Transcript Health Care Reform Update from Washington Gabrielle de la Gueronniere Legal Action Center February 11, 2010

Health Care Reform
Update from Washington
Gabrielle de la Gueronniere
Legal Action Center
February 11, 2010
What We’ll Discuss Today
National healthcare reform
 Where
we are and how we got here
 Overview of what reform looks like, including
similarities and differences between bills
 Review of key addiction-related provisions in the
bills
 Next steps and options for passage
2
Efforts to “fully and equitably
include addiction and mental
health in healthcare reform”
Wellstone-Domenici Parity Act passage created
momentum
LAC helped organize and continue to lead the
Coalition for Whole Health, a coalition of more than
40 national SUD and MH organizations
CWH developed recommendations, sign-on
letters, responses to draft legislative proposals
CWH worked with champions on amendments
CWH developed and circulated conference
recommendations
3
National Healthcare Reform
Timeline
More than a year of work, missed deadlines, compromises
Passed 5 committees and both chambers

Education and Labor, Energy and Commerce, Ways and Means in the
House
 Health, Education, Labor and Pensions (HELP) and Finance in the Senate
The House passed the Affordable Health Care for America Act (H.R.
3961) on November 7th

220-215 vote
The Senate passed the Patient Protection and Affordable Care Act
(H.R. 3590) on December 24th

60-39 vote
The process for resolving the differences between the two bills had
begun; January 19th Massachusetts election stopped it in its tracks
4
Current Health Insurance
Coverage Picture
Source
Percent
Employer
52.3%
Individual
4.7
Medicaid
14.1
Medicare
12.4
Other Public
1.2
Uninsured
15.4
Source: StateHealthFacts.org
5
Key Similarities Between Bills
Insurance reforms and consumer protections
Individual mandate
Sliding-scale subsidies for those up to 400%
FPL to buy/take up offers of insurance
Medicaid expansions: everyone (including
childless adults) under certain income would
be eligible
6
Key Similarities Between Bills
(cont’d)
Health insurance exchange(s) created for
small employers and individuals to buy
insurance and pool risk
Minimum benefits packages for the
exchange
Investments in workforce and
prevention/wellness
7
Key Differences Between Bills
Medicaid expansion:

Senate bill expands Medicaid to 133% FPL, restricts flexibility to disregard
certain types of income, and requires newly eligible adults enroll in less
comprehensive “benchmark” plans
 House bill expands Medicaid to 150% FPL, preserves income disregard
flexibility, and extends traditional benefits to childless adults
Exchange(s) for small businesses & individuals to purchase insurance:


The Senate creates state-based exchanges
The House creates one national exchange, which includes public option
Subsidies for individuals up to 400% FPL to purchase insurance:

The House provides much greater support for premiums and reduced costsharing for individuals and families at or below 300% FPL
 The Senate provides greater support for premiums for families between
300% and 400% FPL
8
Key Differences Between Bills,
Continued
Mandates:


Both bills include a mandate for individuals to have health insurance
The House bill also requires employers to offer insurance to their
employees
Minimum benefits requirements:


Both bills have similar minimum benefit requirements for the
exchange
The House bill also requires large employers to meet requirements
Start date for coverage and exchange:


The Senate date for implementation is January 1, 2014
The House date for implementation is January 1, 2013
There are a number of other differences in financing, tax
changes, public option, abortion, and other issues to be
worked out.
9
Key Addiction and Mental Health
Provisions in the Bills
Both bills require SUD/MH services as part of the
minimum benefit package

Senate bill exempts large employers.
Both require that individual, small, & large group
plans comply with Wellstone/ Domenici
Both prohibit insurance discrimination against
individuals with pre-existing conditions
Both prohibit discrimination against individuals
based on health status

Senate bill specifically includes SUD/MH in this
requirement.
10
Key Addiction and Mental Health
Provisions in the Bills (cont’d)
Medicaid expansions

House bill:
– Newly eligible childless adults would receive traditional benefits
– Bill prohibits states from enrolling these individuals into
managed care unless they show the MCO could meet their
health, MH, and SUD needs

Senate bill:
– Newly eligible childless adults would be enrolled in a generally
less-comprehensive “benchmark” plan that would include
SUD/MH services at parity
11
Key Addiction and Mental Health
Provisions in the Bills (cont’d)
Workforce development provisions

Senate bill:
– Loan repayment provisions
– Grants to higher education institutions for MH/SUD
professionals

House bill:
– Workforce grants for MH/SUD service providers
12
Key Addiction and Mental Health
Provisions in the Bills (cont’d)
Chronic disease prevention, wellness promotion
and screening/briefing intervention provisions

Senate bill:
– Medical home grants
– Inclusion of SUD in National Prevention, Health Promotion, and
Public Health Council
– SUD/MH services at school-based community health centers
– State and local health dept grantees work with MH/SUD
providers.

House bill:
– Authorizes $30m SBIRT grant program
13
Key Addiction and Mental Health
Provisions in the Bills (cont’d)
Inclusion of relevant MH/SUD agencies in federal
studies or working groups:

Senate bill:
– HHS education and outreach campaign on benefits of
prevention
– Requires dissemination about prevention work done by
SAMHSA
– Requires states to consult and coordinate with SAMHSA on
MH/SUD for Medicaid medical home option
– Includes SAMHSA as agency in “Interagency Working Group on
Heath Care Quality.”

House bill:
– Adds SAMHSA to list of agencies consulted for the development
of national prevention and wellness plan
14
Strong Public Support for Including
Addiction in Healthcare Reform
According to a recent poll commissioned by the Closing the Addiction
Treatment Gap initiative of the Open Society Institute:

77% of Americans support including addiction treatment in healthcare
reform, including Democrats (88%), Independents (72%), and Republicans
(72%)

69% say they would support paying $2 more per month in premiums to
make treatment more accessible & affordable

83% agree that, like diabetes, addiction is a health condition that requires
ongoing attention and support, including Democrats (88%), Independents
(78%), and Republicans (82%)
15
Strong Public Support for Including
Addiction in Healthcare Reform (cont’d)
88% say treatment is important, including Democrats (92%),
Independents (85%) and Republicans (87%)
87% see treatment as an ongoing process. Additionally, the public sees
treatment as effective, even if individuals relapse and need another
period of treatment.
Only 26% say there are enough affordable, accessible, quality
treatment centers/services in their community. Of those who know
someone who has looked for treatment, 46% report difficulty finding
affordable, quality services.
Additionally, a poll conducted in 06/2009 found that 49% of Americans
feel they couldn’t afford treatment if they or a family member needed it.
16
Possible Next Steps for National
Healthcare Reform
Unclear how Congress will proceed…
Options include:

Do nothing
– Pelosi: “I don’t see that as a possibility. We will have
something.”

Both chambers could pass a bill that bridges differences
 Pass scaled-back bill that might gain Republican support
 House could pass Senate bill
17
Passing a Compromise Bill?
The House and Senate could pass a
compromise bill
 The
Democratic Congressional leadership
seemed close to compromise before
Massachusetts election
 Multiple roadblocks to address
 Difficult to envision bill with bi-partisan Senate
support and approval by the House…
18
Scaled-Back Insurance Reform
Bill?
Could include requiring insurers to cover anyone
who applies (guaranteed issue) and prohibiting
insurers from charging higher premiums based on
health status and other factors (community rating)
Difficult to make this work…


Insurance market reforms won’t work in isolation
Adverse selection problem: sick people rush in,
premium costs rise, healthy people rush out, making
insurance unaffordable for everyone
19
House Pass Senate-Approved
Bill?
The House could pass the Senate bill as is, and it
would go to the President’s desk for signature
Also not so easy…


House has a number of concerns with the Senate bill
Pelosi: House doesn’t have the votes to pass the
Senate bill in its current form
Possible if House has assurance that Senate will
make fixes through reconciliation

Limits of reconciliation
20
If Healthcare Reform Passes,
What Could this Mean?
Nearly everyone would have health insurance
Everyone obtaining insurance through the individual or small
group markets would be covered for SUD & MH services
Wellstone/Domenici parity requirements would be expanded to
all qualified plans
Insurers would be prohibited from discriminating against
individuals based on health status, including addiction histories
Medicaid expansion to all parents and childless adults, increased
federal share of costs
Increased federal commitment to prevention and wellness and
workforce development
21
Next Steps Following Passage of
Healthcare Reform
Benefit design must be adequate
Ensure access to care

Outreach and education
 Regulate managed care
Must be in chronic disease prevention & wellness initiatives
Strengthen workforce
Strengthen programs’ infrastructure and capability
Remove barriers to recovery, such as



Employment
Food Stamps/TANF (cash assistance)
Housing
 Higher education
 Driver’s licenses
 Voting
22
If healthcare reform doesn’t pass
this year…
The issue isn’t going away, and the problems will only get worse
Develop strong relationships with Members of Congress, educate them
on the issues
Need to continue to identify and cultivate champions
Continue momentum from parity and healthcare reform to increase
resources and expand treatment
Action on recently released parity regulations



Analysis
Public comment period until May 3rd
Outreach and education on compliance; enforcement
Proposed ONDCP and SAMHSA initiatives



Closing the addiction treatment gap
Collaborating more closely with primary health care
Expanding interventions/treatment for criminal justice-involved people
23
Additional Information
Keep yourself informed about healthcare
reform developments:
 Coalition for Whole Health documents on
LAC website at www.lac.org under
“National Healthcare Reform” link
 Additional legislative updates from Legal
Action Center and other field groups
24