July 24, 2017

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.

July 17, 2017

There has been an unexpected development since Friday when Sen. McConnell had announced his intention to vote on the BCRA to repeal and replace the Affordable Care Act tomorrow.

Sen. McCain has had surgery for a blood clot above his left eye which will mean he cannot attend the Senate this week. This means that the vote on BCRA is more fragile than it had been, though Sen. McCain's vote was not a certain yes or no.

We have a little time to work on stopping this bad bill. Please continue to call your Governors and Senators to let them know you oppose it.

ADDITIONALLY - ask the senators who are no votes (all Democrats, Ron Paul and Susan Collins) or leaning no to come together as a group to request a new process - that the bill get bipartisan support to receive the thoughtful open transparent process it deserves.

lease review the issues which I sent out in my posts of June 12 and June 19 which detail how these bills are harmful to people with mental health needs including the possible loss of essential benefits, including mental health and substance use for states who choose waivers to Medicaid; the extreme cuts to Medicaid, with the bulk of lost insurance being people covered by Medicaid; and the end of required coverage for pre-existing conditions for state that choose waivers for Medicaid.

Also – please call Sen. Susan Collins (R-ME) to thank her for her principled opposition to this bill at (202) 224-2523.

The main political issue is whether there are three senators willing to vote against this deeply flawed bill. We need to continue to oppose this bill with the senators who are wavering on their vote, mainly the more moderate Republicans.

Here is the message I am suggesting with the contact information for these Senators:

Call these Senators today to ask them to oppose the AHCA without protections for substance use disorders and mental health.

A list of key decision-making Senators to call is below:

• Capito (R-WV) | (202) 224-6472
• Cassidy (R-LA) | (202) 224-5824
• Heller (R-NV) | (202) 224-6244
• Murkowski (R-AK) | (202) 224-6665
• Portman (R-OH) | (202) 224-3353
• Sullivan (R-AK) | (202) 224-3004
• Flake (R-AZ) | (202) 224-4521

Sample call script:

I am a constituent [if you are] and a member of the Clinical Social Work Association. Please oppose the Better Care Reconciliation Act of 2017. Please join with other Senators who have concerns about this bill and develop a bipartisan group to give it the thoughtful open transparent process it deserves. [Your name, degree, contact information]

If you wish to contact other Republican Senators, you can do so by going to https://www.senate.gov/general/contact_information/senators_cfm.cfm where you will find all the phone numbers for U.S. Senators.

One other way to oppose this bill is to contact your Governor and ask your Governor to let your state’s senators know that your Governor opposes this bill. The same message can be used.

As always, let me know when you have sent messages.

July 14, 2017

We are approaching our final chance to stop the Better Care Reconciliation Act. Even if you have called the Senators listed below, please call them again to oppose this bill. The CBO score will come out on Monday, July 17, and the bill will be voted on Tuesday, July 18.

Please review the issues which I sent out in my posts of June 12 and June 19 which detail how these bills are harmful to people with mental health needs including the possible loss of essential benefits, including mental health and substance use for states who choose waivers to Medicaid; the extreme cuts to Medicaid, with the bulk of lost insurance being people covered by Medicaid; and the end of required coverage for pre-existing conditions for state that choose waivers for Medicaid.

Also – please call Sen. Susan Collins (R-ME) to thank her for her principled opposition to this bill at (202) 224-2523.

The main political issue is whether there are three senators willing to vote against this deeply flawed bill. We need to continue to oppose this bill with the senators who are wavering on their vote, mainly the more moderate Republicans.

Here is the message I am suggesting with the contact information for these Senators:

Call these Senators today to ask them to oppose the AHCA without protections for substance use disorders and mental health.

A list of key decision-making Senators to call is below:

• Capito (R-WV) | (202) 224-6472
• Cassidy (R-LA) | (202) 224-5824
• Heller (R-NV) | (202) 224-6244
• Murkowski (R-AK) | (202) 224-6665
• Portman (R-OH) | (202) 224-3353
• Sullivan (R-AK) | (202) 224-3004
• Flake (R-AZ) | (202) 224-4521

Sample call script:

I am a constituent [if you are] and a member of the Clinical Social Work Association. Please oppose the Better Care Reconciliation Act of 2017 which will not protect the coverage needed for mental health disorders, substance use disorders, and will severely cut Medicaid coverage. These policies would increase costs for everyone by increasing the use of emergency rooms and law enforcement as the place that these disorders will be addressed. BCRA will cause emotional suffering for those who need help. [Your name, degree, contact information]

If you wish to contact other Republican Senators, you can do so by going to https://www.senate.gov/general/contact_information/senators_cfm.cfm where you will find all the phone numbers for U.S. Senators.

One other way to oppose this bill is to contact your Governor and ask your Governor to let your state’s senators know that your Governor opposes this bill. The same message can be used.

As always, let me know when you have sent messages.

July 10, 2017

Here is an update on the Better Care Reconciliation Act of 2017 in the Senate.

There are seven Republican senators who have announced that they will not vote it in its present form. This means that the bill cannot pass. Majority Leader Mitch McConnell has said he may “be forced” to work with Democrats to shore up the individual markets if the bill is not viable.

CSWA believes that a bi-partisan approach to health care is by far the best solution. Please do not take for granted that your senators will take this approach, even if they are Democrats. Call your senators today with the following message:

“I am a member of the Clinical Social Work Association and a constituent. Please support a bi-partisan effort to improve the Affordable Care Act by shoring up the individual market subsidies. The mental health of our citizens will be jeopardized without this support.”

You can find telephone numbers and email addresses at https://www.senate.gov/general/contact_information/senators_cfm.cfm.

As always, let me know when you have contacted your senators. Please let me know if you have any questions.

June 27, 2017

The Senate Better Care Reconciliation Act of 2017 has been put on hold until after July 10, due to the fact that four senators have announced they will not vote for it. This means it will not pass the Senate.

Adjustments to the bill will be considered after next week’s recess. This means there will only be 15 days to consider the bill, an amended version of the American Health Care Act from the House, in July. Leadership in the Senate has said that the bill must be voted on before the August recess.

Many thanks to all the CSWA members who have contributed to the tidal wave of resistance to the BCRA. Please try to meet with your senators next week or attend town halls to express the importance of coverage for Medicaid expansion; maintaining mental health and substance use treatment as a required benefit; and coverage of pre-existing conditions.

June 26, 2017

The Congressional Budget Score (CBO) for the Senate amendment to the House bill HB 1628 was released today, and as many have predicted, it is as potentially damaging, in some different ways, for the poor with mental health problems, as House bill is. Of course this populations are known to have higher mental health needs (33%) than the country as a whole.

The Better Care Reconciliation Act of 2017, the Senate bill to replace the ACA, will mean that 22 million people will lose health care by 2026, with 18 million losing it next year. This is almost exactly what the CBO score for the House AHCA bill, which predicted 23 million would lose health insurance, said.

Please review the issues which I sent out in my posts of June 12 and June 19 which detail how these bills are harmful to people with mental health needs including the possible loss of essential benefits, including mental health and substance use for states who choose waivers to Medicaid; the extreme cuts to Medicaid, with the bulk of lost insurance being people covered by Medicaid; and the end of required coverage for pre-existing conditions for state that choose waivers for Medicaid.

The main political issue is whether there are three senators willing to vote against this deeply flawed bill. We need to continue to oppose this bill with the senators who are wavering on their vote, mainly the more moderate Republicans.

Here is the message I am suggesting with the contact information for these Senators:

Call these Senators today to ask them to oppose the AHCA without protections for substance use disorders and mental health.

A list of key decision-making Senators to call is below:

Sample call script:

I am a constituent [if you are] and a member of the Clinical Social Work Association. Please oppose the Better Care Reconciliation Act of 2017 which will not protect the coverage needed for mental health disorders, substance use disorders, and will severely cut Medicaid coverage. These policies would increase costs for everyone by increasing the use of emergency rooms and law enforcement as the place that these disorders will be addressed. BCRA will cause emotional suffering for those who need help. [Your name, degree, contact information]

If you wish to contact other Republican Senators, you can do so by going to https://www.senate.gov/general/contact_information/senators_cfm.cfm where you will find all the phone numbers for U.S. Senators.

One other possible way to oppose this bill is to contact your Governor and ask your Governor to let your state’s senators know that your Governor opposes this bill. The same message can be used.

As always, let me know when you have sent messages.

June 22, 2017

Thanks to grassroots pressure to members of the Senate (including from many CSWA members – thank you!), Majority Leader McConnell has made the draft of the Senate's version of the House American Health Care Act available for review. Titled the Better Care Reconciliation Act of 2017, this bill is not to be considered a finished version; changes are likely to be negotiated right up to next week's planned vote.

As it currently stands, the BCRA could severely limit Medicaid through state-determined waivers and per-capita caps on enrollment. It would exclude services available to women under Planned Parenthood and services available to children under the CHIP program. Additionally, states would be able to redefine what constitutes pre-existing conditions and how they determine what essential benefits are.

High risk conditions including addictions, PTSD and serious mental health disorders have nowhere near the funding that is needed to cover them in this version. Medicaid enrollees have a 33% higher rate of these conditions and would thus be more severely affected in states that choose to put caps on Medicaid enrollment.

Since there is so much that is yet to be determined about this bill, CSWA is not prepared to offer any message different from the one that we recommended on Monday. Please continue to make calls to senators in opposition to per-capita caps to Medicaid/the end of Medicaid expansion, and in support of preserving essential benefits at the federal level.

June 20, 2017

CSWA has been asked to make one more set of phone calls TOMORROW, June 20, 2017, National Call-in Day, to oppose the American Health Care Act. The AHCA which came over from the House of Representatives, will severely curtail access to mental health treatment and substance use treatment in the public and private insurance sectors, severely cut Medicaid coverage, and eliminate the essential benefits of the Affordable Care Act which require that mental health coverage be included in every policy at parity with medical coverage.

Even if you have called already, please call again. If you have not called your senators, here is your last best chance to let your senators know that you oppose this bill. The Senate is gearing up for a vote on such legislation by the end of next week, so NOW is the time to speak up and protect mental health and Medicaid.

Taking action is easy:

1. Dial this number on June 20, 2017 between 9-5 EDT: 202-224-3121

2. Ask for your Senator.

3. Use this message: “I am a constituent and a member of the Clinical Social Work Association, calling about the American Health Care Act. I urge you to oppose any proposal that results in cuts or rollbacks of Medicaid or cuts to the essential benefits. AHCA directly targets important health care protections like the essential health benefits, coverage of pre-existing conditions and eliminates mental health parity in health care. I’m calling from [city, state, and zip] and my name is [first and last name].”

4. Call your other Senator and share the same message!

As always, let me know when your calls have been made at lwgroshong@clinicalsocialworkassociation.org.

June 12, 2017

The Senate has put the American Health Care Act on a fast track for passage. The form this bill will take is unclear. CSWA encourages all members to contact a small group of moderate Republicans who may determine the fate of mental health coverage and Medicaid coverage. Please review the posts CSWA sent on May 4 and May 25 on these topics.

Below are the office numbers, twitter accounts, and Facebook accounts for these senators. Please take a moment to send the messages CSWA has provided.

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

- Laura Groshong, LICSW, CSWA Director of Policy and Practice

URGE KEY SENATORS TO OPPOSE AHCA UNLESS MEDICAID AND MENTAL HEALTH COVERAGE

Senators are considering the American Health Care Act (AHCA) in preparation for a possible vote by the 4th of July. As passed by the House, the AHCA would repeal major provisions of the Affordable Care Act (ACA) (aka Obamacare) by:

· Ending the guaranteed coverage of substance use disorders and mental health treatment services

· Cutting Medicaid by $880 billion and stripping more than 20 million people of their health insurance

With very narrow margins in the Senate, it will only take 3 Senators to stop the AHCA without protections for substance use disorders and mental health treatment from passing the Senate.

Call these Senators today to ask them to oppose the AHCA without protections for substance use disorders and mental health.

A list of key decision-making Senators to call is below:

Sample call script:

I am a constituent [if you are] and a member of the Clinical Social Work Association. Please urge the Senator to oppose the AHCA bill without required coverage for mental health disorders, substance use disorders, and with caps to Medicaid. These policies would increase costs for everyone and cause emotional suffering for those who need help.

Social Media

You can also contact senators through social media. Social media handles for key Senators are listed below:

Sample Twitter Posts

@[Twitter Handle]: I ask you to oppose the #AHCA without protections for substance use disorders and #mentalhealth.

Please #VoteNoAHCA.

Note: the period in front of the Twitter handle is important to ensure that it is posted visibly on the senators' page.

Sample Facebook Posts

In the face of the #opioid overdose and suicide epidemics, equal and affordable access to a full continuum of substance use disorder and mental health treatment services must be an essential component of health care coverage.

#Medicaid coverage is a critical lifeline for millions of Americans with substance use disorders and #mentalillness. Cutting or capping Medicaid and ending the Medicaid expansion will be devastating to those who can’t afford health care in the private market.

[Facebook handle], please ensure that no American loses the access to life-saving substance use disorder and mental health treatment that they have today.

I ask you to #VoteNoAHCA.

May 25, 2017

Here is a report on where we stand with the repeal and replace the ACA regarding Medicaid sort of at the halfway mark. There are some issues that are becoming clearer that I wanted to share with you. We need to be educators for our members of Congress and state Governors right now. There is much confusion about what the proposed ‘fixes’ and cuts to Medicaid would do. The interconnectedness of Medicaid, Medicare, private insurance, and employer based insurance is being ignored so that the only ones who will have access to affordable health care are the wealthy.

First, the Congressional Budget Score (CBO) for the House American Health Care Act (AHCA), which came out yesterday almost two weeks after the bill passed, has little difference from the first version of the bill. The tax breaks for the wealthy, lowering the deficit, and leaving 23-24 million currently covered by insurance uncovered are the same, though there are some minor changes.

What is clearer is that those on Medicaid specifically are the group that is targeted. We all know the difficulties with Medicaid from a LCSW point of view – the restrictions in some states for our providing care, the low reimbursement rates in many states, the paperwork hassles, etc. Nevertheless, CSWA believes that our ethics and values compel us to make the effort to include some Medicaid clients in our practice. There is a pragmatic reason for this. If Medicaid enrollees do not have health insurance, they will wind up using emergency rooms. This is the most expensive form of care and will raise premiums for everyone.

I was on a conference call with several national Medicaid advocates yesterday and learned that the Senate is not planning to protect the Medicaid enrollees in their version of the AHCA bill. Keep in mind that 50% of the 74 million Medicaid enrollees are children; 25% are disabled (many with mental health disorders), and 20% are elderly. States will have to cover these people if federal funding ends. Most members of Congress, especially the ‘gang of 13’ who are writing the Senate version of the AHCA, are in denial about this. The main attitude is still that there are a majority of people on Medicaid who COULD work and are just lazy, as opposed to at most 5% who are able to work (and unlikely to be lazy).

BACKGROUND ISSUES

1. Medicaid is not part of AHCA; cutting insurance for Medicaid enrollees will not solve the cost problems with the ACA, it will increase them.

2. The “per capita caps”, a new mechanism for cutting Medicaid enrollees by having a block grant that is an absolute limit with NO adjustment for Medicaid increase or decrease in enrollees. This eliminates the current extra Federal help if Medicaid enrollees increase. It is especially important to get this point across to Republican Governors who will be on the firing line if this goes through.

3. CHIP, the main coverage for children, sits on the shoulder of Medicaid. If Medicaid is cut, CHIP will fail. No one can justify preventing children in poverty from having access to health care.

4. The current plans in the AHCA will cost shift Medicaid to the states. Congress seems unwilling to look at how devastating that will be for state budgets.

ACTION ITEM

Here is what we need to do this next week of Memorial Day. Congress is in recess and members are back in district. This is the time we need to have meetings with them and clarify the following:

1. Explain the above issues to all your members of Congress or staff next week in person.

2. Ask Republican Senators to commit to NO per capita caps.

3. Ask Republican Senators to commit to maintaining Medicaid expansion.

4. Stop making absolute caps the way to cut services.

Set up visits now! Even if you have senators who are unfriendly to our views, visit them. Go with a group from your Society if you can. Let me know what the results of these meetings are. It will also be useful to meet with your representatives.

Medicaid is the stepchild of health care but it is also the way to improve the overall health care system. Please help educate our members of Congress and governors.