House Passes Health Care Reform Legislation

In an historic vote, the House passed major health care reform legislation on November 7, with a vote of 220-215. NASW strongly supports the health care reform bill (H.R. 3962), which included a Medicare provision allowing clinical social workers to bill independently for serving certain nursing home residents. A copy of NASW’s endorsement letter highlighting provisions of great concern to social workers is linked here.

Abortion Emerges as Major Controversy in Reform

During negotiations leading up to passage, a new unsettled question arose over whether consumers who buy insurance without any government subsidy will be able to obtain insurance that covers abortion services through the federal insurance exchange established in the bill.

Abortion rights advocates and opponents agree the House language spearheaded by Bart Stupak, D-MI, would restrict access to abortion procedures for consumers who receive subsidies to buy insurance in a reconfigured health care system. Anti-abortion groups say the amendment explicitly bars private insurers from including abortion coverage in plans they sell in the exchange to consumers who pay the premiums out of pocket, but pro-choice organizations are very concerned the new language goes much further and threatens the availability of private insurance coverage for these services. NASW opposes the Stupak amendment and is working with pro-choice groups to eliminate it in the Senate and final bill. The Senate will begin consideration of health reform legislation next week, and differences between the House and Senate version will ultimately be worked out in a conference committee.

NASW Acts on New Medicare Provider Enrollment Barrier

NASW plans to join with a large coalition of medical and health care practitioner groups to urge the Centers for Medicare and Medicaid Services, (CMS) to halt implementation of a new payment policy affecting clinical social workers and other health professionals that bill independently under Medicare Part B. The new administrative barrier concerns PECOs, a database that clinical social workers will soon be required to enroll in as a condition of participation in Medicare Part B. In 2003, Medicare switched to the new PECOS database for Medicare providers.  Recently Medicare claims have been denied for any provider who is not in the PECOS system, although practitioners were not told they needed to re-enroll as Medicare providers so they could be in the PECOS system.  There are nearly 800,000 Medicare providers, but only over 500,000 have enrolled in PECOS up to the present.  The remaining 300,000 providers must re-enroll and get revalidated.  This process is similar to many insurance company processes and is long and cumbersome.  Claims by these 300,000 providers are now being denied and electronic claims are being denied immediately.  Those submitting paper claims are not being paid, but without explanation.

FTC Red Flags Rule Enforcement Delayed

The FTC has announced that it is again delaying enforcement of the “Identity Theft Red Flags” Rule” until June 1, 2010. The rules would have directly affected clinical social workers in small private and group practices. One of the controversial aspects of the Rule was its applicability to health care professionals, particularly small or solo practitioners.  The Rule has been delayed previously on two separate occasions.  NASW provided information about the identity theft regulations in the June 2009 LDF Legal Issue of the Month and the article may be accessed here.

As the regulatory situation has grown more difficult, a number of health and other professionals have approached Congress seeking a legislative solution. Congress has responded with quick movement on a bill, H.R. 3763, which would exclude licensed health practitioners with fewer than 20 people in a practice from reporting under the Fair Credit Reporting Act and from the Red Flags Rule. The bill was introduced in the House and passed the floor a brief three weeks after introduction. It is now pending before the Senate where momentum could slow down in response to the FTC’s action postponing implementation of the regulation. More information is available at an FTC website here.

NASW Calls for Increased Mental Health Funding

The National Association of Social Workers has joined with the Mental Health Liaison Group (MHLG), a coalition of national organizations representing the diverse mental health advocacy community, in calling for higher federal funding levels for mental health services, supports and research.  The coalition argues that higher federal funding levels are essential to meet the extraordinary mental health needs of communities throughout the nation, which are especially strained by the extraordinary economic crisis. NASW and MHLG called on the Congress to go above the Administration’s proposed increases for the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Institutes of Health (NIH), which includes funding for the National Institute of Mental Health (NIMH).

In a coalition letter signed by NASW, the group called for funding increases in overlooked federal mental health programs, including increases for the mental health block grant and consumer-centered programs, among others, whose funding levels have remained stagnant for nearly a decade.  NASW and the coalition are pursuing a comprehensive funding approach, advocating for a broad array of services and supports to address the needs of all communities with many residents who have been affected by the crisis, and because of the likelihood that every state will be forced to reduce services. For a copy of NASW’s coalition letter to Congress, see here. 

Congress Negotiates Health Reform Details

Democratic leaders continue to convene in high level meetings to work out the details of comprehensive health reform bills headed soon to the House and Senate floor. With critical decisions being worked out behind closed doors, advocacy organizations are scrambling to learn how their top priority concerns are faring in the ongoing negotiations. NASW continues to press for a variety of priorities including expanding coverage of the uninsured and ensuring that health disparities are addressed. NASW members interested in learning the details of the various bills may access two new resources to compare the various bills on a wide range of variables.  Follow this link to a new Kaiser Family Foundation’s side by side document comparing the major health care reform bills and also this one of a new Commonwealth Fund analysis of the major health care reform bills.

Social Work Medicare Equity Act Language Included in House Bill

Section 1307 of the House Bill (H.R. 3200) includes language that removes clinical social work services from the Skilled Nursing Facility (SNF) per diem rate and alternatively authorizes independent practitioners to bill for them independently. With this provision, licensed clinical social workers that participate in Medicare will be able to bill Medicare directly. This is a long-sought change by NASW and a critical parity provision for clinical social workers that will expand the availability of services to certain Medicare SNF residents. 

 Political Climate

Senate Majority Leader Harry Reid has sent a health care reform bill containing a “state opt out” to the Congressional Budget Office (CBO) for scoring, or a determination of how much the bill would cost.  The “opt out” would permit individual states to remove themselves from the federal insurance program if they wish.  Sending the bill to the CBO is a strong indication that Reid believes he can pass a “state opt out” bill through the Senate with at least 60 votes (and exactly 60 votes, in all likelihood).  Speaker Pelosi has expressed a strong preference for a bill containing some kind of public option, but has indicated that a “state opt out” would accomplish many of the same goals and does not believe it would hinder the progress of a final bill.  If Sen. Reid can secure 60 votes for this bill, the process of reconciliation with the House bill would then commence, before a final version is sent to the White House.

Best Practices and Lessons Learned: Shaping National Health Care Reform

Kyrsten Sinema, MSW, JD is a social worker, NASW member and a member of the Arizona legislature, serving as Arizona’s Assistant House Democratic Leader. She led a Lunch Time Series teleconference to discuss federal health care reform. Sinema is one of 32 state legislators nationwide — the only state lawmaker from Arizona — selected for President Obama’s White House Health Reform Task Force. She provided an overview of the various health reform proposals being considered. NASW members can read the transcript online.

Benjamin Confirmed as U.S. Surgeon GeneralOn October 29, the full senate unanimously approved Regina Benjamin, MD as U.S. Surgeon General.  The Surgeon General of the United States is the operational head of the Public Health Service Commissioned Corps (PHSCC) and thus the leading spokesperson on matters of public health in the federal government.

First announced as the U.S. Surgeon General nominee on July 13, 2009, Dr. Regina Benjamin was the founder and chief executive officer of the Bayou La Batre Rural Health Clinic in La Batre, LA, the immediate past chair of the Federation of State Medical Boards of the United States and previously served as associate dean for rural health at the University of South Alabama College of Medicine. In 2002, as the president of the Medical Association of the State of Alabama, she became the first black woman to be president of a U.S. state medical society. 

NASW supported Dr. Benjamin’s confirmation.

Congress Extends the Ryan White Act

Last week, Congress passed the Ryan White HIV/AIDS Treatment Extension Act of 2009. The bill will extend for four years the Ryan White Program, which provides lifesaving and life-extending health care, medications and support services to over 530,000 low-income people living with HIV/AIDS in the United States. On October 21, the bill passed the House floor on a vote of 408 to 9. On October 19, the Senate passed the same bill by unanimous consent. The bill is awaiting President Obama’s signature. The Ryan White HIV/AIDS Program was originally authored in 1990 and reauthorized three times since, always with strong bipartisan support.

Update Health Care Reform

On October 13, the Senate Finance Committee voted on its version of the bill to overhaul health care in the United States.  The Senate Finance committee was the last congressional committee of jurisdiction to tackle the issue of health care reform.  The Senate leadership is in the process of merging the Finance Committee legislation with a bill approved by the Senate Committee on Health, Education, Labor and Pensions (HELP). The HELP bill contained several provisions supported by NASW and not included in the Finance Committee proposal, including a public option plan.

According to Senate rules, they will permit a huge number of floor amendments, threatening perhaps several weeks of debate, if opponents have the votes to tie up consideration. It is likely that at least some of these amendments will raise high-priority concerns for NASW.   For example, one such amendment would focus on including the public plan option in the final bill.  Please go here to see an earlier NASW action alert supporting the public option plan.

The House leadership has been meeting over the past month in an effort to merge the bills passed out of three committees of jurisdiction (Energy and Commerce, Ways and Means and Education and Labor).

(more…)

Clinical social workers that participate in Medicare Part B will have their payment rates protected against a large cut provided the Senate acts favorably on the “Medicare Physician Fairness Act of 2009” (S. 1776). This legislation would permanently repeal the flawed sustainable growth rate (SGR) formula that determines future payment rates in Medicare and TRICARE. 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 this bill, which would halt scheduled cuts in Medicare payments to clinical social workers and other health professions and has urged Congress to adopt a plan to recalibrate how those payments are set each year. See NASW’s letter to Congress here.

For ongoing information, please visit our health care reform page.

Video: Can We Live up to the Social Work Legacy?

Please take a moment to view a video NASW just recorded for you regarding the Dorothy I. Height and Whitney M. Young, Jr. Social Work Reinvestment Act (H.R. 795/ S.686. This legislation is a first step to address serious workforce challenges such as low salaries, high educational debt, and safety concerns and will determine the best course of action to strengthen our profession. The bill is important to all social workers, and in this brief video we explain why leaders like Frances Perkins, Dorothy Height, and Whitney Young provide lessons for us to learn from and a legacy we must continue. NASW hopes we can count on our fellow social workers to stand up for our profession as we have always stood up for our clients.

NASW Attends Congressional Hispanic Caucus Institute and Congressional Black Caucus Foundation Annual Legislative Conference

On September 13-15 NASW attended the Congressional Hispanic Caucus Institute Public Policy Conference. On September 23-26, NASW attended the Congressional Black Caucus Foundation Annual Legislative Conference (ALC). The Public Policy Conference and the ALC featured issue forums that focused on issues ranging from poverty and economic issues to housing, health and veterans.

HHS Secretary Sebelius Announces Senate Confirmation of Carmen Nazario as Assistant Secretary for Children and Families

The U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced that the United States Senate unanimously confirmed social worker Carmen Nazario as Assistant Secretary for Children and Families. In that role, she will oversee the Administration for Children and Families within HHS.

“Carmen Nazario has a distinguished record of more than 40 years working in human services at every level of government, as well as in the private and non-profit sectors,” said Secretary Sebelius.  “She has devoted her career to developing and implementing programs that promote the well-being of children and families, and she will build on that important work as Assistant Secretary for Children and Families.” (more…)

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. For ongoing information, please visit our health care reform page.

Congress Advances Health Care Reform

Congress made major progress last week on health reform legislation. House leaders continued to negotiate merging three somewhat different committee versions of their bill into H.R. 3200. The final House language for H.R. 3200 could be released this week and Democratic leaders plan to begin floor votes within three days of release.  The design of a public insurance option remains a sticking point in the bill, along with payment rates for providers that participate in the public plan. NASW has supported this House effort, including the public option.

In the Senate, the Finance Committee has largely completed their version of reform legislation and received a favorable cost estimate from the Congressional Budget Office, which has boosted its political prospects. NASW has important reservations with the Senate Finance Committee bill, including the number of people excluded from coverage after full implementation, the omission of direct billing privileges for clinical social workers serving nursing home residents covered by Medicare, the failure to boost payment rates for psychotherapy services under Medicare, and the omission of a strong public option. NASW will await receipt of final Senate language before taking a position on floor consideration, which could begin next week. Senate floor consideration will continue for perhaps several weeks, and a number of amendments and key votes are expected during the debate. For more details on NASW activities, visit our webpage here.

African-American and Latino Organizations Join Forces to Push for Health Care Reform

On October 5, the country’s largest African-American and Latino organizations announced they are joining forces with other major national civil rights and grassroots organizations to mobilize the nation’s 100 million people of color for a final push in support of universal health care reform.  NASW attended this press conference, works with these groups, and is a member of the Leadership Council on Civil Rights. The organizations included the NAACP National Voter Fund, the National Council of La Raza, the Leadership Council on Civil Rights, the Campaign for Community Change, and the United States Student Association and PowerPAC.org.

The groups released television and print ads in English and Spanish that will run in four states with sizable African-American and Latino populations, part of a grassroots effort to ensure that members of Congress appreciate the importance of reform to the people of color they represent.  Those four states are Florida, North Carolina, Louisiana and Arkansas.

The ads can be viewed at www.healthequityforall.org.

Administration Announces Parity Regulation Delay

The new federal mental health and addiction services parity law, P.L. 110-343, passed in October 2008, requires that regulations be issued by Oct. 3, 2009; however, HHS Secretary Sebelius announced on October 2 the new rules will arrive late. Said Sebelius in her letter to Capitol Hill offices, “We (Dept. of Labor/DHHS) are committed to ensuring access to these critical services, and it is our goal to issue regulations by January 2010 that will address the key issues…”  According to Sebelius, the Department received over 400 public comments in response to a regulatory notice published this spring. NASW submitted comments at that time.

The effective date of the new law is for health plans with renewal dates beginning on or after January 1, 2010. Employer groups of fewer than 50 employees are exempt from the new requirements, but all other private insurance plans, including those covered by ERISA, are subject to the new federal requirements. According to the law, health insurance plans that offer any level of mental health or substance abuse treatment benefits must offer them at parity level with other health care benefits available under the plan. With the delay in the new regulations, health plan administrators will lack guidance on technical issues in the law, although they will still be required to follow the law or risk administrative and legal action by employees or state regulators for non-compliance. For more information about the law, see NASW’s Legal Issue of the Month for January 2009

August Recess

We will be taking a break from the Health Care Reform Roundup while Congress is in recess (through September 7). We still encourage you to attend Town Hall Meetings throughout the month of August and write to your members of Congress about health care reform.

We are sending announcements to Advocacy Listserv members when we hear of a Town Hall Meeting in your district or state. Personal stories are very effective at these Town Hall Meetings. Make sure you identify yourself as a social worker. Here are some talking points you can use at the Town Hall Meeting:

1. Pass health care reform now.
2. We want all people covered; national policy must ensure a universal right to insurance coverage for a continuum of health and behavioral health services.
3. We want quality health care. Health care reform must promote wellness, maintain optimal health, prevent illness and disability, ameliorate the effects of unavoidable incapacities, and provide supportive long-term palliative end-of-life care.
4. We want health care that recognizes the need for social work services; social workers are an important part of the health care team.

President Obama hosted Town Hall Meetings on health care reform in New Hampshire, Montana, and Colorado. You can find out about these on the White House Web page. See the blog and pictures from NASW New Hampshire Executive Director, Stephen Gorin about his experiences at the town hall meeting in New Hampshire.

Executive Branch Meetings

Women for Health Insurance Reform

On Wednesday, August 12, NASW was invited to attend a meeting in the Executive Office Building of the White House regarding Women for Health Insurance Reform – Stability and Security for All Americans.   The goal of the meeting was to emphasize how important women are in discussing the need for health care reform.  The speakers for the meeting were Valerie Jarrett, Senior Adviser to the President; Tina Tchen, Director of the White House Office of Public Engagement; David Simas, White House Communications Office, Office of Health  Reform; Buffy Wicks, Deputy Director of the White House Office of Public Engagement; Kavita Patel, White House Office of Public Engagement; and Neera Tanden, Senior Advisor, HHS Office of Health Reform.  The overall message from the meeting was that it is important to remember that reforming the current health care system can:

• ensure health care stability and security for all Americans
• reduce costs to make health care affordable
• bring stability and improved care to Americans by offering new consumer protections
• protect a patient’s  choice of doctors, hospitals, and insurance plans
• assure quality affordable health care for all Americans

The White House also discussed eight Health insurance Consumer Protections. They can be found at

http://www.whitehouse.gov/health-insurance-consumer-protections

Status of Health Care Reform

On Friday, August 14, NASW participated in a conference call with the White House to discuss the current status of the health care reform/insurance debate, messaging and strategy.  The White House also announced its new web page, www.whitehouse.gov/RealityCheck to help separate fact from fiction about health insurance reform.  The conference call speakers included Tina Tchen, Director of the White House Office of Public Engagement; Michael Strautmanis, Chief of Staff to the Assistant to the President for Intergovernmental Relations and Public Engagement; Michael Hash and Lauren Aaronson, Senior Advisers; and David Simas, White House Communications Office, Office of Health Reform.

Health Care Reform and Older Adults

On Friday, August 14, NASW was invited to the White House for a stakeholders’ meeting to discuss health care/insurance reform and aging issues.  The round table discussion was facilitated by Nancy-Ann DeParle, Counselor to the President and Director of the White House Office of Health Reform; and Tina Tchen, Director of White House Office of Public Engagement. Valerie Jarrett, Senior Adviser to the President welcomed the groups to the meeting.  The hour-long discussion began after the group watched the President as he conducted a live town hall meeting from Montana.  The specific focus of the meeting was to talk with organizations that had an interest in aging issues. The organizations discussed their views about how to engage older Americans in the health care reform debate, as well as how to dispel myths and offer specific facts about health care reform.

Legislation

Senator Grassley, Ranking Member on the Senate Finance Committee, has indicated he would like to take out the end of life planning provisions in the Senate bill.

Resources

Speaker Pelosi has created FAQ’s about H.R. 3200 and Myths and Facts about H.R. 3200.

Chairman Waxman provided responses to health care reform claims on his Web page.

For ongoing information, please visit our health care page.

Keep up with the latest from NASW on Facebook, Twitter, and the NASW Advocacy Blog.  We want your feedback:  post to the Wall and leave your comments on the blog.

NASW has posted briefing papers on a range of issues. You may want to check out the briefing papers on Health Care Reform, Health Care Disparities, and Care Coordination.

On Friday, August 14, NASW was invited to the White House for a stakeholders’ meeting to discuss health care/insurance reform and aging issues.  The roundtable discussion was facilitated by Nancy-Ann DeParle, Counselor to the President and Director of the White House Office of Health Reform; and Tina Tchen, Director of White House Office of Public Engagement. Valerie Jarrett, Senior Adviser to the President welcomed the groups to the meeting.  The hour-long discussion began after the group watched the President as he conducted a live town hall meeting from Montana.  The specific focus of the meeting was to talk with organizations that had an interests in aging issues. The organizations discussed their views about how to engage older Americans in the health care reform debate, as well as how to dispel myths and offer specific facts about health care reform.

On Friday, August 14, NASW participated in a conference call with the White House to discuss the current status of the health care reform/insurance debate, messaging and strategy.  The White House also announced its new webpage, www.whitehouse.gov/RealityCheck to help separate fact from fiction about health insurance reform.  The conference call speakers included Tina Tchen, Director of the White House Office of Public Engagement; Michael Strautmanis, Chief of Staff to the Assistant to the President for Intergovernmental Relations and Public Engagement;  Michael Hash and Lauren Aaronson, Senior Advisors; and David Simas, White House Communications Office, Office of Health Reform.

On Wednesday, August 12, NASW was invited to attend a meeting in the Executive Office Building of the White House regarding Women for Health Insurance Reform – Stability and Security for All Americans.   The goal of the meeting was to emphasize how important women are in discussing the need for health care reform.  The speakers for the meeting were Valerie Jarrett, Senior Adviser to the President; Tina Tchen, Director of the White House Office of Public Engagement; David Simas, White House Communications Office, Office of Health  Reform; Buffy Wicks, Deputy Director of the White House Office of Public Engagement; Kavita Patel, White House Office of Public Engagement; and Neera Tanden, Senior Advisor, HHS Office of Health Reform.  The overall message from the meeting was that it is important to remember that reforming the current health care system can:

• ensure health care stability and security for all Americans
• reduce costs to make health care affordable
• bring stability and improved care to Americans by offering new consumer protections
• protect a patient’s  choice of doctors, hospitals, and insurance plans
• assure quality affordable health care for all Americans

The White House also discussed eight Health insurance Consumer Protections. They can be found at http://www.whitehouse.gov/health-insurance-consumer-protections