Here is a brief update on Practice Government Relations activities heading into the summer.
Continued attempts at ACA Repeal
While we do not anticipate any congressional action on the “Affordable Care Act” (ACA) this year; the Trump administration has continued to pursue executive agency action and rulemaking that is undermining the law. The nonpartisan Congressional Budget Office (CBO) recently released updated numbers on health insurance coverage and cost. Their findings indicated that from 2017-2019 premiums will increase by 31-54% for 7 million Americans. These increases are largely due to rule changes by the administration. CBO singled out the administration’s decision to stop paying insurance companies for cost-sharing reductions, elimination of the law’s Federal tax enforcement, and allowing the sale of largely unregulated short-term, limited duration insurance and association health plans. The Practice Organization recommended the administration abandon short-term, limited duration insurance and association health plans when they were proposed earlier this year.
In February, twenty state attorneys brought a lawsuit again challenging the constitutionality of the ACA. On June 7th, the Department of Justice (DOJ) told a Federal Judge it believes two central pillars of the ACA are unconstitutional: guaranteed coverage for people with pre-existing conditions and limiting insurers’ ability to use age or health status to set rates. These provisions have allowed millions of Americans access to health care and the administration’s stance threatens to price them out of the market altogether. Further the DOJ indicated that it would not defend the law against this challenge, leaving states attorneys general in support of the law with that task.
Another key access provision in the ACA is its expansion of Medicaid to low income families. CMS is attempting to make changes to Medicaid’s “equal access provisions”. These provisions tie payment rates to provider participation, ensuring state Medicaid services are as available as non-Medicaid services. A proposed rule by CMS would eliminate requirements that states report on individuals’ access to health care services, limiting CMS’s ability to enforce these provisions. APA recently responded to the proposed rule by asking CMS to ensure that Medicaid beneficiaries continue to have access to mental and behavioral health services, and to further study the impact of the proposed changes that could affect as many as 2.6 million or more vulnerable enrollees. Additionally, CMS has approved waivers for Medicaid work requirements for four states with another six states pending. These waivers allow states to take away coverage from Medicaid recipients who are unemployed or are unable to meet a set number of work hours each month. These requirements threaten health coverage for millions of Americans who are unable to meet these standards and divert state funding and resources away from people who need it.
As reported in our April 30th Information Alert, Congress is considering dozens of bills to help address the opioid epidemic in an effort to enact legislation this summer. Opioid overdoses are taking a heavy toll across the entire nation, and consequently opioid legislation is an area of bipartisan agreement. Right now, various opioid bills are being packaged together and moving through the various health committees in both the House and Senate.
Practice Government Relations attempted to attach our priority legislation, the Medicare Mental Health Access Act (MMHA), H.R.1173/S.448 (a bill to include psychologists in Medicare’s “physician” definition), to the package moving through the Ways and Means Committee. Despite working with our primary House sponsors, Representatives Kristie Noem (R-SD) and Judy Chu (D-CA), we were unable to include our bill, although no other provider specific legislation was included in the final package.
Regardless, several opioid bills we support have been approved by committee and are heading toward floor votes. H.R. 3331, introduced by Representatives Lynn Jenkins (R-KS) and Doris Matsui (D-CA), would authorize a Center for Medicare and Medicaid Innovation (CMMI) health information technology demonstration program for psychologists and other mental health and addiction treatment providers to adopt electronic health records. H.R. 4684, the “Ensuring Access to Quality Sober Living Act of 2017”, introduced by Rep. Chu, would develop best practices for recovery housing services. These and other opioid bills will be voted on by the House in the coming days and could then be considered by conference committee with Senate-passed legislation.
Military and Veterans Health Policy
APAPO’s Military and Veterans Health Policy staff is actively engaged on multiple legislative and executive branch issues relevant to practicing psychologists. During the 2018 Practice Leadership Conference (PLC) select states went to their members of Congress about TRICARE reimbursement rate cuts. Practice Government Relations worked with bipartisan Members of Congress, headed by Sen. Jon Tester (D-MT) and Rep. Tulsi Gabbard (D-HI), to send House and Senate letters to Rear Admiral Bono, Director of the Defense Health Agency (DHA). The letters requested briefings for Congressional leaders on TRICARE mental health reimbursement and network adequacy problems with its two new 2018 contractors. We provided a survey on June 1st about your experiences with TRICARE, the results will be shared on Capitol Hill and with the DHA.
Regarding the VA, although APAPO supported the veteran’s caregiver benefit expansion component of the new VA MISSION Act, signed into law on June 6th, we expressed strong opposition to provisions redesigning private sector mental healthcare purchased by the VA (known as the VA CHOICE program). We remain a strong voice urging the Administration to work with provider groups as well as veterans service organizations to ensure that during implementation of the MISSION Act, regulations and private sector provider contracts will hold outside mental healthcare professionals to the same high standards required of VA psychologists in treating veterans.
At the end of May, APA, our Division 18/VA Section, and the independent Association of VA Psychologist Leaders (AVAPL) held the 21st annual leadership conference for and with Department of Veterans Affairs psychologists. With a theme focusing on veteran suicide prevention and protecting integrated care at the VA, the conference was an opportunity to share best practices and encourage advocacy.
For more information, contact APA Practice Organization Government Relations Office at Pracgovt@apa.org or (202) 336-5889. Visit APA Practice Organization on-line at APAPracticeCentral.org/Advocac y.