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:
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.
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
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: