Senate Health Care Reform Bill Close to Passage - 12-20-09

This action will send this bill with the previously passed House bill, H.R. 3692, the Affordable Health Care for America Act, to a conference committee. It is likely that the result of that committee will be closer to the Senate bill than the House bill, which has a public option, and would cover approximately 36 million people, as opposed to the 30 million that would be covered by the Senate's version.

A last minute amendment by Sen. Debbie Stabenow (D-MI) will create Centers of Excellence for Depression (SEC. 10410) which would study and provide data about successful treatments for depression.  I have been in touch with Sen. Stabenow's staff about the importance of including psychotherapy of all types, as well as combination of medication and therapy in the areas being studied, and they assure me that this in their intention.  For a complete list of the over 200 amendments, go to the CSWA website at www.clinicalsocialworkassociation.org under "Legislative Topics; Policy Papers Letters" on the left side of the home page.

As I previously noted, these bills are viewed differently by different people.  It could be a test of whether you see a glass as half full or half empty.  Though many hoped-for reforms are not included in these bills, i.e., a single payer plan, expansion of Medicare, a public option, there are many positive steps toward improving health care coverage and ending exclusionary insurance practices in one or both bills:

·    30 million more people overall will be covered in 2-3 years - an average of 150,000 lives will be saved over 10 years

·    Strict insurance market reforms - ending insurers' refusal to provide insurance for pre-existing conditions; ending rescission of insurance when an enrollee becomes ill; and ending gender discrimination

·    Expansion of Medicaid to 133% or 150% of Federal poverty level (currently 100%)

·   New preventive and wellness coverage

·    Federal subsidies for individual plans and some small group plans

·    Restriction of insurance company administrative costs to 15% (currently average 20-25%) for large groups; and small groups or individual plans which exceed 20% in administrative costs must submit an explanation for these costs

Also as noted earlier, for Licensed Clinical Social Workers, the Senate bill includes most of the points that CSWA has had as priorities in health care reform, the Senate bill includes the following:

1)    reinstatement for LCSWs as independent clinicians in Medicare Part A (as of 10/1/11);

2)    mental health parity requirements for all plans (while this is likely to include expanded mental health benefits and coverage of more DSM-IV-TR diagnoses, the parity 'formula' is yet to be determined);

3)    the Social Security Administration definition of clinical social work (significant because clinical social work has not been defined in most health care reform bills to date);

4)    $8 million in grant money for schools of social work to alleviate the shortage of social workers at the Bachelor and Master's level identified by the Department of Labor;

5)    $10 million in grant money specifically for training of clinicians to work with children and adolescents with emotional problems; and

6)    creation of 30 Centers of Excellence for Depression through SAMHSA funding of $100,000,000 for 2011-15 and $150,000,000 for 2016-20; academic institutions, including schools of social work, and clinical agencies will be eligible for these grants.

It does not appear that action is necessary to pass H.R. 3950, though calling or emailing your senators in support of this bill would be fine. I will keep you informed on the progress of health care reform and wish you a happy holiday season.