In November, groups hoping for the repeal of the “Don’t Ask, Don’t Tell” policy were disappointed when the Senate Armed Services indefinitely postponed a long awaited hearing on the matter.

However, the issue was moved to the forefront during the State of the Union speech, when President Obama uttered the words, “This year, I will work with Congress and our military to finally repeal the law that denies gay Americans the right to serve the country they love because of who they are.”  (The full text of the speech is available here.)

“Don’t Ask, Don’t Tell” may be on the agenda for the Senate Budget Committee hearing on Tuesday, Feb. 2 at 10:00.  NASW will continue to keep you updated as this issue moves through Congress.

First Lady Michelle Obama has made military families a priority throughout her time in the White House. First, she thanked veterans and their families privately for their contributions. Then, she publicly stated her support alongside Dr. Jill Biden at the 2009 World Series.

Now, she has delivered the most meaningful contribution of all: a promise of funding. According to Mrs. Obama, a three percent increase in funding will be implemented to a wide range of military programs. Official information, including a video, can be found at the official White House website here.

This work comes on the heels of other White House announcements that not only benefit veterans, but social workers as well. For example, one year advanced funding for the Veterans Administration was authorized by President Obama in October. Multiyear budgets can help social workers understand their job security within the VA’s employment structure.

Additionally, The White House has announced the construction of 359 military facilities across the country, to provide our nation’s veterans with improved rehabilitation and support services. This was part of The Recovery Act, described in greater detail here.

All in all, the first year of the Obama Administration has witnessed important gains not just for military personnel and veterans, but for the social workers who serve them.

In October, Representative Barbara Lee (CA-9) introduced H.R. 3699, a bill to prohibit any funds being expended to increase the number of members of the United States armed forces serving in Afghanistan. The bill currently has 27 cosponsors and has been referred to the House Committee on Armed Forces. Rep. Lee, a social worker, was the only opponent to George W. Bush’s War Resolution in 2002 by introducing House Concurrent Resolution 473 into the 107th Congress, which urged the United States to re-engage the diplomatic process and stressed the government’s commitment to the United Nations’ inspections process. NASW applauds the efforts of Representative Lee to restore peace.

Recognizing the impact of the economic recession on working families, President Obama and Vice President Biden held a meeting of the Middle Class Task Force on January 25, 2010 to discuss ways to reduce the financial burden for this group and increase investments for them. Over the past year, the Task Force has held several meetings on this topic and their recommendations include the following:

1. An increased Child and Dependent Care Tax Credit for families making under $85,000 a year. The administration also plans to provide a $1.6 billion increase in child care funding to help an additional 235,000 children.

2. A decrease in students’ federal loan payments to 10% of their income, referring to the Income-Based Repayment (IBR) program, created by Congress in 2007. For more information about IBR or Public Service Loan Forgiveness, go to NASW’s loan forgiveness website at http://www.socialworkers.org/loanforgiveness/default.asp.

3. Creating a system of automatic workplace IRAs, requiring that employers give employees the option to enroll in a direct-deposit IRA.

4.Tax credits to match retirement savings and new safeguards to protect them.

5.Support for families balancing work with caring for elderly relatives, which is intended to help families manage multiple responsibilities and allow seniors to live in the community for as long as possible.

For more information about these initiatives or to review remarks by the President and Vice President at the Middle Class Task Force meeting, go to http://www.whitehouse.gov/photos-and-video/video/key-investments-middle-class-families.

NASW encourages you to watch the State of the Union Address on Wednesday, January 27, 2010 at 9pm EST. The speech will provide you with information about the President’s agenda for 2010.  What will he say about health care reform, education, the economy and the wars in Iraq and Afghanistan?  Will he mention immigration reform?   How will his agenda affect your social work practice?  Here is information about how you can watch it online or ask questions via YouTube. View directions here: http://voices.washingtonpost.com/federal-eye/2010/01/obama_to_answer_questions_on_y.html.

The White House is streaming the speech at www.whitehoue.gov/live. Users will also be able to embed the stream into their own sites, and the official White House iPhone application that will carry the stream can be found on the iTunes app store (link will open in iTunes).

Facebook users will be able to watch the State of the Union speech on that site, thanks to another official White House application, this time one that combines the video feed with status updates.

CNN is once again cooperating with Facebook to cover the State of the Union address. The network will start with its online coverage of the speech at 8 p.m. EST, and the whole speech as well as the GOP’s response will be shown next to comments from Facebook users.

C-SPAN will show the video on its site and accompany it with a transcript based on closed captions in near-real time.

YouTube will air the speech live on its Citizentube channel, with a twist: The site will stream suggestions from its users on how to improve the economy, as well as our schools, climate change and national security issues. The Citizentube coverage will come complete with commentary by General Wesley Clark, economist Nouriel Roubini, Newsweek editor Fareed Zakari and NASA climatologist Jim Hansen. YouTube is calling this “Your State of the Union,” and the whole show will start at 8 p.m. EST.

Hulu will stream the entire event online as well, complete with the ability to embed its player into third-party websites.

On Thursday, January 21, the Supreme Court handed down its decision in the case of Citizens United v. Federal Election Commission. In essence, this decision holds that corporations and unions may spend money from their general funds on political and campaign activities. We are presently analyzing the impact of this decision on NASW and PACE, and will provide you with more information as soon as possible.

Democrats Regroup on Strategy for Health Care Reform

Democratic congressional leaders are currently developing a new strategy to pass health care reform after the stunning loss of a Senate seat in Massachusetts. Although their new strategy will be finalized after some days have elapsed and is not yet final, several conclusions are apparent from their public comments. First, Democrats fear that failing to enact the health care bill now could increase voter anger later in this election year. Second, many legislative strategists prefer what is described as a two-bill strategy, one immediately following the next.

Under the two-bill strategy, the first step would require House passage of the Senate health bill (HR. 3590). Getting to majority House support for this bill (at least 218 votes) is extremely difficult because many Democrats have important differences with provisions in the Senate bill. Democratic House leaders say they do not now have the necessary votes to pass the Senate measure. The second bill would be necessary to secure the necessary votes in the House for the first bill. The second bill would be considered under procedures known as budget reconciliation.  This bill would include many compromises and changes to the Senate bill. The reconciliation measure would also include any provisions negotiated with the White House and Senate leaders. The two-bill option has important legislative advantages. Most importantly, any bill taken up under reconciliation procedures may move under fast-track floor procedures in the House and Senate, and passage requires 51 votes in the Senate, instead of a filibuster-proof 60 votes.

Another strategy would involve going back to the drawing board and breaking the bill into smaller components, passing those where there is more agreement. Given this highly fluid political environment, NASW will continue to press for its legislative priorities as Congress debates a new approach. Our current Action Alert is here, and we urge members to track our actions here.

Mental Health and Substance Abuse Parity Update

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) became effective for most private health plans on January 1, 2010, but federal agency regulations defining how it will be interpreted have not been cleared by the Administration. Thus health insurance carriers, which must have their 2010 plan benefits in compliance in the absence of any regulations, may be uncertain or confused about exactly what mental health and substance abuse benefits are required to be equivalent to medical and surgical benefits they offer.

According to a HHS/CMS website here, the now current federal law applies to two different types of coverage:

• 1) Large group self-funded group health plans (CMS has jurisdiction over self-funded public sector (non-federal governmental) plans, while the Department of Labor has jurisdiction over private sector self-funded group health plans.

• 2) Large group fully insured group health plans.

Some state’s insurance regulations may also contain additional coverage protections for fully insured group health plans or individual coverage. MHPAEA is designed to prevent large group health plans from imposing financial requirements and treatment limitations on mental health and substance use disorder (MH/SUD) benefits that are more restrictive than financial requirements and treatment limitations on medical/surgical benefits.  MHPAEA also prevents large group health plans from placing annual or lifetime dollar limits on mental health and substance abuse benefits that are lower than annual or lifetime dollar limits for medical/surgical benefits offered under the plan.

The law does not apply to small group health plans or health insurance coverage in the individual (non-employment based) market, but individual state law may require mental health parity in such cases. MHPAEA defines large group health plans as those with more than 50 workers and does not apply to group health plans sponsored by employers with fewer than 51 workers. Federal summary information about the law is available here and NASW has prepared its own summary, posted here and shown under January 2009.

NASW Remains Active on Health Care Reform

Congress is working now to reconcile differences on health care reform legislation. Negotiating room is limited by the very close 60 vote margin in the Senate for initial passage. Democratic leaders must find compromises on divisive issues such as abortion coverage, taxes and fees to pay for expanded coverage, inclusion of a government-run plan, and methods to expand coverage to those unable to pay full costs. Negotiations are expected to continue until the end of the month.

Democratic leaders will work out their differences with a small group of health committee chairmen, supported by their key staff. NASW has expressed its preferences among key provisions in the House and Senate bills. Among the differences NASW has weighed in on are Medicare payments to clinical social workers serving nursing home residents, workforce provisions under the Social Work Reinvestment Act, the public option, and reproductive choice. NASW Executive Director Elizabeth Clark’s latest letter to congressional negotiators is here. NASW is aware the final bill may not measure up to all the hopes of its members, but we continue to press for improvements to the bill as it moves toward passage. To stay in touch with congressional developments and NASW’s response, please follow our webpage here.

Update on CSW Medicare payments in Federal Legislation

Clinical social workers that bill Medicare independently under Part B face two large rate cuts at the start of 2010. These include a five percent cut in psychotherapy rates due to an expiring provision in Medicare law and a 21 percent cut in all Medicare rates due to the Sustainable Growth Rate (SGR) formula that affects all Part B practitioners. For more than a decade, all Medicare Part B payment rates have been set by the SGR formula, which by statute annually cuts payments to providers. Each year Congress has intervened to postpone the SGR cut, but due to the costs of a permanent repeal, Congress has not agreed to a solution to the underlying flaws in the formula. NASW supports a permanent change in the Medicare formula (see our letter here). Last month Congress agreed to postpone the SGR cut for two months, but on March 1, 2010, the SGR cut will again go into effect. The latest agreement leaves Congress just this month and next to enact another plan to address the SGR formula, and they plan to pass it separately and following an agreement on health care reform.

In addition to the SGR reduction, psychotherapy rates face a five percent cut due to a CMS five-year rate review implemented in 2008. Clinical social workers and psychologists have worked together for several years to ensure the psychotherapy rate cut also does not go into effect.  An increase for psychotherapy billing codes is included in the House version of health care reform (H.R. 3590), but not the Senate version (S. 3962). NASW is now pressing Congress to include the House provision, and we are organizing social worker support for the House provision. NASW’s Action Alert on health care reform items will appear shortly on our website here.

NASW Joins Opposition to Independent Medicare Board

NASW has joined with 75 other advocacy organizations in opposition to the establishment of a Medicare Independent Payment Advisory Board (IPAB) included in the Senate-passed health reform bill. The purpose of the IPAB is to reduce the per capita rate of growth in Medicare spending, but in most years Medicare’s per capita growth rate has been below or equal to the growth rate in private sector health spending. The IPAB reductions would be in addition to $400-500 billion in provider payment reductions already included in health care reform legislation. NASW and its coalition partners believe further cuts of this magnitude could jeopardize both access to care for Medicare beneficiaries and even the infrastructure of the entire health care system.

The coalition believes the IPAB, which would be appointed by the President, would assume too much authority over the Medicare program to make recommendations to reduce per capita Medicare spending regardless of whether spending is growing faster than general health care inflation. The coalition argues that replacing elected officials with political appointments from the President does not remove politics from the equation. Furthermore, the proposal usurps congressional authority over the Medicare program, and greatly limits the ability of Medicare beneficiaries, advocates and providers to work with Congress to improve the program, making it especially difficult to include coverage of new and better treatments, procedures and technologies.

Comparison of House and Senate Packages

Social workers interested in learning more details about the impact of the House and Senate versions of health reform legislation on coverage, affordability, and costs may wish to view a report by the Commonwealth Fund, a respected source of comparative health policy information. See:  ”The Health Insurance Provisions of the 2009 Congressional Health Reform Bills: Implications for Coverage, Affordability, and Costs.”

Kaiser Family Foundation Analysis Available

If you would like to see how the proposals may affect individuals, view the Kaiser Family Foundation analysis on how individuals might be affected.

“We cannot accept ongoing marginalization of half the world’s population”
- Sec. Hillary Clinton

Jan 8, 4pm - Secretary of State Hillary Rodham Clinton just completed a major speech commemorating the 15th anniversary of the International Conference on Population and Development (ICPD) in support of women’s rights to reproductive health and family planning. Secretary Clinton highlighted the importance of ensuring women’s access to reproductive health and family planning services and helping women and girls lead healthy, productive and fulfilling lives.  She also emphasized that we must advocate for equity on behalf of women and girls and that they should, and will, be a central part of the United States foreign policy.   View the speech at www.icpd2015.org