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The National Voice of Clinical Social Work 

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Legislative Alerts

CSWA Director of Legislation and Policy, Laura Groshong regularly provides Legislative/Regulatory Alerts to the membership to keep them informed about important legislation or regulations that have been introduced at the national level.  In addition to keeping members informed, the CSWA also monitors all current national legislation that affects clinical social workers and the need for action to members of Congress. The list of Legislative Alerts listed below allows members to review the history of CSWA action on national bills in Congress that affect clinical social workers and the outcomes of our actions.

  • 02 Nov 2017 12:53 PM | CSWA Administrator (Administrator)

    CSWA is part of more than 200 Groups Support Alexander-Murray Bipartisan Short-Term Legislation to Stabilize Premiums, Protect Access to Insurance | View the letter submitted by the Mental Health Liaison Group (MHLG)

  • 18 Oct 2017 5:44 PM | CSWA Administrator (Administrator)

    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 : “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.

  • 26 Sep 2017 3:27 PM | CSWA Administrator (Administrator)

    I am pleased to report that the Graham-Cassidy bill has been shelved.  This is a huge victory for all people in favor of the Affordable Care Act and the way it has helped our country.  Please thank Senators McCain, Collins and Paul for standing up to this terrible bill.  And thanks to all who have worked with CSWA to make this possible.  I am traveling right now but will be sending more information tomorrow. 

    Laura Groshong, LICSW, Director, Policy and Practice
    Clinical Social Work Association
    The National Voice of Clinical Social Work
    Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY

  • 22 Sep 2017 3:10 PM | CSWA Administrator (Administrator)

    Dear CSWA Members,

    Sen. John McCain has just joined Sen. Rand Paul to oppose the Graham-Cassidy-Heller-Johnson bill to repeal the Affordable Care Act making it almost impossible for the Senate to pass this bill.

    Thanks to all CSWA members who sent messages to your Senators.  Please write them thank you notes if they are one of the above named group who oppose this terrible bill.

    While the Senate has until September 30 to repeal the ACA with only 51 votes, the likelihood of this happening is now slim.  I will keep you posted on further developments.

  • 19 Sep 2017 11:47 PM | CSWA Administrator (Administrator)

    You have no doubt heard about the competing bills to revise or repeal the Affordable Care Act. One is the Alexander-Murray bill be reviewed in the Senate HELP Committee which seeks to tweak the ACA but maintain the parts that allow those who have been able to gain insurance to keep it.  The other is the Graham-Cassidy bill which will essentially replace the ACA in the way that many previously proposed Republican-driven bills would have with a bill that would cause millions of ACA-covered citizens to lose care.

    I know we are all struggling with health care ‘fatigue’ but we need to make one more effort to stop the bill that would severely impact access to health care.

    The basic thrust of Graham-Cassidy is to turn everything over to the states for funding health care through block grants, would remove essential benefits.  It is similar to the "skinny" version of House American Health Care Act which would likely result in about 22 million people losing insurance as the other Republican bills would have.

    Please go to and send the following message to your senators.

    "I am a licensed clinical social worker and a member of the Clinical Social Work Association [and/or your Society].  I have serious concerns about the way that my patients will be affected by the Graham-Cassidy bill that will repeal the Affordable Care Act.  The elimination of the essential health benefits, which include mental health and substance use treatment, will surely severely limit access to care for these life-threatening conditions to millions of Americans. The opioid crisis we face requires more, not less, funding. Before the Affordable Care Act went into effect, many desperate individuals and families went bankrupt trying to pay for the costs associated with chronic emotional disorders.   No matter what you may have heard, the costs associated with these conditions have been LOWERED over the past six years; the proposed changes to Medicaid and the elimination of universal inclusion of mental health treatment as a benefit, will be devastating to millions of Americans.  If we do not care for the most vulnerable among us, we have lost that compass. The bill being considered by the HELP Committee will be much more reasonable.  Please vote for the Alexander-Murray bill, not the Graham-Cassidy bill."

    As always let me know when your messages have been sent.

  • 04 Aug 2017 4:33 PM | CSWA Administrator (Administrator)

    Our Government Relations Committee has been carefully tracking the eight attempts in Congress to repeal and replace the Affordable Care Act over the past four months. We are pleased that none of the proposed attempts has been passed by both Houses.

    One of the major drawbacks to the process from CSWA’s point of view has been the partisanship that has led to only the majority party crafting the bills that were considered. Bipartisanship is the only way a reasonable bill to improve the ACA can be developed. Both Houses now have working groups that will be trying to accomplish this. It remains to be seen whether leadership will support these groups.

    I want to draw your attention to part of a speech given by Sen.John McCain (R-AZ) on July 25 that supports the importance of bipartisanship eloquently.

    “…I hope we can again rely on humility, on our need to cooperate, on our dependence on each other to learn how to trust each other again and by so doing better serve the people who elected us. Stop listening to the bombastic loudmouths on the radio and television and the Internet. To hell with them. They don’t want anything done for the public good. Our incapacity is their livelihood.
    Let’s trust each other. Let’s return to regular order. We’ve been spinning our wheels on too many important issues because we keep trying to find a way to win without help from across the aisle. That’s an approach that’s been employed by both sides, mandating legislation from the top down, without any support from the other side, with all the parliamentary maneuvers that requires…. 

    What have we to lose by trying to work together to find those solutions? We're not getting much done apart. I don't think any of us feels very proud of our incapacity. Merely preventing your political opponents from doing what they want isn't the most inspiring work. There's greater satisfaction in respecting our differences, but not letting them prevent agreements that don't require abandonment of core principles, agreements made in good faith that help improve lives and protect the American people...” To read or see the whole speech go to

  • 28 Jul 2017 12:03 PM | CSWA Administrator (Administrator)

    In the dead of night this morning, an attempt was made was made to by Sen. Mitch McConnell, Senate Majority Leader (R-KY), to pass a repeal of the Affordable care act through a "skinny" version of the House American Health Care Act which had been passed by the House.  The bill, which was released two hours prior to the vote, had little "debate" and no committee hearing.  

    I can't thank all of you who contacted your senators and other senators about what ending the ACA would do for access to mental health treatment enough.  The senators who prevented this disaster for millions of Americans should be thanked include Sens. Lisa Murkowski (R-AK), Susan Collins (R-ME), and most importantly, John McCain (R-AZ) who had just undergone brain surgery and made the bravest decision of his career in voting against this bill.  Please make calls to them for their principled stance.  

    Also thank Sen. Patty Murray (D-WA) for her last ditch attempt to have the bill sent to the HELP Committee before the vote to approve it which, though it failed, showed the Senate how far from usual process it had strayed. Please make calls to all the senators above using the link thank your own senators if any of them opposed this bill.

    We will see if there is any last gasp effort by the Senate to ram through some version of this bill but at this time it appears unlikely. 

    As always, let me know when you have made your calls.

  • 26 Jul 2017 5:09 PM | CSWA Administrator (Administrator)

    The first vote on the Senate health care repeal and replace bill, the Better Care Reconciliation Act, has failed but there are many votes to go before the fate of the Affordable Care Act is decided.

    As the debate to repeal and replace the Affordable Care Act continues, it is important for us as clinical social workers to keep our focus on the way that all the bills that have been considered would affect patient access to mental health and substance use treatment.  The elimination of essential benefits would return insurance plans to the days when they could pick and choose benefits and often left out mental health coverage. Another group that will be harmed if the essential benefits are eliminated are women - maternity and gynecology benefits were also typically not covered before the ACA.

    The bill that will actually be voted on is still not clear. However, the plan to repeal the mandated payment for those who do not choose to get insurance, now being called the "bare-bones" plan or the "skinny repeal" plan, is gaining steam and will severely erode the funding base for those covered by the ACA in Medicaid and the individual market. 

    There is still great confusion about the plan that will eventually be voted on, but here is a message that will keep CSWA's concerns in front of your senators:

    "I am a member of the Clinical Social Work Association and a constituent.  Please make sure that mental health needs remain covered as they are in the Affordable Care Act.  Make sure that the maternity and medical needs of women remain covered. Finally keep Medicaid expansion without caps and the mandated payment in place.  We need all these components to avoid serious risks to coverage of the health and mental health of our citizens."

    To contact your senators, go to and enter your state.  To contact Republican senators most likely to support our views, go to    and contact as many as possible.

    As always, let me know when you have made your calls.

  • 25 Jul 2017 6:31 PM | CSWA Administrator (Administrator)

    Dear CSWA Members,

    As discussed in yesterday's post (below), the US Senate voted 51-50 today to proceed with debate on repealing and/or replacing the Affordable Care Act.  This debate could include discussion of the American Health Care Act, the House bill which has passed to the Senate, the Better Care Reconciliation Act in the Senate which has failed to pass twice, or be a simple repeal with a replacement to follow.

    The AHCA and the BCRA are much more similar than they are different. Both would seriously undermine access to mental health treatment by removing essential benefits; remove mental health parity from Medicare; cut access to Medicaid using caps and/or block grants; and possibly create plans which would eliminate coverage of pre-existing conditions.

    There is a new wrinkle in the announcement by the Senate Parliamentarian, Elizabeth MacDonough, that some of the provisions in the bills may require 60 votes to pass, as opposed to the 51 currently being sought.  That would significantly change the likelihood that the bills could be passed.

    I will be sending messages over the 20 hours of debate allowed, which will probably take no more than a few days, to send to your Senators. There will be many amendments that are yet to be announced. 

    This has been a marathon campaign and we need to keep fighting the changes being proposed that would harm our work as clinical social workers and our patients' access to treatment.

  • 24 Jul 2017 9:30 PM | CSWA Administrator (Administrator)

    Dear CSWA Members,

    As you know, a vote on a health care bill that would allow debate on whether to repeal and/or replace the Affordable Care Act has been scheduled in the Senate tomorrow.  There is no clarity from leadership exactly about what will be in the bill. Therefore, it is difficult for CSWA to give specific guidance any what message to give your senators.  Here is a summary of the possible bill that will be voted on.

    1. A bill that will repeal the ACA without replacing it, with the goal of passing a replacement prior to the 2018 elections.
    2. The Better Care Reconciliation ACT which will include caps on Medicaid, eliminate the essential benefits, and allow some pre-existing conditions to be the basis for denying insurance.
    3. The American Health Care Act which was passed by the House a month ago and has much of what is in the BCRA.
    4. A bill which has not been discussed and will some new version of the bills above.

    The CBO score on the BCRA, which came out last Monday, had the same 22-23 million that would lose insurance as the AHCA. 

    All the bills we have heard about are damaging to access to mental health treatment, mental health parity, and coverage for Medicaid enrollees who need mental health services.

    I will let you know more when the actual bill is finally revealed.  In CSWA's view, this process is an example of bad governance.  It seems very politically based and has little to do with people getting good health care or actually improving the ACA.

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