Last week the US Senate began hearings on a bipartisan effort to provide greater short-term or moderate term stability to the health benefit exchanges which depend upon federal subsidies to provide affordable health insurance to individuals who do not qualify for Medicaid or employer insurance.
These exchanges also depend upon the mandate that everyone must pay at least part of their health insurance if they have above Medicaid incomes, which is the single part of the Affordable Care Act that Republicans have most strongly campaigned to eliminate. Continue reading Growing Washington bipartisanship on many issues gives hope for healthcare future, but everything is still at risk.
In discussing this year’s state budget most of our attention has gone to the re-realignment of in-home support services back to counties in a form that will divert $36 million of realignment funds that otherwise would have gone to mental health – and increasing amounts in future years the could total as much as $200 million annually after six years – unless there are changes made to this legislation. Viewed in total dollars at risk over the long term this action alone makes it a bad budget year for mental health and substance use disorders. But in terms of advocacy and support we got just about everything else we were seeking, so we have to view the budget overall in a positive way similar to the press release that the County Behavioral Health Directors Association recently sent out.
At the start of 2017, CCCBHA’s highest priority was to secure funding for the children’s crisis care system. This had been approved in the 2016-17 state budget. But in presenting his 2017-18 budget Governor Brown eliminated $17 million in funding for that program, as well as $67.5 million for mental health and substance use disorder services and facilities for people discharged from state prisons. Continue reading The State budget has more good news than bad, but federal uncertainty is still the elephant in the room
Last week the House of Representatives passed the American Health Care Act by the narrowest of margins, with all Democrats and 20 Republicans voting no. It succeeded because of amendments to satisfy the so-called “Freedom Caucus” of very conservative Republicans who objected to the bill in March because it left too much of the Affordable Care Act intact.
The key amendment was to allow states to eliminate pre-existing condition protections replacing that with high risk pools that could be subsidized with federal funds.
The focus on pre-existing conditions got all the news media attention and certainly will adversely affect people with mental illnesses and substance use disorders both of which would be considered pre-existing conditions – even if the only treatment was one or two visits to a therapist, or a single prescription for an antidepressant. Continue reading AHCA approved by House. What does its passage mean in California?
Another Attempt to Weaken the Affordable Care Act?
Grassroots advocacy is making a difference.
As widely reported, there is a new version of Trump care/House Republican efforts to weaken the Affordable Care Act (ACA). The changes give states additional freedom to eliminate protections for people with pre-existing health conditions. Anyone who has ever received a prescription for an antidepressant or seen a therapist is considered one of those high risk individuals. The new bill also authorizes elimination of 10 essential benefits. These include behavioral health as well as habilitation and rehabilitation services important to people with behavioral health problems.
All of the Medicaid cuts there were in the original proposal are still there. The changes satisfied the so-called freedom Caucus of extreme conservative Republicans. On the other hand it has strengthened the opposition of so-called moderate Republicans. Here is a brief presentation summarizing the status of this effort and other related possible health policy changes. Note especially the charts on pages three and 13.
When the original bill was considered last month all 14 California Republicans were reported to be in support. Now we have heard that Congressman Jeff Denham from the northern San Joaquin Valley is not supporting the bill. This means that the grassroots efforts of organizations like ours are making a difference. See Sacramento Bee Article.
Unless the bill has been passed by the house before you read this, those of you who provide services in areas represented by Republicans in Congress should redouble your efforts to remind these members of the consequences of cuts in behavioral health services and access to insurance which includes these benefits.
There has never been a time when there’s been so much public attention on how health care systems work. This is the time for all of you to continue to expand your efforts to educate your political leaders and build relationships that will impact policy support beyond this year. These efforts will pay off, even if it doesn’t appear that way in terms of immediate change of position.
Continue reading Another Attempt to Weaken the Affordable Care Act