More About Shannon Spillane

Shannon Spillane

Shannon Spillane is Director of Communications. You can follow her on Twitter @ShannonCBPP.

Full bio and recent public appearances | Research archive at CBPP.org


A Congressional Budget Dictionary

March 27, 2015 at 10:03 am

Congressional Republicans are using complicated — and likely poll-tested — language to make their budget plans’ deep spending cuts and dramatic structural changes in key programs for low- and moderate-income people sound benign and even positive.

As Budget Committee member Sen. Chuck Grassley (R-IA) noted before the plans’ release, “From the standpoint of a budget, the less words of the English language you use, the better off you are.”

While it’s common practice for lawmakers to use language that puts their plans in the best possible light, it’s important to understand exactly what they mean.  Here are three key “translations”:

The House budget summary says:
It will make Pell Grants, which help more than 8 million students from low- and modest-income families afford college, “permanently sustainable.”

This turns out to mean:
The House budget would institute sharp funding cuts in Pell Grants, which in turn would make it harder for millions of students to afford college at a time when those costs are rising quickly.  Over time, this likely would reduce economic opportunity and the readiness of the U.S. workforce.

The House budget summary says:
The budget would convert both the Supplemental Nutrition Assistance Program (SNAP) and Medicaid to “State Flexibility Funds.”  It states that this would give state governments “the power to administer [SNAP] in ways that best fit the needs of their communities with greater incentives to achieve better results,” and also would “empower state policymakers to tailor their Medicaid programs based on the unique challenges they face.”

This means:
The budgets would convert SNAP and much or all of Medicaid to “block grants,” with fixed — and sharply reduced — federal funding.

The programs would no longer respond automatically to increased need due to rising poverty and unemployment during economic downturns.  And the combination of block grants and big funding cuts would leave states having to figure out whose benefits to cut or terminate.  The magnitude of the cuts would leave them without good options.  The SNAP cuts would force states to shrink or eliminate food assistance for millions of low-income families, while the Medicaid cuts would force them to make eligibility and benefit cuts that would likely leave millions of beneficiaries uninsured or underinsured (on top of the loss of coverage that millions of poor Americans would face due to the House and Senate budget plans’ repeal of health reform and its Medicaid expansion).

Finally, sometimes even silence needs a translation.  The House and Senate budgets make no mention of extending crucial provisions of the Earned Income Tax Credit (EITC) and the Child Tax Credit (CTC) for low- and modest-income working people now slated to expire at the end of 2017.

This means:
The plans would allow these provisions to expire,  thereby pushing more than 16 million people — including almost 8 million children — into or deeper into poverty and squandering the opportunity to help promote work, reduce poverty, and support children’s development.

Once you get beyond the euphemisms and flowery language, a clear agenda stands out in these plans:  shrinking government in substantial part through steep reductions in programs for low- and moderate-income Americans that, in turn, would lead to higher levels of poverty and inequality, less opportunity, and a future workforce that’s less able to compete with its counterparts overseas.

Health Reform Moves Forward as House Votes (Again) to Repeal

May 16, 2013 at 4:24 pm

The House is expected to vote today, for the 37th time, to repeal part or all of health reform.  Nevertheless, in the nearly two and a half years since the first such vote, health reform has made significant progress in achieving its basic goals: helping more Americans get affordable coverage, protecting consumers, and slowing cost growth across the health care system, both public and private.

Here’s a look at some of health reform’s accomplishments to date:

  • Free preventive care for tens of millions of Americans. Insurance companies now have to cover preventive care services at no charge, and Medicare provides preventive services without cost sharing, too.  As a result, nearly 105 million Americans received free preventive health care in 2011 and 2012, according to HHS.

    Preventive care includes screenings for chronic illnesses like diabetes and cancer, routine vaccines for adults and children, and other recommended care for kids, such as regular doctor visits.

    Better access to preventive care will help millions of families with their budgets and likely produce other benefits, such as fewer unnecessary deaths from disease, less spending on costly and avoidable illnesses, and a healthier population overall.

  • Protections for children and adults with serious illnesses. Health reform bars insurers from denying coverage to children with pre-existing health conditions like cancer, autism, or diabetes.  As a result, for the first time in most states, families with children with serious illnesses, chronic conditions, or special health care needs can buy coverage for their children in the individual health insurance market.

    Also, health reform’s ban on “lifetime limits” on health benefits means that people who get a serious illness won’t have to worry that their benefits will run out or that expensive treatments will push them into bankruptcy — or worse, that coverage limits will prevent them from getting lifesaving care.

  • More affordable prescriptions for more than 6 million seniors. Health reform has begun to close the “doughnut hole,” the gap in Medicare prescription drug coverage that many seniors experience once their annual drug costs exceed $2,930.

    Before health reform, seniors had no additional coverage until their costs hit about $6,600.  Now, seniors receive a 52.5 percent discount on brand-name drugs and a 21 percent discount on generic prescription drugs while they are in the coverage gap.

    More than 6 million Medicare beneficiaries have saved more than $6.1 billion as a result of these changes, according to HHS.

  • Initial steps to help slow health care costs. Some of health reform’s cost-control provisions, such as cutting overpayments to the private insurance plans that participate in Medicare, are already producing savings.  Other steps are underway to make the health care system more efficient by rewarding effective, high-value health care, although they may not yield results for several years.

    For example, Medicare is cutting payments to hospitals with high readmission rates in order to encourage them to prevent more avoidable readmissions.  Also, many physician-led “accountable care organizations” are up and running.  These organizations are structured to encourage health care providers to take responsibility for the cost and quality of care they deliver, potentially reining in costs.

4 Things We Won’t Achieve If Congress Repeals Health Reform

July 11, 2012 at 12:42 pm

The House of Representatives plans to vote today yet again on a bill to repeal the Affordable Care Act (ACA).  With that vote pending, it’s a good time to look at some of the law’s key provisions that would die under a repeal.

Yesterday, we listed four pieces of the law that have already taken effect.  Today, we take a closer look at four major, positive effects that the law will have over the next several years.

  1. Dramatic reduction in the number of uninsured. The ACA will reduce the number of uninsured by as many as 33 million by 2022 (see chart).  That will ensure that 93 percent of non-elderly legal U.S. residents will have insurance.
  2. More affordable insurance for individuals and families. Starting in 2014, many people who now struggle to afford health insurance will get help paying for premiums and out-of-pocket costs (like co-payments for doctor visits).  This help will come in the form of tax credits to help people buy coverage through the new health insurance marketplaces, called exchanges.
  3. Important protections for consumers. Starting in 2014, the ACA will bar insurance companies from denying coverage to anyone with pre-existing health conditions (the law’s current ban applies only to children).  This means that people who previously were shut out of the health insurance market because they had battled cancer or had had a relatively common procedure such as a c-section will be able to buy insurance and get the care they need.  Insurers also won’t be able to charge higher premiums to women or sicker people, and they will be sharply restricted in their ability to charge older people more.
  4. Progress in continuing to slow the growth of health care costs across the economy. Health care costs have risen more gradually in the last few years, but they continue to put pressure on the budgets of families and businesses, as well as public programs like Medicare and Medicaid.  The ACA takes a number of important steps to lower costs throughout the U.S. health care system and improve the quality of care by beginning to change the way health care is delivered.  Moreover, it has put Medicare on stronger financial footing, extending its solvency until 2024.

4 Things We Would Lose If Congress Repealed Health Reform

July 10, 2012 at 4:41 pm

The House of Representatives plans to vote tomorrow on a bill to repeal the Affordable Care Act — that is, health reform.  As with previous repeal votes, we think this is a good time to look at key provisions that are already having an impact.

1. Health insurance for 3.1 million young adults. Health reform requires insurers and employers that offer dependent coverage to allow parents to include children up to age 26 on their insurance plans.  As a result, 3.1 million more young adults had health insurance in December 2011 than in September 2010, according to the Department of Health and Human Services (HHS).

In the past, most insurance companies dropped children once they turned 19 or a few years later if they were students.  That’s one reason why nearly a third of all young adults lacked insurance in 2010 — a larger share than any other age group.

2. Free preventive care for tens of millions of Americans. Insurance companies now have to cover preventive care services at no charge, and Medicare provides preventive services for free now, too.  As a result, nearly 87 million Americans received a free preventive health care service last year, according to HHS:  54 million through private insurance and 32.5 million through Medicare.

Preventive care includes screenings for chronic illnesses like diabetes and cancer, routine vaccines for adults and children, and other recommended care for kids, such as regular doctor visits.

Better access to preventive care will help millions of families with their budgets and likely produce other benefits, such as fewer unnecessary deaths from disease, less spending on costly and avoidable illnesses, and a healthier population overall.

3. Protections for children and adults with serious illnesses. The Affordable Care Act bars insurance companies from denying coverage to children with pre-existing health conditions like cancer, autism, or diabetes.  As a result, for the first time in most states, families with children with serious illnesses, chronic conditions, or special health care needs can buy coverage for their children in the individual health insurance market.

Also, insurers can no longer cut off care for people with serious illnesses who need expensive medical care.  The Affordable Care Act bars insurers from imposing “lifetime limits” on benefits.  Now, people who get cancer or another illness that requires expensive treatments won’t have to worry that their benefits will run out or that the expensive treatments will push them into bankruptcy — or worse, that coverage limits will prevent them from getting lifesaving care.

4. More affordable prescriptions for more than 5 million seniors. Health reform has begun to close the “doughnut hole,” the gap in Medicare prescription drug coverage that many seniors experience once their annual drug costs exceed $2,930.  Before health reform, seniors had no additional coverage until their costs hit about $6,658.

Last year, seniors received a 50 percent discount on brand-name drugs and a 7 percent discount on generic prescription drugs while they were in the coverage gap.  This year, the generic discount jumps to 14 percent.

More than 5 million Medicare beneficiaries saved more than $3.2 billion in 2010 and 2011 as a result of these changes, according to HHS.  The law will close the entire doughnut hole by 2020.

More improvements to the nation’s health care system will take effect in the months and years ahead.  Tomorrow, we’ll look at five important benefits of the Affordable Care Act that won’t take effect if Congress repeals health reform.

Health Reform: What’s at Stake

June 14, 2012 at 10:02 am

Predicting how the Supreme Court will rule this month on the Affordable Care Act has become a popular parlor game in Washington, D.C.  Adding to the chatter, health insurance companies UnitedHealth, Humana, and Aetna made headlines this week when they promised to preserve several of the Affordable Care Act’s provisions — including extending dependent coverage up to age 26 — regardless of how the Court rules.

But those pledges aren’t universal among insurers, and they don’t include some of the key aspects of the ACA that will make dramatic improvements to both the health care system and the lives of tens of millions of people — including coverage of pre-existing conditions.

Insurer commitments alone won’t achieve the full set of gains that the ACA will.  The law has already made a difference to many Americans — and it has much more potential that’s yet to be realized.  Consider the opportunities that will be lost if the Supreme Court fails to uphold health reform:

1. Health coverage for tens of millions of the uninsured.

Health reform will make it possible for 33 million uninsured people to obtain health coverage by 2022, according to the Congressional Budget Office (see chart).

2. More affordable insurance for those who already have it.

Starting in 2014, many people who now struggle to afford health insurance will get help paying for premiums and out-of-pocket costs (like co-payments for doctor visits).  This help will come in the form of tax credits and help with cost-sharing for private coverage that people buy through the new health insurance marketplaces, called exchanges, that health reform will establish for each state.

3. Greater consumer protections.

Starting in 2014, the health reform law will bar insurance companies from denying coverage to anyone with pre-existing health conditions — including those who are currently uninsured (the law’s current ban applies only to children).  This means that people who previously couldn’t buy health insurance at any price because they had cancer or had had a relatively common procedure such as a c-section will be able to buy insurance and get the care they need.