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Laura Groshong, LICSW, CSWA Director, Policy and Practice
One thing to keep in mind as we try to make sense of the chaotic developments over the past week is that the Affordable Care Act, with President Trump’s help, has become a political football, with winners and losers as to its fate. The real winners and losers will be our patients who may find themselves able to continue to receive mental health services, without plans that cover mental health services, or without insurance at all.
President Trump’s ire at the inability of the Senate – and the specific senators who opposed the three attempts to repeal and replace ACA – has intensified to the point where he decided to issue an executive order last Friday which would undermine the funding of the ACA by removing the subsidies to insurers for ACA plans, i.e., cost-sharing reductions, that make the finances work. Since plans had to announce their rates for 2018 last week, many raised premiums up to 40%, which will price most of the ACA plans out of reach for those who need them. There was no pressure the President to do this; insurers were willing to make the usual 8-10% increases that have funded the ACA until a few weeks ago. The President’s ongoing threats to repeal the ACA himself had an effect on the ACA markets and led to these increases. Some states that saw the possibility premiums would be raised a lot created funds to cover the shortfall. A list of these states is being compiled and will be sent out shortly. There may be more states that choose to protect their citizens by finding a way to fund the ACA plans as well. It may, however, be too late to keep rates affordable in 2018.
What does this have to do with LCSWs? The main way that the ACA is beneficial to mental health and substance use treatment is that they are one of the ten ‘essential benefits’ which must be covered by all plans. This guarantees a mental health/substance use benefit. Those of us on the younger side of 40 may not remember what plans were like before the ACA. A brief history of those bad old days – there were many plans that simply did not cover mental health because they did not have to; it was perceived as expensive; and there was no accounting for medical cost-offsets when people had access to MH/SA treatment.
So our patients’ ability to get coverage for our services is in peril unless the essential benefits are maintained in some form. This is where the bill being developed by Sen. Lamar Alexander (R-TN) and Sen. Patty Murray (D-WA) comes in. As Chair and Ranking Member of the HELP Committee, they have been looking for a way to tweak the ACA for the past nine months. The Alexander-Murray deal would continue the insurer subsidies for two years, while establishing new flexibility for states in mandating penalties for those who do not have insurance and other parts of the ACA. While it is not a perfect solution, the return to bipartisan process is almost as important as what the bill actually says. Somehow in the course of this unfortunate path we have been on, the President now believes that Congress has failed to do its job in not repealing the ACA and it is up to him to do so in a piecemeal way. This means that the President has become an enemy of bipartisan politics, a method to form compromise that CSWA stands firmly behind.
Whether the Senate can find the will to bring the Alexander-Murray bill to the floor or get a vote on it is unclear at this time. It will take some spine, some luck, and much continued encouragement on our part to get our senators to do the right thing and preserve the ACA.
If you can meet with your senators this week, do so. They are in district. If not, please send them, Sens. McConnell, Alexander, Murray, McCain, Murkowski, and Collins the following message at https://www.senate.gov/senators/contact/ : “I am an LCSW and a member of the Clinical Social Work Association and [your state society]. Please support the Alexander-Murray bill and encourage Sen. McConnell to schedule it for a vote. Without continuing the Affordable Care Act in some form, our citizens may not have access to the mental health and substance use services that they need. We are in the midst of an opioid crisis; the majority of people affected by it also have mental health problems. Please preserve the ACA and mental health/substance use treatment as an essential benefit.”
As always, let me know when you have sent your messages.
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