entire lives just to be able to participate in their community. Donna Ellenbecker.
ELLENBECKER: We actually have a class that's a date. And that class is about, you know, how do you go to the movies with a friend?
KODJAK: How do you get there? A taxi? A bus? How much will it cost? How do you find a seat?
ELLENBECKER: The woman that said she wanted to go to the movies with her friend, she would need somebody to come with her to help her with all of those things because she doesn't have the skills to be able to do it independently right now.
KODJAK: Ellenbecker worries that money for that kind of help just won't be there.
ELLENBECKER: It's a 25 percent cut, you know? And there's no way that a 25 percent cut can come out of any other program except long-term care.
KODJAK: That's because many of those support services are considered optional under the law. So if state lawmakers have to choose between, say, a job coach and traditional medical care, she says it's the job coaching that's likely to lose out. Alison Kodjak, NPR News, Slinger, Wis.
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