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.

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.

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.

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.

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.

NASW offices are closed December 24 - January 1. While we will be monitoring the developments of health care reform, the next Health Care Reform Roundup will be distributed the week of January 4.

Senate Breaks Logjam on Health Reform
After nearly 20 days of continuous debate, the Senate finally appears ready to complete consideration of its version of health reform legislation, HR. 3590. When Senate consideration is complete, a conference committee process between the House and Senate will occur, and conferees will negotiate a final agreement that must again pass both chambers. As the Senate completes consideration of their version, NASW has called on you to contact your Senators to support passage of their bill (H.R. 3590). A link to our most recent action alert is here.

The Senate breakthrough this week came in the form of a manager’s amendment that dropped the government-run insurance plan, or public option, which NASW supported. The now amended Senate bill would create a new system of national, private insurance plans supervised by the federal Office of Personnel Management (OPM), which currently administers health benefits for federal employees. OPM would be required to recruit at least two insurers to participate in a new system of national health insurance plans, and one must be a nonprofit. Additionally, states would organize and regulate their own insurance exchanges that would sell private plans available on a statewide basis. The new Senate amendment includes a financial requirement for private insurers that would establish minimums on insurers’ premium revenues that must be spent on medical claims known as the “medical loss ratio.” The latest Senate changes also tighten restrictions on insurance coverage for abortion, another crucial NASW concern.

Conference Committee Considerations
Conferees’ room for maneuvering is expected to be limited because any changes in the final conference bill could unravel the agreement that provided Democrats with the 60 votes necessary for final Senate passage. Conferees will have to find compromises on divisive issues such as abortion coverage, revenues to pay for expanded coverage, whether to include a government-run plan, and methods to expand coverage to those unable to pay full costs. On each of these issues the Senate is expected to have a stronger hand in negotiations.

At this time it is unclear what process House and Senate Democratic leaders will use for conference committee consideration. They may work out their differences in negotiations with a small group of Democratic leaders and committee chairmen, supported by key congressional staff. NASW expects the process will start at the staff level soon after the Senate passes its bill. Leaders hope to have the final bill on the President’s desk by late January.

NASW Strategy

When conference committee consideration begins, NASW will express its preferences among key competing provisions of the House and Senate bills. Among the differences NASW expects to weigh in on are provisions concerning Medicare Skilled Nursing Facility coverage of clinical social work services, workforce provisions under the Social Work Reinvestment Act, the public option, and reproductive choice. NASW is aware the final bill may not measure up to all the hopes of its members, but we will 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.

Employment Non-Discrimination Act

NASW continues to work diligently on the Employment Non-Discrimination Act (H.R.3017/S.1584).  With 194 sponsors in the House of Representatives and 44 in the Senate, E.N.D.A. has begun to attract enormous attention.  The Employment Non-Discrimination Act is dedicated to the principle that every worker should be judged solely on his or her merits.  Further, hardworking Americans should not be kept from supporting their families and making a positive contribution to the economic life of our nation due characteristics that have no bearing whatsoever on their acumen to do a job.  The Association remains allied with traditional civil rights groups who affirm that inequality and discrimination subvert the principles of Democracy.

Political Climate
Despite the many twists and turns health care reform has taken in the past several months, we are not necessarily closer to a solution in mid-December than we were in mid-September.  The Senate still has not completed its own bill, and is trying to write legislation that can earn 60 votes.  Once they do so, a conference between House and Senate negotiators will have to occur in order to send a single bill to President Obama.  At this point, no one can guarantee when such a conference will take place.  The cause of this delay is simple: for all the attention rightfully placed on abortion-related aspects of the discussion, there is still no agreement on the fundamental way in which more Americans would receive health care coverage.  Many reasonable approaches have been mentioned in the Senate, including expansion of Medicare and a public option.  But one week before Christmas Day, there is still no single plan that has garnered the support of 60 Senators.  Until that happens, there can be no conference with the House and thus no bill for President Obama to sign into law.NASW has called on its members to contact their Senators to support the bill (H.R. 3590), and a link to our most recent action alert is here. NASW has written to Majority Leader Reid supporting the Senate reform bill, and a copy may be viewed on the NASW Web site.

Reinvestment for Educators
NASW President Jim Kelly, Baccalaureate Social Work Program Directors President Freddie Avant, and Action Network for Social Work Education and Research Chair Jeane Anastas, recently filmed a video regarding “Reinvestment for Educators” to discuss why the Social Work Reinvestment Initiative is important for social work educators. The bill will support recruitment of new social work students, retain experienced social workers, and fund social work education and research. To view the full legislation, please click here. After viewing the video, please send a letter of support to your Representative and Senators.

Social Work Medicare Equity Act in Health Care Reform
Section 1307 of the House health care reform bill (H.R. 3200) authorizes clinical social workers eligible to participate under Medicare Part B to bill independently for services to Medicare Part A covered residents of Skilled Nursing Facilities (SNFs). The provision removes Part B-eligible clinical social work services from the Medicare SNF per diem rate and alternatively authorizes them to bill for them separately. This is a long-sought change by NASW that will expand the availability of clinical social work services to SNF residents covered by Medicare Part A and provide parity recognition for the profession in a SNF setting. The Senate version of health care reform legislation (H.R. 3590) does not contain a similar provision, and this difference must be ironed out in conference committee on the legislation. NASW is working with House and Senate offices to support the provision when conference committee consideration begins.

SWRA Provisions Advance on Health Care Reform
There are several provisions within Health care reform legislation, H.R. 3590, which advance the Social Work Reinvestment Act (SWRA).  Related provisions are contained in the House-passed measure, H.R. 3200. The Senate bill includes the following key provisions addressing social work professional education and training needs:

• Sec. 3508 - Establishes a demonstration program to integrate quality improvement and patient safety training into clinical education of health professionals. Schools of social work are among the eligible grantees.

• Sec. 5101 - Creates a National health care workforce commission tasked with reviewing health care workforce and projected workforce needs. The needs of the social work profession are among those that would be considered by the Commission and schools of social work also have representation.

• Sec. 5102 - Creates state health care workforce development competitive grants to s. enabling State partnerships to complete comprehensive planning and to carry out activities leading to coherent and comprehensive health care workforce development strategies at the State and local levels. All health professions are eligible for state planning attention, including social work.

• Sec. 5203 - Establishes health and behavioral health workforce loan repayment programs for pediatric subspecialists and providers of mental and behavioral health services to children and adolescents who are or will be working in a Health Professional Shortage Area, Medically Underserved Area, or with a medically underserved population.

• Sec. 5305 - Authorizes funding for geriatric education and training; career awards; comprehensive geriatric education to advanced practice nurses, clinical social workers, pharmacists, and psychologists.

• Sec. 5306 - Awards to mental and behavioral health education and training grants to schools for the development, expansion, or enhancement of training programs in social work, graduate psychology, professional training in child and adolescent mental health, and pre-service or in-service training to paraprofessionals in child and adolescent mental health.

• Section 756 of the Public Health Services Act is amended to include language regarding the qualifications of institutions eligible for these training grants and that at least four will go to Historically Black Colleges and Universities (HBCU) or Minority Serving Institutions (MSI).  Authorization for up to $8 million in funds is provided for social work.

Medicare MD & MSW Fee Schedule Update
Clinical social workers that participate in Medicare Part B will have their payment rates temporarily protected against large cuts scheduled for 2010 because Congress acted on a short-term bill to delay the cut required by the flawed sustainable growth rate (SGR) formula, which determines outpatient payment rates in Medicare and TRICARE. The SGR formula is frequently inappropriately described as the Medicare “physician fee” formula, but it actually sets the rate of increase or decrease for all Medicare Part B independent practitioners, including clinical social workers. NASW supports legislation that would halt scheduled cuts in Medicare payments to clinical social workers and other health professionals and has urged Congress to adopt legislation to recalibrate how these payments are set each year. See NASW’s letter to Congress here.

Correcting the problem before the rate cuts go into effect on Jan. 1, each year is politically difficult due to the multi-billion dollar costs of correcting the formula. Current law requires large annual reductions in Medicare SGR determined fees, which include rates paid to clinical social workers. Congress rejected several earlier SGR bills this fall, but then passed an eight week extension into February, enabling it to address the payment problem once it finishes work on health care reform. NASW is continuing to work with coalition partners in support of an SGR remedy.

Appropriations Bill Funds Study on Mental Workforce Issues
During the week of December 9, Congress finished the annual appropriations bill for the federal FY 2010, Labor-HHS-Education spending bill, which is available on the House Appropriations website. One item of special interest to the social work profession is the inclusion of $900,000 for the Institute of Medicine (IOM) to study mental health workforce needs focused on (1) a systematic analysis of the current and projected mental and behavioral healthcare needs of the American people, particularly for aging and growing ethnic populations; and (2) developing policy recommendations for achieving a competent and well-trained mental health workforce to address those needs.  Congressional authors justified the study as necessary in light of the projected doubling of the aged population by 2030, new evidence of the importance of addressing mental health needs as part of effective chronic disease management, increased numbers of veterans with post traumatic stress disorder, improved diagnostic techniques, and implementation of the new federal mental health parity law. The study expands on IOM’s 2008 broader study on the geriatric workforce, which did not explore mental health workforce needs in depth. NASW worked with other mental health professional groups to support this funding in the new law, and will advocate vigorously for the representation of the social work profession in the work of the IOM.

Health Legislation Prospects for 2010
At the start of the new year, Congress is not expected to consider major new health legislation, but congressional committees will consider routine health legislation, particularly those bills that were set aside last year to make time for health reform legislation. These include the 21st Century Cancer ALERT Act, reauthorization of HHS/Public Health Service programs under the jurisdiction of the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA). Furthermore, congressional oversight of new federal programs to promote the use of health information technology (HIT) and to protect confidential patient information is expected to be a priority. NASW will represent clinical social worker interests to ensure the profession is included for all Medicare HIT incentive payments and that psychotherapy notes are protected in federal privacy regulations.
Congress also faces a variety of funding challenges to implement health care reform, particularly programs that support the education and training of the health professions. NASW will aggressively pursue expanded federal support for the social work profession in these federal initiatives. As in past years, Congress has not settled on a long-term solution to the Medicare physician payment formula, which also determines the payment rate for clinical social workers and all the health professions that directly bill Medicare Part B.  NASW will continue to advocate for adequate payment rates for the profession during this protracted debate. NASW members who wish to stay informed about health and behavioral health developments in the new Congress should follow NASW’s webpage.

NIH Approves New Stem Cell Lines
On December 2, the National Institutes of Health (NIH) approved 13 new human embryonic stem cell lines for use by NIH funded researchers. Another 96 embryonic stem cell lines are undergoing NIH review. In March, President Obama expanded the number of such cell lines beyond those available under a policy set by President George W. Bush, which permitted research to begin only with lines already available on Aug. 9, 2001. To read more, go to the NIH press release.

Needle and Syringe Exchanges Ban Lifted
On December 13, the Senate passed the Consolidated Appropriations Act of FY2010 by a vote of 57 - 35.  The President is expected to sign the bill before the continuing resolution expires.  Among many other important provisions, the bill removes the federal funding ban on syringe exchange. The provision allows the distribution of syringes through syringe exchange as long as local public health or local law enforcement authorities do not object to a specific location as being inappropriate for distribution.

NASW Supports Child Welfare Workforce Improvement Act
On November 30, NASW sent a letter to Senator Blanche Lincoln (AR) thanking her for introducing S. 2837 the Child Welfare Workforce Improvement Act. The bill will help ensure a workforce that can accurately assess the strengths and needs of children and families, connect children and their families to services, monitor their progress, and improve outcomes for children. NASW sent an alert to the Advocacy Listserv looking for cosponsors.

Immigration Bill Introduced in House
Representative Luis Gutierrez (IL-4) introduced immigration legislation, Comprehensive Immigration Reform for America’s Security and Prosperity (H.R. 4321), in the House on December 15. Congress is beginning to shape the immigration debate with the introduction of this bill and NASW is developing our strategy. You can view the bill here. Immigration will be an important issue tackled in 2010.

Veteran’s Affairs
Recently, we heard from a member of NASW who is an MSW student and a veteran who recently returned from Afghanistan.  He hoped to find a mental health counselor who was both a veteran and a social worker.  While he strongly supports the work of all social workers, he wanted to find one who could directly relate to his experience in war.  The Veterans Administration in his area was unable to locate such a person for him, and other non-VA efforts came up empty as well.

This is a clear connection between member needs and NASW advocacy.  Veterans represent a constituency who may choose to enter social work to benefit both their peers and other members of society, but only if there is a distinct path for them to do so.  Thus, NASW has intensified its focus on veteran’s issues.  This improvement is meant to benefit not just veterans, but the field of social work as well.

Several Amendments Dominate Debate in Senate on Health Care Reform

There are 91 amendments to the Senate Health Care Reform bill. A list of all the Senate amendments to the Health Care Reform bill can be found here. The list is compiled by OpenLeft.com, a news, analysis and action website dedicated toward building a progressive governing majority in America.

State-by State Analysis of the Impact of Health Care Reform

The Department of Health and Human Services has released an analysis of the impact of healthcare reform on a state-by-state basis.

Senate Tables the Nelson Abortion Amendment

On December 8, the Senate voted to table or set aside the amendment offered by Senator Ben Nelson (D-NE).  The Nelson amendment to the health care reform bill would have banned the use of federal taxpayer money for abortions failed by a vote of 54-45.

The Nelson amendment was similar to the Stupak/Pitts abortion amendment that was added to the passed House health care reform bill last month.   With the inclusion of the Stupak/Pitts amendment, the House bill would prohibit the proposed new government-run insurance plan from covering abortions except in cases of rape, incest or to save a mother’s life, and bars any health plan receiving federal subsidies in a new insurance marketplace from offering abortion coverage.

NASW strongly opposes the Stupak/Pitts inclusion in the House bill and advocates for its removal when the House and Senate negotiates the bills during conference committee.

Rally for Reproductive Rights in Health Care Reform a Success

Hundreds of people came to Capitol Hill from as far away as California to rally for reproductive rights in health care reform. NASW sponsored the event along with other organizations. The room in the Capitol building was filled to capacity and there was need to use an overflow room to accommodate the participants. In addition to the rally, individuals lobbied their members of Congress.

Wednesday, December 09, 2009
FOR IMMEDIATE RELEASE
Contact: J. Jioni Palmer

WASHINGTON, D.C. – Members of the Congressional Black Caucus will be on the House Floor TONIGHT to discuss job creation in the African American community.

The Special Order Hour will be anchored by CBC Chairwoman Barbara Lee (D-CA). The Special Order Hour will be broadcast on C-SPAN.

WHAT: Special Order Hour on job creation in the African American community

WHO: Members of the Congressional Black Caucus

WHEN: TONIGHT, Wednesday, December, 2009 at approximately 7:00/8:00 pm.

WHERE: U.S. House of Representatives, House Floor

www.thecongressionalblackcaucus.com

Becky Myers, LSW, ACSW
Director, External Relations
Dec 3, 2009

Today, staff and members of NASW attended the National Lobby Day and Rally against the Stupak Amendment. NASW was a sponsor and worked to plan and implement the event. The U.S. House of Representatives passed an amendment to the health care reform legislation sponsored by Bart Stupak (MI-1) and Joe Pitts (PA-16). This “Stupak” amendment would restrict access to abortion procedures for consumers who receive subsidies to buy insurance in a reconfigured health care system. Pro-choice organizations are very concerned the new language threatens the availability of private insurance coverage for comprehensive reproductive health care services. Today these groups joined forces to lobby their members of Congress and rally against this amendment being included in the Senate healthcare reform package and conference legislation.

The rally was led by Cecile Richards, President of Planned Parenthood, and sponsored by a number of women’s, religious, professional, campus, and related groups in support of reproductive choice. The support from members of Congress was overwhelming with many in attendance including social worker Susan Davis, Senator Barbara Boxer, Senator Patty Murray, Rep. Jerry Nadler, Rep. Nita Lowey, Rep. Rosa DeLauro, Rep. Dianna DeGette, Rep. Lynn Woolsey, and Rep. Donna Edwards. Additional speakers included Ellie Smeal from the Feminist Majority, Willie Parker, the Medical Director with Planned Parenthood of Metro DC, and Rev. Carlton Veazey

The crowd was quite large and included all ages, races, and genders. People came from all over the United States and from 38 different college campuses. The overall message was that we are all in support of healthcare reform and universal access for everyone, but not on the backs of women. Everyone expressed that healthcare reform efforts should be targeted to increase access, not deny women the right to choose, and absolutely not to reverse current law.

Stand up for reproductive choice today by contacting your Representative and Senators today!

Because Congress will be in recess for the Thanksgiving holiday, there will be no Health Care Roundup on Tuesday, December 1. The next publication will be on Tuesday, December 8.

Rally on Reproductive Choice in Health Care Reform

The U.S. House of Representatives passed an amendment to the health care reform legislation sponsored by Bart Stupak (MI-1) and Joe Pitts (PA-16). This amendment would restrict access to abortion procedures for consumers who receive subsidies to buy insurance in a reconfigured health care system. Pro-choice organizations are very concerned the new language threatens the availability of private insurance coverage for comprehensive reproductive health care services.

NASW is co-sponsoring a rally and lobby day on Wednesday, December 2. The day starts at 9am with a lobby training followed by a briefing from 9:30 - 10:30am. Lobby visits from 10:30-11:30.  There will be an event from 12:00-2:00 and more lobby visits from 2:00-4:30.  Events will take place in the Dirksen Auditorium G-50. A wrap up will take place at 4:30 in Rayburn Banquet Room B369. If you would like to participate in the lobby day, please contact Dina Kastner at advocacy@naswdc.org (the mailbox is now accepting messages) so she can set up appointments for you.

Senate Opens Floor Debate on Health Reform

On Saturday, November 21 the U.S. Senate agreed to hold debate on health reform legislation known as the “Patient Protection and Affordable Care Act,” (H.R. 3590). The bill is expected to be on the floor for several weeks after Thanksgiving and will require significant changes to clear the filibuster hurdle of 60 votes to secure passage. NASW plans to strongly support passage, but will also support changes in the bill including those that improve coverage and protect against any weakening amendments of women’s rights to reproductive choices. NASW expects to be very actively involved in this debate; members wishing to keep up to date on our activities should visit our health reform webpage here.

Financial Impact of Health Reform

There is a great deal of analysis available on health reform legislation, but information from non-partisan congressional sources, such as the Congressional Budget Office, is frequently most pertinent to legislative decision making. Readers interested in learning more about the impact of health care reform legislation on federal spending may wish to view congressional analyses of the legislation.  These two inks summarize the budgetary impact of the House bill, HR. 3962: Health Care by the Numbers and Controlling Health Care Costs.

The Senate bill the “Patient Protection and Affordable Care Act,” (H.R. 3590) is still new so nonpartisan analyses of its budgetary impact are still becoming available. One summary is linked here and more information appears here. A brief comparison of the Senate and House versions of health reform legislation is available by this link to a Washington Post interactive site.

HHS Secretary Kathleen Sebelius on Monday announced the release of Health Insurance Reform: The Case for Change, a series of state-by-state reports highlighting the benefits of health insurance reform. The reports are available now here.

Medicare Fee Fix Passes House Floor Moves to Senate

The House passed legislation H.R. 3961 on November 19, which would prevent a scheduled 21 percent cut in Medicare doctors’ payment rates, although its fate remains uncertain. Without congressional action, payment rates for Medicare physician and clinical social worker services will drop by 21 percent on January 1, 2010. The prospect of steep payment cuts has raised fears that care to beneficiaries could be disrupted. The fate of corrective legislation that would permanently repeal the flawed sustainable growth rate (SGR) formula that determines future payment rates in Medicare and TRICARE remains uncertain. The SGR formula is frequently inappropriately described as the Medicare “physician fee” formula, but it actually sets the overall rate of increase or decrease for all Medicare Part B independent practitioners, including clinical social workers. NASW supports corrective legislation that would halt scheduled cuts in Medicare payments to clinical social workers and other health professionals and has urged Congress to adopt a plan to recalibrate how those payments are set each year. See NASW’s letter to Congress here.

Correcting the problem before the rate cuts go into effect on Jan. 1, will be politically extremely difficult. The Senate’s huge health care reform bill (H.R. 3590) includes short-term Medicare rate relief, but this provision is highly controversial and may change during floor consideration. Currently, the Senate plans to return to its physician payment bill once they finish work on health care reform, likely meaning it won’t be considered until sometime after the cuts go into effect on Jan. 1. Congress in the past has occasionally failed to enact the physician payment legislation in time, but has simply later passed retroactive legislation that restores the payment rates. Current law requires even further reductions in Medicare physician fees, a loss which will total to a 40 percent cut by 2016. If the Senate agrees to separate physician payment legislation, it may simply approve the House passed bill, but for now, a politically acceptable solution has not been identified.

Health Technology Loan Measure Passed by House

On November 18, the House passed, by voice vote, a bill (HR 3014) creating a new program to be administered by the Small Business Administration that would guarantee small business loans to health professionals such as clinical social workers and physicians to obtain health information technology for use in small or independent health practices. Eligible health information technology includes computer hardware, software, and related technology that supports the meaningful electronic health record use requirements of Medicare and purchased by an eligible professional to aid in the provision of health care, including electronic medical records. Information technology whose sole use is financial management, maintenance of inventory of basic supplies, or appointment scheduling would not qualify for the loan program. The legislation has been referred to the Senate where action is uncertain at this time.

GINA Employment Provisions Take Effect

On November 21, the Genetic Information Nondiscrimination Act (GINA) took effect for all employers with 15 or more employees and it took effect for individual health insurance plans last May.

GINA was passed by Congress last year and prohibits the use by employers of genetic or family medical history in making hiring, firing, promotion or job placement decisions.  Employers cannot require employees to undergo a genetic screening or ask employees for such medical information.

In related news, NASW joined various groups on a letter to the Department of Labor, Department of Health and Human Services and the Internal Revenue Service stating our opposition to any delay or weakening of the GINA regulations.  The letter states, “any delay in implementation would continue to allow employers to inquire about employees’ private genetic information or their families’ medical history, while penalizing employees who choose to keep that information private; any such exemption would create a loophole to significantly weaken the protections afforded to employees and the American people under GINA”.