Today the President’s Middle Class Task Force released its annual report with significant recommendations that would provide support for families.   Chaired by Vice-President Joe Biden with social worker Dr. Jared Bernstein serving as Executive Director, recommendations were categorized in the following four areas:

• Protecting Workers and Creating Middle Class Jobs
• Retirement Security
• Balancing Work and Family Responsibilities
• Pathways to the Middle Class
  

The National Association of Social Workers (NASW) enthusiastically supports the recommendations of the Task Force and wrote a letter, along with a number of other groups, specifically regarding “Helping Families Balance Work and Caregiving Obligations.” The proposed policies in this area supported our own suggestions and experience in working with families who care for their older relatives.

In 2006 and 2008, NASW, in partnership with the New York Academy of Medicine (NYAM), conducted research focusing particularly on sandwich generation women (SGW) who were between the ages of 35 and 54 and caring for their own children and aging relatives. Key findings from our surveys support the need for the expanding the Dependent Care Tax Credit, which has only been raised once in 28 years, as well as expanding the $102.5 million Caregiver Initiative, which provides resources for respite care, transportation, and assistance with activities of daily living.

To see all of the letters on this issue, click here.  For more information on the Middle Class Task Force, go to www.astrongmiddleclass.gov.

Earlier this week the White House released a summary of its $950 billion plan to reconcile the House and Senate versions of comprehensive health reform legislation. Release of the plan marks a new phase of more direct presidential involvement in the legislative negotiations. The President’s plan largely favors the Senate’s bill and clarifies use of a legislative strategy known as budget reconciliation, which could pass the bill through Congress with 51 votes. Democrats on Capitol Hill reacted in a receptive manner to the proposal, although leaders are expected to flesh out many important details as the plan is worked into legislative language.

On Thursday, February 25, the President will meet with Democratic and Republican congressional leaders at Blair House in an attempt to reach compromises on comprehensive legislation. However, Republicans have not accepted the President’s premise for the meeting, which is to bring forward their own plans to address comprehensively the major coverage and costs problems that plague the U.S. health system. Absent a breakthrough at the talks this week, Democratic leaders are expected to attempt to pass final legislation without Republican votes. The President’s proposal generally follows NASW principles for health reform, and we expect to support the compromise legislation as it moves toward House and Senate consideration.\

The Kaiser Family Foundation created a side-by-side chart comparing the health care proposal unveiled by President Obama on February 22 and the previously passed House and Senate health care bills.  To view the full chart, please go here.

Urgency for State Medicaid Relief Grows

A new report by Families USA, an NASW coalition partner, documents a large number of states facing Medicaid cutbacks unless Congress quickly increases temporary funding for state Medicaid programs. Families USA reports that States are dealing with unprecedented budget shortfalls as a result of declining tax revenues, high levels of unemployment, increasing poverty and declining wages.  They concluded that at least 30 state legislatures are contemplating cutbacks to Medicaid, beginning this July.

In addition to protecting funding for current services to Medicaid recipients, the report shows that increased federal funding will improve state economies while expanding and protecting jobs. The Families USA report is available here: States in Need: Congress Should Extend Temporary Increase in Medicaid Funding.

President Obama’s federal budget proposal released earlier this month called for maintaining current Medicaid services during the economic downturn with an additional $25 billion in federal fiscal relief for state Medicaid programs. NASW has joined with Families USA and other advocacy groups in pushing for the funds in new legislation. The proposal would include a 6.2 percent increase in the amount of money states receive for Medicaid, and those with higher unemployment rates would receive more. Our coalition urges passage at the earliest opportunity as most state legislatures are already well along in the development of their budgets for their new fiscal year.

Essential Medicare Legislation Still Delayed

Partisan gridlock is continuing to stall legislation extending expiring Medicare provisions that establish provider payment rates. Congress had hoped to use the comprehensive health reform bill as a vehicle to address Medicare provider payment extensions, but the cost of the Medicare provisions and confusion on the health reform bill led to their being temporarily set aside for another legislative vehicle. Earlier this month the Senate Finance Committee attempted to again pass the Medicare “extenders package,” but the vehicle, a large jobs bill, was rejected by party leaders before coming to the floor. Currently, leaders know the Medicare package is urgent to pass now, but they have not found an acceptable vehicle for the multi-billion dollar package.

The expiring Medicare provisions include large rate cuts that directly impact payments to clinical social workers billing Medicare independently under Part B. Clinical social workers face two large rate cuts under expiring law. These include the physician payment provision in Medicare law that leads to a 21 percent cut in all Medicare Part B rates due to the Sustainable Growth Rate (SGR) formula that affects all practitioners. For more than a decade, all Medicare Part B payment rates have been set by the SGR formula, which by statute annually expire, cutting 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 HYPERLINK “http://capwiz.com/socialworkers/utr/1/AURAMBWPUD/FHCOMBWQIV/4723954896“here). In late December Congress agreed to postpone the SGR cut for two months, but on March 1, 2010, the SGR cut will again go into effect. That agreement leaves Congress only a few days to enact another extension to correct the SGR formula.

In addition to the SGR reduction, Medicare psychotherapy rates already received a five percent cut on January 1st due to a CMS five-year rate review implemented in 2008. Clinical social workers and psychologists are working together to ensure the psychotherapy rate cut is restored in any bill delaying the larger SGR cut.  An increase for psychotherapy billing codes was included in the House version of health care reform (H.R. 3590), but not the Senate version (S. 3962). Again, with the delay in enacting comprehensive reform, a new legislative vehicle must be found to delay this cut. NASW is working very aggressively with a coalition of health practitioner groups to pressure Congress to attach the psychotherapy rate provision in the larger SGR legislation.

County of Residence Impacts Personal Health

A new project undertaken by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute ranks county health status in every state in the nation. The project found that the health of a community depends on many different factors – ranging from individual health behaviors, education and jobs, to quality of health care, to the environment. The project has recently released a collection of 50 state reports designed to help community leaders demonstrate that where people live influences how healthy they are and how long they live. For information on health by county in any state, see HYPERLINK “http://capwiz.com/socialworkers/utr/1/AURAMBWPUD/GCWDMBWQIW/4723954896“here.

Within four weeks of taking office, Congress presented a “stimulus package” to President Obama, who signed it.  The American Recovery and Reinvestment Act (ARRA) is now one year old.  About half of the money has been distributed, mostly to states, as well as to extend unemployment benefits, expand eligibility for Food Stamps, support Medicaid for states.  Independent economic analyses of ARRA show where it has been effective.  It’s hard to make the argument that things would have been worse for people without the package, because for many people, their economic situation is difficult and challenging.  However, reading accounts of the mass suffering during the depression makes us glad that we did not have to witness similar challenges.  It was the work of social workers led by Frances Perkins and Harry Hopkins that supported people and institutionalized programs like unemployment insurance and social security to ensure people could be cared for throughout the ups and downs of economic cycles.

NASW, partnering with you, our members, continues this legacy of providing direct aid and advocating for structural economic changes.  (See our advocacy alerts on extending benefits to people who have lost their jobs and supporting Medicaid relief to states.) We look forward to continuing these efforts.

You may find these recent articles of interest regarding the ARRA:   http://www.nytimes.com/2010/02/17/business/economy/17leonhardt.html?src=twt&twt=nytimes and  http://online.wsj.com/article/SB10001424052748704804204575069772167897834.html?mod=WSJ_hpp_MIDDLTopStories

Take Action Now! – Social Work Reinvestment

On February 3, Ed Towns (NY-10) introduced H.R. 795, the Dorothy I. Height and Whitney M. Young, Jr. Social Work Reinvestment Act. To date there are 38 cosponsors. The act establishes a Social Work Reinvestment Commission to address the future of the profession. It also establishes demonstration programs that address the current state of the social work profession. You can contact your member of Congress and ask them to become a cosponsor of the legislation.

Pay discrimination denounced

The first 6 weeks of the 111^th Congress have been exciting. Congress passed and the President signed the Lilly Ledbetter Fair Pay Act (Public Law No. 111-2). The law reverses a Supreme Court decision that acutely limits women workers’ capacity to sue for wage discrimination. It changes the law to declare that an unlawful practice occurs when a discriminatory compensation decision or other practice is adopted, when a person becomes subject to the decision or other practice, or when a person is affected by the decision or practice, including each time wages, benefits, or other compensation is paid. Therefore, a person can file a complaint about wage discrimination after any pay check that includes the pay discrimination. NASW Executive Director, Betsy Clark, was invited to the bill signing ceremony at the White House. You can view the video of the signing on our Web site.

Children’s Health Care passed

Another big win was passage of SCHIP legislation (Public Law No. 111-3). This legislation includes a mandate that mental health treatment be on par with medical health services. More specifically, the new law prohibits SCHIP plans from setting lower treatment limitations or higher financial requirements on coverage of mental health or substance use services than they set for other health services. It will cover around 4 million additional uninsured children. It is paid for, primarily with a 62-cent increase in the federal tobacco tax. It will extend federal support of CHIP through 2013. It encourages states to enroll children who are already eligible but not yet covered, and gives states new tools to reach uninsured children. It removes the five-year waiting period for legal immigrant children and pregnant women who enroll in Medicaid or CHIP. See the final vote. (more…)

A new report by federal actuaries shows government programs will pay for more than half of all U.S. health care spending by 2012. The health care spending projection data can be found on the CMS web site at http://www.cms.hhs.gov/NationalHealthExpendData/03_NationalHealthAccountsProjected.asp

In an effort to keep you informed of the work NASW is doing on health care reform, we will periodically send out a roundup of activities.

Health Reform Update

With the election of Senator Scott Brown (R-MA), there were concerns that health care reform would take a back seat to other congressional priorities such as jobs and the economy. Congressional leaders are still committed to passing health care reform legislation this year.  Congress believes that the status quo of health care is no longer acceptable and the impact of not reforming health care could be worse than doing nothing.  Many congressional members and health care advocates are supporting the following strategies to move the health care legislation forward.

• 1. The House would pass the Senate health bill (HR. 3590) with at least 218 votes. Currently, there are not enough votes for this option because many House democrats have differences with certain provisions in the Senate bill.
• 2. The Senate would then pass a reconciliation bill to include the items that are germane to the budget. The reconciliation measure would also include any provisions negotiated with the White House and Senate leaders. With the reconciliation bill, the Senate would only need 51 votes for passage.
• 3. The final option is to draft a compromise bill. The measure would change the massive Senate-approved health bill to what bargainers from the White House, Senate and House agreed to in December.

These negotiations are ongoing with an uncertain timetable for completion. NASW will continue to press for its legislative priorities as Congress debates its next steps as well as additional health issues that are of interest to social workers.

NASW Cosponsored Health Action 2010 Conference

Families USA held its 15th Annual Grassroots Meeting Health Action 2010 on January 28-30, 2010 in Washington, DC.  NASW was a cosponsor of the conference.  Some of the presenters included White House Senior Advisor Valerie Jarrett, Secretary of Health and Human Services Secretary Kathleen Sebelius, Sen. Al Franken, Reps. Donna Edwards and Chris Van Hollen, NAACP President Benjamin Todd Jealous, and U.S. Surgeon General Dr. Regina Benjamin. To view, their presentations and more from the conference, go to:

http://www.familiesusa.org/conference/health-action-2010/webcast.html

Feds Issue Parity Rules

Federal officials with the departments of Health and Human Services, Labor and Treasury jointly issued interim final rules on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA), signed into law by President Bush in October 2008. The rules implementing the new law require that mental health and addiction benefits in group health insurance plans be equal to most medical and surgical benefits. It will take effect this July 1. The new rules prohibit group health insurance plans from restricting access to care by limiting benefits and requiring higher patient costs than those that apply to general medical or surgical benefits.

The interim final rules were based on a review of more than 400 comments, officials said. NASW joined with a 44-member coalition of mental health groups last year in commenting on the “Request for Information” in a letter linked here. The coalition’s letter urged the federal government to interpret the intent of the legislation in the most consumer-favorable manner possible. Co-signers are very pleased the new rules appear to have done so. Among the most significant interpretations, the rules require that group health plans that choose to offer mental health and addiction benefits along with medical and surgical benefits “must treat them equally in terms of out-of-pocket costs, benefit limits and practices such as prior authorization and utilization review.” The regulations were published Tuesday, February 2, 2010, with a comment period extending until May 3. The effective date for the rules will be for plan years beginning on or after July 1. NASW is working now on comments for the proposed rules.

MHPAEA contains several significant limitations. One is the absence of a mandate that mental health and addiction benefits be offered by every plan, and the law does not specify which conditions have to be covered, a major point of contention during congressional debate. At this early time, mental health groups report they have seen no significant trend of employers eliminating coverage for behavioral health benefits as a way to avoid implementing parity requirements. A second major limit of the law is that it applies only to public or private employers with 50 or more workers, including both self-insured and fully insured entities. Group health plans for companies with fewer than 50 employees are exempt, and the law does not apply to issuers who sell plans to individuals. Federal officials said that about 160 million residents are covered in large employers’ group health insurance plans.

The rules greatly expand an earlier law, the Mental Health Parity Act of 1996, which required parity only for aggregate lifetime and annual dollar limits between the categories of benefits. Another major benefit of the new law is that it extends protections to substance use disorder benefits. NASW and other advocacy groups spent years advocating for the legislation along with a large coalition of mental health and substance abuse treatment advocacy organizations. Its long-time congressional champions included the late Sen. Edward M. Kennedy, D-MA, Sen. Pete Domenici (R-NM) now retired, Rep. Patrick J. Kennedy, D-R.I. and Rep. Jim Ramstad (R-MN) also now retired.

Resources for social workers

• NASW’s January 2009 summary here.
• Federal Fact Sheet summarizing the law here.
• New interim final rules here.
• Legal summary of the rules here.

President Backs Medicaid Relief for the States

President Obama’s new federal budget proposal tops $3.8 trillion, and it includes many programs that directly impact social workers and their clients. One proposal is particularly critical to maintaining current Medicaid services during the economic downturn. The President’s budget backs an additional $25 billion in federal fiscal relief for state Medicaid programs. NASW had joined with other advocacy groups in pushing for additional Medicaid state fiscal relief in new legislation. Advocates and the states support the additional federal funds to help maintain state Medicaid services during the current economic crisis that has depleted funds for care. The President’s budget includes a 6.2 percent increase in the amount of money states get for Medicaid, and those with higher unemployment rates would get even more assistance. Large states with generous Medicaid programs such as California and New York stand to benefit most from the plan. Advocates of the funding also argue that it protects unrelated state jobs and activities by allowing states to avoid shifting funds to maintain critical Medicaid services.

House to Vote on Antitrust Exemption for Health Insurers

House Democratic Leaders plan to vote on the floor within days on a partial repeal of the health insurance industry’s exemption from antitrust laws (H.R. 3596). The legislation would eliminate a long-standing federal law that excludes the insurance industry from federal antitrust regulation. Under the Constitution, regulation of interstate commerce is a federal responsibility. However, in 1945 the McCarran-Ferguson Act authorized states, in the absence of federal law or regulation, to regulate all insurance products, including health, leading to the state insurance regulatory system in place today. This Act also exempted the insurance industry from federal antitrust law. Therefore, the Justice Department cannot now enforce federal antitrust law on the insurance industry. Some advocates believe that eliminating this restriction may boost competition among insurers and thereby help reduce prices to consumers. Other analysts believe the change will not impact insurance company practices. NASW is tracking this legislation and more background appears in a prior issue of the Health Care Reform Roundup here.

Passing the measure now begins a new House Democratic Leadership strategy of moving popular but narrow bills that will be split off from the House’s comprehensive version of health care reform (H.R. 3962). Support for antitrust legislation is widespread in the House, and it is expected to draw some Republican support. However, prospects in the Senate appear much dimmer as the measure failed to reach the 60 vote threshold for passage last December. Other popular provisions in comprehensive health care bill, including banning insurers from denying coverage for pre-existing medical conditions, are not candidates for splitting off for separate enactment.

Democrats hope to score political points by supporting a bill aimed at the insurance industry while Republicans could risk appearing as though that they are trying to protect them. Democrats also believe that passage of several small provisions from the larger health reform initiative could help revive some momentum for passage of the comprehensive bill.

Key Medicare Provisions up in the Air

A major legislative problem was created by the delay in passing comprehensive health care legislation; that is, how to pass expiring Medicare provisions that require immediate congressional action. The expiring Medicare provisions include large rate cuts that directly impact payments to clinical social workers billing Medicare independently under Part B. Clinical social workers face two large rate cuts under expiring law. These include the physician payment provision in Medicare law that leads to a 21 percent cut in all Medicare Part B rates due to the Sustainable Growth Rate (SGR) formula that affects all practitioners. For more than a decade, all Medicare Part B payment rates have been set by the SGR formula, which by statute annually expire, cutting 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). In late December Congress agreed to postpone the SGR cut for two months, but on March 1, 2010, the SGR cut will again go into effect. That agreement leaves Congress only this month to enact another extension to correct the SGR formula. Congress had hoped to use comprehensive health reform as a vehicle to address the Medicare SGR correction.

In addition to the SGR reduction, Medicare psychotherapy rates already received 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 was included in the House version of health care reform (H.R. 3590), but not the Senate version (S. 3962). Again, with the delay in enacting comprehensive reform, a new legislative vehicle must be found to delay this cut. NASW is working very aggressively with a coalition of health practitioner groups to pressure Congress to include this provision in the SGR legislation.

Health Reform Essential for Reducing Deficit

Rising health care costs represent the single largest cause of the federal government’s long-term budget deficit making passage of comprehensive health reform legislation essential to any effective action on long-term deficit reduction. According to the Congressional Budget Office, the Senate and House health reform bills would reduce deficits both over the decade from 2010 through 2019 and after that. Both bills also contain a wide range of measures to restructure the U.S. health system and slow the growth of health care costs, particularly Medicare costs.

A new analysis by the Center on Budget and Policy Priorities describes the problem and how the pending legislation would address it here.

U.S. Government to pay more than half of U.S. health costs by 2012

A new report by federal actuaries shows government programs will pay for more than half of all U.S. health care spending by 2012. The health care spending projection data can be found on the CMS web site at

http://www.cms.hhs.gov/NationalHealthExpendData/03_NationalHealthAccountsProjected.asp

U.S. Surgeon General Report on Obesity

On January 28, First Lady Michelle Obama, HHS Secretary Kathleen Sebelius, and Surgeon General Dr. Regina Benjamin announced initiatives to help Americans lead healthier lives through better nutrition, regular physical activity, and improving communities to support healthy choices. To read the Surgeon General’s Report, go to:

http://www.surgeongeneral.gov/library/obesityvision/obesityvision2010.pdf

Families USA held its 15th Annual Grassroots Meeting Health Action 2010 on January 28-30, 2010 in Washington, DC.  NASW was a cosponsor of the conference.  Some of the presenters included White House Senior Advisor Valerie Jarrett, Secretary of Health and Human Services Secretary Kathleen Sebelius, Sen. Al Franken, Reps. Donna Edwards and Chris Van Hollen, NAACP President Benjamin Todd Jealous, and U.S. Surgeon General Dr. Regina Benjamin.

To view, their presentations and more from the conference, go to: http://www.familiesusa.org/conference/health-action-2010/webcast.html

With the election of Senator Scott Brown (R-MA), there were concerns that health care reform would take a back seat to other congressional priorities such as jobs and the economy. Congressional leaders are still committed to passing health care reform legislation this year.  Congress believes that the status quo of health care is no longer acceptable and the impact of not reforming health care could be worse than doing nothing.  Many congressional members and health care advocates are supporting the following strategies to move the health care legislation forward.

1. The House would pass the Senate health bill (HR. 3590) with at least 218 votes. Currently, there are not enough votes for this option because many House democrats have differences with certain provisions in the Senate bill.
2. The Senate would then pass a reconciliation bill to include the items that are germane to the budget. The reconciliation measure would also include any provisions negotiated with the White House and Senate leaders. With the reconciliation bill, the Senate would only need 51 votes for passage.
3. The final option is to draft a compromise bill. The measure would change the massive Senate-approved health bill to what bargainers from the White House, Senate and House agreed to in December.

These negotiations are ongoing with an uncertain timetable for completion. NASW will continue to press for its legislative priorities as Congress debates its next steps as well as additional health issues that are of interest to social workers.
NASW Cosponsored Health Action 2010 Conference

Families USA held its 15th Annual Grassroots Meeting Health Action 2010 on January 28-30, 2010 in Washington, DC.  NASW was a cosponsor of the conference.  Some of the presenters included White House Senior Advisor Valerie Jarrett, Secretary of Health and Human Services Secretary Kathleen Sebelius, Sen. Al Franken, Reps. Donna Edwards and Chris Van Hollen, NAACP President Benjamin Todd Jealous, and U.S. Surgeon General Dr. Regina Benjamin. To view, their presentations and more from the conference, go to: http://www.familiesusa.org/conference/health-action-2010/webcast.html

Feds Issue Parity Rules

Federal officials with the departments of Health and Human Services, Labor and Treasury jointly issued interim final rules on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA), signed into law by President Bush in October 2008. The rules implementing the new law require that mental health and addiction benefits in group health insurance plans be equal to most medical and surgical benefits. It will take effect this July 1. The new rules prohibit group health insurance plans from restricting access to care by limiting benefits and requiring higher patient costs than those that apply to general medical or surgical benefits.

The interim final rules were based on a review of more than 400 comments, officials said. NASW joined with a 44-member coalition of mental health groups last year in commenting on the “Request for Information” in a letter linked here. The coalition’s letter urged the federal government to interpret the intent of the legislation in the most consumer-favorable manner possible. Co-signers are very pleased the new rules appear to have done so. Among the most significant interpretations, the rules require that group health plans that choose to offer mental health and addiction benefits along with medical and surgical benefits “must treat them equally in terms of out-of-pocket costs, benefit limits and practices such as prior authorization and utilization review.” The regulations were published Tuesday, February 2, 2010, with a comment period extending until May 3. The effective date for the rules will be for plan years beginning on or after July 1. NASW is working now on comments for the proposed rules.

MHPAEA contains several significant limitations. One is the absence of a mandate that mental health and addiction benefits be offered by every plan, and the law does not specify which conditions have to be covered, a major point of contention during congressional debate. At this early time, mental health groups report they have seen no significant trend of employers eliminating coverage for behavioral health benefits as a way to avoid implementing parity requirements. A second major limit of the law is that it applies only to public or private employers with 50 or more workers, including both self-insured and fully insured entities. Group health plans for companies with fewer than 50 employees are exempt, and the law does not apply to issuers who sell plans to individuals. Federal officials said that about 160 million residents are covered in large employers’ group health insurance plans.

The rules greatly expand an earlier law, the Mental Health Parity Act of 1996, which required parity only for aggregate lifetime and annual dollar limits between the categories of benefits. Another major benefit of the new law is that it extends protections to substance use disorder benefits. NASW and other advocacy groups spent years advocating for the legislation along with a large coalition of mental health and substance abuse treatment advocacy organizations. Its long-time congressional champions included the late Sen. Edward M. Kennedy, D-MA, Sen. Pete Domenici (R-NM) now retired, Rep. Patrick J. Kennedy, D-R.I. and Rep. Jim Ramstad (R-MN) also now retired.

Resources for social workers

NASW’s January 2009

Federal Fact Sheet summarizing the law

New interim final rules

Legal summary of the rules

President Backs Medicaid Relief for the States

President Obama’s new federal budget proposal tops $3.8 trillion, and it includes many programs that directly impact social workers and their clients. One proposal is particularly critical to maintaining current Medicaid services during the economic downturn. The President’s budget backs an additional $25 billion in federal fiscal relief for state Medicaid programs. NASW had joined with other advocacy groups in pushing for additional Medicaid state fiscal relief in new legislation. Advocates and the states support the additional federal funds to help maintain state Medicaid services during the current economic crisis that has depleted funds for care. The President’s budget includes a 6.2 percent increase in the amount of money states get for Medicaid, and those with higher unemployment rates would get even more assistance. Large states with generous Medicaid programs such as California and New York stand to benefit most from the plan. Advocates of the funding also argue that it protects unrelated state jobs and activities by allowing states to avoid shifting funds to maintain critical Medicaid services.

House to Vote on Antitrust Exemption for Health Insurers

House Democratic Leaders plan to vote on the floor within days on a partial repeal of the health insurance industry’s exemption from antitrust laws (H.R. 3596). The legislation would eliminate a long-standing federal law that excludes the insurance industry from federal antitrust regulation. Under the Constitution, regulation of interstate commerce is a federal responsibility. However, in 1945 the McCarran-Ferguson Act authorized states, in the absence of federal law or regulation, to regulate all insurance products, including health, leading to the state insurance regulatory system in place today. This Act also exempted the insurance industry from federal antitrust law. Therefore, the Justice Department cannot now enforce federal antitrust law on the insurance industry. Some advocates believe that eliminating this restriction may boost competition among insurers and thereby help reduce prices to consumers. Other analysts believe the change will not impact insurance company practices. NASW is tracking this legislation and more background appears in a prior issue of the Health Care Reform Roundup.

Passing the measure now begins a new House Democratic Leadership strategy of moving popular but narrow bills that will be split off from the House’s comprehensive version of health care reform. Support for antitrust legislation is widespread in the House, and it is expected to draw some Republican support. However, prospects in the Senate appear much dimmer as the measure failed to reach the 60 vote threshold for passage last December. Other popular provisions in comprehensive health care bill, including banning insurers from denying coverage for pre-existing medical conditions, are not candidates for splitting off for separate enactment.

Democrats hope to score political points by supporting a bill aimed at the insurance industry while Republicans could risk appearing as though that they are trying to protect them. Democrats also believe that passage of several small provisions from the larger health reform initiative could help revive some momentum for passage of the comprehensive bill.

Key Medicare Provisions up in the Air

A major legislative problem was created by the delay in passing comprehensive health care legislation; that is, how to pass expiring Medicare provisions that require immediate congressional action. The expiring Medicare provisions include large rate cuts that directly impact payments to clinical social workers billing Medicare independently under Part B. Clinical social workers face two large rate cuts under expiring law. These include the physician payment provision in Medicare law that leads to a 21 percent cut in all Medicare Part B rates due to the Sustainable Growth Rate (SGR) formula that affects all practitioners. For more than a decade, all Medicare Part B payment rates have been set by the SGR formula, which by statute annually expire, cutting 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 HYPERLINK “http://capwiz.com/socialworkers/utr/1/GGWSLZNPUF/GECOLZPYYB/4637793656“here). In late December Congress agreed to postpone the SGR cut for two months, but on March 1, 2010, the SGR cut will again go into effect. That agreement leaves Congress only this month to enact another extension to correct the SGR formula. Congress had hoped to use comprehensive health reform as a vehicle to address the Medicare SGR correction.

In addition to the SGR reduction, Medicare psychotherapy rates already received 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 was included in the House version of health care reform (H.R. 3590), but not the Senate version (S. 3962). Again, with the delay in enacting comprehensive reform, a new legislative vehicle must be found to delay this cut. NASW is working very aggressively with a coalition of health practitioner groups to pressure Congress to include this provision in the SGR legislation.

HYPERLINK “http://capwiz.com/socialworkers/utr/1/GGWSLZNPUF/GNJULZPYYC/4637793656“Health Reform Essential for Reducing Deficit

Rising health care costs represent the single largest cause of the federal government’s long-term budget deficit making passage of comprehensive health reform legislation essential to any effective action on long-term deficit reduction. According to the Congressional Budget Office, the Senate and House health reform bills would reduce deficits both over the decade from 2010 through 2019 and after that. Both bills also contain a wide range of measures to restructure the U.S. health system and slow the growth of health care costs, particularly Medicare costs.

A new analysis by the Center on Budget and Policy Priorities describes the problem and how the pending legislation would address it HYPERLINK “http://capwiz.com/socialworkers/utr/1/GGWSLZNPUF/LFADLZPYYD/4637793656“here.

U.S. Government to pay more than half of U.S. health costs by 2012

A new report by federal actuaries shows government programs will pay for more than half of all U.S. health care spending by 2012. The health care spending projection data can be found on the CMS web site at

HYPERLINK “http://capwiz.com/socialworkers/utr/1/GGWSLZNPUF/JKIJLZPYYE/4637793656“http://www.cms.hhs.gov/NationalHealthExpendData/03_NationalHealthAccountsProjected.asp

U.S. Surgeon General Report on Obesity

On January 28, First Lady Michelle Obama, HHS Secretary Kathleen Sebelius, and Surgeon General Dr. Regina Benjamin announced initiatives to help Americans lead healthier lives through better nutrition, regular physical activity, and improving communities to support healthy choices. To read the Surgeon General’s Report, go to:

HYPERLINK

On Tuesday, Feb. 2, the Senate Armed Services Committee, chaired by Sen. Carl Levin (D-MI), held a hearing on the status of the U.S. military’s Don’t Ask, Don’t Tell (DADT) policy. The two witnesses invited to the hearing were Admiral Michael Mullen, Chairman of the Joint Chiefs of Staff, and Robert Gates, Secretary of Defense.

Sen. Levin opened the hearing by calling the Don’t Ask, Don’t Tell policy “discriminatory”, then cited the popularity of repealing the DADT rule according to polling data. He noted that other countries have repealed similar rules without major problems, and expressed concern at the number of significant military figures, including linguists with skills in Middle Eastern languages, who have been lost due to the DADT policy.

Click here to watch the hearing in its entirety.

Adm. Mullen’s testimony was surprisingly personal. Rather than simply speak from the Joint Chiefs of Staff perspective, he expressed concern about the notion that people who wish to serve in the military have to lie about who they are in order to do so. Adm. Mullen also acknowledged that some disruption in the military’s overall lifestyle would be inevitable, but that thoughtful and thorough studies would be conducted to limit any problems.

After that, all Members of the Committee were permitted to ask questions, most of which broke down on party lines. Democrats universally expressed support for the idea of repealing DADT, with just a few asking Sec. Gates and Adm. Mullen about proper implementation of the potential new policy. The Republicans either opposed repeal of DADT outright, or expressed such strong concerns about the change that they effectively support retaining DADT, even if they did not explicitly say so.

As always, we will closely monitor any further hearings, bills, and other relevant updates on the DADT issue.