Transcript Document

In Support of Our Patients
and Our Profession:
Social Work Leadership
at the State Level to Advance the
Goals of National Health Reform
SSWLHC Annual Meeting; Denver, CO
November 1, 2012
Speakers
Stacy Collins, MSW
National Association of Social Workers
Jennifer Miles, MSW
National Association of Social Workers:
CO Chapter
Workshop Objectives
• Discuss the current status of health care
reform implementation
• Enhance health care social workers’
understanding of their capacity for advocacy
leadership
• Showcase successful state-level social work
advocacy efforts on behalf of patients and
social work practice
• Present the current opportunities for social
work advocacy leadership in state-level
implementation of health reform
Major outcomes of the June 28th
SCOTUS decision:
 Individual mandate was upheld
 State Insurance Exchanges will be established
 Medicaid expansion will go forward, but is
now optional for states
 Implementation of the law goes forward
How do we get to (near) universal
coverage?
• People receiving coverage through their
employers will continue to receive this coverage
• People under 133% of the Federal Poverty Line
(FPL) - about $15K for an individual - now
covered by Medicaid (for opt-in states)
• People between 100-400% FPL can receive
federal subsidies to purchase coverage on their
state “health insurance exchange” – a virtual
marketplace for health plans
• Medicare will continue to cover everyone over
the age of 65
Major ACA benefits
for individuals and families
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No coverage rescissions (2010)
No lifetime caps (2010) or annual caps (2014)
PCIP insurance plan (2010)
Dependent coverage to age 26 (2010)
Guaranteed Issue - No Pre-ex exclusions (2014)
Closing the Medicare donut hole
No cost-sharing for preventive services
Care transitions program (post discharge for
Medicare)
Hospital-focused ACA features
• CMS Payment reductions for hospitals with
excessive 30-day readmissions and/or hospital
acquired infections
• Bundled payments/ACOs/Medical homes –
“payment for performance”
• Enhanced data collection to address health
disparities
• CMMI grants to hospitals
ACA: Direct Benefits for the
Profession
• Loan repayment for mental health providers
working in health professional shortage areas
• Mental and Behavioral Health Education and
Training Grants for SW & psychology schools
(awards announced Sept 2012)
• Health care workforce development grant $
available to states
Only 14 months away!
Major components of health reform –
Medicaid expansion and state
insurance exchanges – need to be up
and running on
January 1, 2014
An Enormous federal and state effort
The ACA legislation passed by Congress was over
2000 pages long
The regulatory process
to implement the bill
is an even bigger effort
Many states opposed to ACA are
stalling implementation until
November
campaign outcome
What happens if Gov. Romney is
elected?
Chaotic Situation
• Law is not easily repealed - no “Obamacare
waivers” that could be issued by executive
order
• Romney administration would have
discretion in interpretation and
enforcement of the law
• Litigation by states and ACA advocates
would likely occur
• Even greater regional health disparities
Three huge tasks that States
must undertake
• Develop a health exchange
• Expand Medicaid
• Develop an Essential Health Benefits
(EHB) plan
ACA implementation
depends on every state
setting up a health exchange
(if not – Feds will do it for them)
Where do states stand on
health exchange development?
Of the 51 states….
16 - Established Exchange
3 - Planning for partnership
exchange (AR, DE, IL)
16 - Studying Options
9 - No Significant Activity
7 - Decision Not to Create (AK, FL, LA,
ME, NH, SC, TX)
Where do states stand on
Medicaid expansion?
All plans operating on the
exchanges have to offer a
set of “essential health
benefits”
Essential Health Benefits
• ambulatory patient services
• emergency services
• hospitalization
• maternity and newborn care
• mental health and substance abuse disorder services
• prescription drugs
• rehabilitative and habiliative services and devices
• laboratory services
• preventive and wellness services and chronic disease
management
• pediatric services, including oral and vision care
States need to choose a
benchmark plan from these four
options:
• largest plan (by enrollment) in the small group
insurance market
• One of the largest (by enrollment) state
employee health plans
• One of the largest (by enrollment) Federal
employee health plans
• the state’s largest non-Medicaid HMO
With EHB plans…
Devil is in the details…..
Health care social workers
can and should get involved
in this process
Make your Voice Matter!
• As health care social workers, we can
make our voices heard in 15 minutes a
month
• Clinical practice has already prepared you
for the job of advocacy
• The interpersonal skills you use daily with
patients, clients and colleagues are well
suited to inform and influence
policymakers and lawmakers
Colorado Advocacy
to implement the ACA
Colorado Example
Colorado is considered to be ahead of many states on
implementation:
• A 2011 bipartisan bill set up the CO Health Benefits
Exchange board charged with establishing exchange
– Open meetings, work groups with board and other
community members, requests for input sent to public
• Division on Insurance has proposed and received
comments on the Essential Health Benefits package
– Comments solicited by state, letters sent from many
• Medicaid expansion – THE question of the 2013 CO
legislative session
– Influence Governor and legislators on topic
Colorado Chapter Involvement
• Hosted an information and networking session
on health care reform for members
• Provided legislative committee members with
information about impact of health care
reform on mental health (created by Mental
Health America of Colorado)
• Provide information to legislative committee
members on opportunities to submit
comments, attend meetings and/or testify
How can health care social workers
contribute to the health reform
advocacy process?
• Share your firsthand experiences!
• Consider yourself an expert on the human impact
of being uninsured, underinsured
• Become active in your state NASW chapter; your
SSWLHC state chapter; your state health coalition
Simple Steps
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Contacting your legislator/governor
Providing testimony
Writing op-eds
Writing LTEs
Oncology SWer on ACA change
in dependent coverage to age 26
At my hospital, I have worked with many young adults
who were diagnosed with cancer while they were in
college. In my 30 years as an oncology social worker, I
have had to tell too many young people that even though
they move back home so their parents can support them
through their cancer treatment, they cannot get on their
parent’s health plan. And often, these patients don’t
qualify for charity care. Because of the change in the law,
many young adult cancer patients will experience one less
stress, during what is often the most stressful time a
person can be diagnosed with cancer.
Angela, an LICSW in WA
Advocacy that all social workers
can and should do:
• Communicate the need to expand Medicaid
and implement an exchange
• If your state has a health exchange, promote
social work appointments to the exchange
governing board and advisory committees
• Advocate for an EHB plan that include robust
mental health and substance abuse services;
rehab and habilitative services
Quote from AZ health official..
• “If we have to have one [health
exchange], then it would be better for
Arizona to do it ourselves rather than
defer to the federal government.”
Donald Hughes, Health Care Policy Adviser to AZ
Governor Jan Brewer, as quoted in New York
Times, 9/24/12
Advocacy exercise!
Getting the ACA
implemented in your state
Some questions to consider:
• How do you find out who’s working on ACA
implementation in your state government?
• Whom do you need to partner with to get Medicaid
expanded/exchange implemented?
• How do you ensure good governance for the
exchanges?
• You have knowledge about the quality of the
potential benchmark plans – how can you bring that
knowledge to bear in the EHB advocacy process?
Health care social workers have
power and influence in the advocacy
arena!
Contact Info:
Stacy Collins, MSW
National Association of Social Workers
[email protected]
Jennifer Miles, MSW
National Association of Social Workers –
CO Chapter
[email protected]