Dear CSWA Members,

Thanks to grassroots pressure to members of the Senate (including from many CSWA members – thank you!), Majority Leader McConnell has made the draft of the Senate's version of the House American Health Care Act available for review.  Titled the Better Care Reconciliation Act of 2017, this bill is not to be considered a finished version; changes are likely to be negotiated right up to next week's planned vote. 

As it currently stands, the BCRA could severely limit Medicaid through state-determined waivers and per-capita caps on enrollment. It would exclude services available to women under Planned Parenthood and services available to children under the CHIP program. Additionally,states would be able to redefine what constitutes pre-existing conditions and how they determine what essential benefits are.

High risk conditions including addictions, PTSD and serious mental health disorders have nowhere near the funding that is needed to cover them in this version. Medicaid enrollees have a 33% higher rate of these conditions and would thus be more severely affected in states that choose to put caps on Medicaid enrollment.

Since there is so much that is yet to be determined about this bill, CSWA is not prepared to offer any message different from the one that we recommended on Monday. Please continue to make calls to senators in opposition to per-capita caps to Medicaid/the end of Medicaid expansion, and in support of preserving essential benefits at the federal level.

Laura Groshong, LICSW, Director, Policy and Practice

Clinical Social Work Association
The National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY

CSWA has been asked to make one more set of phone calls TOMORROW, June 20, 2017, National Call-in Day, to oppose the American Health Care Act.  The AHCA which came over from the House of Representatives, will severely curtail access to mental health treatment and substance use treatment in the public and private insurance sectors, severely cut Medicaid coverage, and eliminate the essential benefits of the Affordable Care Act which require that mental health coverage be included in every policy at parity with medical coverage.

Even if you have called already, please call again.  If you have not called your senators, here is your last best chance to let your senators know that you oppose this bill.   The Senate is gearing up for a vote on such legislation by the end of next week, so NOW is the time to speak up and protect mental health and Medicaid.

 Taking action is easy:

1. Dial this number on June 20, 2017 between 9-5 EDT: 202-224-3121
2. Ask for your Senator.
3. Use this message: “I am a constituent and a member of the Clinical Social Work Association, calling about the American Health Care Act. I urge you to oppose any proposal that results in cuts or rollbacks of Medicaid or cuts to the essential benefits. AHCA directly targets important health care protections like the essential health benefits, coverage of pre-existing conditions and eliminates mental health parity in health care. I’m calling from [city, state, and zip] and my name is [first and last name].”
4. Call your other Senator and share the same message!

As always, let me know when your calls have been made at lwgroshong@clinicalsocialworkassociation.org 

Laura W. Groshong, LICSW, Director, Policy and Practice

Clinical Social Work Association
The National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY

The Senate has put the American Health Care Act on a fast track for passage.  The form this bill will take is unclear.  CSWA encourages all members to contact a small group of moderate Republicans who may determine the fate of mental health coverage and Medicaid coverage. Please review the posts CSWA sent on May 4 and May 25 on these topics.

Below are the office numbers, twitter accounts, and Facebook accounts for these senators. Please take a moment to send the messages CSWA has provided.

As always, let me know when your messages have been sent.

Laura Groshong, LICSW, CSWA Director, Policy and Practice

Clinical Social Work Association
The National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY

URGE KEY SENATORS TO OPPOSE AHCA UNLESS MEDICAID AND MENTAL HEALTH COVERAGE 

Senators are considering the American Health Care Act (AHCA) in preparation for a possible vote by the 4^th of July.  As passed by the House, the AHCA would repeal major provisions of the Affordable Care Act (ACA) (aka Obamacare) by:

· Ending the guaranteed coverage of substance use disorders and mental health treatment services 

· Cutting Medicaid by $880 billion and stripping more than 20 million people of their health insurance 

With very narrow margins in the Senate, it will only take 3 Senators to stop the AHCA without protections for substance use disorders and mental health treatment from passing the Senate.

Call these Senators today to ask them to oppose the AHCA without protections for substance use disorders and mental health.

A list of key decision-making Senators to call is below: 

• · Capito (R-WV)
• (202) 224-6472
• · Cassidy (R-LA)
• (202) 224-5824
• · Collins (R-ME)
• (202) 224-2523
• · Gardner (R-CO)
• (202) 224-5941

• · Heller (R-NV)
• (202) 224-6244
• · Murkowski (R-AK)
• (202) 224-6665
• · Portman (R-OH)
• (202) 224-3353
• · Sullivan (R-AK)
• (202) 224-3004
• · Flake (R-AZ)
• (202) 224-4521

Sample call script:

I am a constituent [if you are] and a member of the Clinical Social Work Association. Please urge the Senator to oppose the AHCA bill without required coverage for mental health disorders, substance use disorders, and  with caps to Medicaid. These policies would increase costs for everyone and cause emotional suffering for those who need help. 

Social Media

You can also contact senators through social media. Social media handles for key Senators are listed below:

• · Capito (R-WV)
• Twitter: @SenCapito
• Facebook: @SenShelley
• · Cassidy (R-LA)
• Twitter: @BillCassidy
• Facebook: @BillCassidy
• · Collins (R-ME)
• Twitter: @SenatorCollins
• Facebook: @SusanCollins
• · Gardner (R-CO)
• Twitter: @SenCoryGardner
• Facebook: @SenCoryGardner   

• · Heller (R-NV)
• Twitter: @SenDeanHeller
• Facebook: @SenDeanHeller
• · Murkowski (R-AK)
• Twitter: @lisamurkowski
• Facebook: @SenLisaMurkowski
• · Portman (R-OH)
• Twitter: @senrobportman
• Facebook: @senrobportman
• · Sullivan (R-AK)
• Twitter: @SenDanSullivan
• Facebook: @SenDanSullivan
• · Flake (R-AZ)
• Twitter: @JeffFlake
• Facebook: @SenatorJeffFlake

Sample Twitter Posts

            · .@[Twitter Handle]: I ask you to oppose the #AHCA without protections for substance use disorders and #mentalhealth.  

          Please #VoteNoAHCA.

• · #Medicaid coverage is a critical lifeline for millions in the US w/ substance use disorders & #mentalillness. @[Twitter Handle]: #VoteNoAHCA
• · .@[Twitter Handle]: ensure no one loses access to life-saving substance use disorder & #mentalhealth treatment they have today. #VoteNoAHCA

Note: the period in front of the Twitter handle is important to ensure that it is posted visibly on the senators' page.

Sample Facebook Posts

In the face of the #opioid overdose and suicide epidemics, equal and affordable access to a full continuum of substance use disorder and mental health treatment services must be an essential component of health care coverage.

#Medicaid coverage is a critical lifeline for millions of Americans with substance use disorders and #mentalillness. Cutting or capping Medicaid and ending the Medicaid expansion will be devastating to those who can’t afford health care in the private market.

[Facebook handle], please ensure that no American loses the access to life-saving substance use disorder and mental health treatment that they have today.

I ask you to #VoteNoAHCA.

Here is a report on where we stand with the repeal and replace the ACA regarding Medicaid sort of at the halfway mark. There are some issues that are becoming clearer that I wanted to share with you.  We need to be educators for our members of Congress and state Governors right now.  There is much confusion about what the proposed ‘fixes’ and cuts to Medicaid would do. The interconnectedness of Medicaid, Medicare, private insurance, and employer based insurance is being ignored so that the only ones who will have access to affordable health care are the wealthy.

First, the Congressional Budget Score (CBO) for the House American Health Care Act (AHCA), which came out yesterday almost two weeks after the bill passed, has little difference from the first version of the bill.  The tax breaks for the wealthy, lowering the deficit, and leaving 23-24 million currently covered by insurance uncovered are the same, though there are some minor changes.

What is clearer is that those on Medicaid specifically are the group that is targeted.  We all know the difficulties with Medicaid from a LCSW point of view – the restrictions in some states for our providing care, the low reimbursement rates in many states, the paperwork hassles, etc.  Nevertheless, CSWA believes that our ethics and values compel us to make the effort to include some Medicaid clients in our practice.  There is a pragmatic reason for this.  If Medicaid enrollees do not have health insurance, they will wind up using emergency rooms.  This is the most expensive form of care and will raise premiums for everyone.

I was on a conference call with several national Medicaid advocates yesterday and learned that the Senate is not planning to protect the Medicaid enrollees in their version of the AHCA bill.  Keep in mind that 50% of the 74 million Medicaid enrollees are children; 25% are disabled (many with mental health disorders), and 20% are elderly.  States will have to cover these people if federal funding ends.  Most members of Congress, especially the ‘gang of 13’ who are writing the Senate version of the AHCA, are in denial about this. The main attitude is still that there are a majority of people on Medicaid who COULD work and are just lazy, as opposed to at most 5% who are able to work (and unlikely to be lazy).  

BACKGROUND ISSUES

• 1.       Medicaid is not part of AHCA; cutting insurance for Medicaid enrollees will not solve the cost problems with the ACA, it will increase them.
• 2.       The “per capita caps”, a new mechanism for cutting Medicaid enrollees by having a block grant that is an absolute limit with NO adjustment for Medicaid increase or decrease in enrollees. This eliminates the current extra Federal help if Medicaid enrollees increase. It is especially important to get this point across to Republican Governors who will be on the firing line if this goes through.
• 3.       CHIP, the main coverage for children, sits on the shoulder of Medicaid.  If Medicaid is cut, CHIP will fail.  No one can justify preventing children in poverty from having access to health care.
• 4.       The current plans in the AHCA will cost shift Medicaid to the states.  Congress seems unwilling to look at how devastating that will be for state budgets.

ACTION ITEM

 Here is what we need to do this next week of Memorial Day.  Congress is in recess and members are back in district.  This is the time we need to have meetings with them and clarify the following:

• 1.       Explain the above issues to all your members of Congress or staff next week in person.
• 2.       Ask Republican Senators to commit to NO per capita caps.
• 3.       Ask Republican Senators to commit to maintaining Medicaid expansion.
• 4.       Stop making absolute caps the way to cut services.

Set up visits now!  Even if you have senators who are unfriendly to our views, visit them.   Go with a group from your Society if you can.  Let me know what the results of these meetings are.  It will also be useful to meet with your representatives.

Medicaid is the stepchild of health care but it is also the way to improve the overall health care system.  Please help educate our members of Congress and governors.

Laura Groshong, LICSW, Director, Policy and Practice, Government Relations Chair

Clinical Social Work Association
The National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY

Thanks to everyone who sent messages to legislators on American Health Care Act, the last version of the Affordable Care Act, which passed the House today on a 217-213 vote.  Many of the moderate Republicans we targeted voted against the bill.  Good work!

I want to remind you that this may be a political victory, though that remains to be seen, but is not yet a policy victory.  AHCA must now be passed by the Senate, a much more divided body, and will very likely have significant changes when and if it does.  

Here is what I suggest you consider for the moment:

- The Congressional Budget Office score which was avoided before this vote will come out next week and may cause some major rethinking of the budgetary impact of these changes

- For LCSWs, the main concerns are 1) the elimination of Essential Benefits, which include mental health and substance use treatment; 2) the creation of high-risk pools which are severely under-funded and will decimate Medicaid coverage and enrollment for people needing mental health/substance use treatment; and 3) the potential collapse of the individual market which covers many LCSWs in solo practice.

- Now is a good time to ask Senators, especially those who supported the Affordable Care Act or opposed the AHCA, to WORK WITH Republicans on developing a bill that will fix the problems that we know the ACA had, without eliminating the 20 million people who were able to get coverage through the ACA or almost doubling premiums for those who are 50-64, among other issues.  CSWA will be working on this nationally, but calling your own Senators to suggest a more collaborative approach would be very helpful. You can contact your senators through https://www.senate.gov/general/contact_information/senators_cfm.cfm?OrderBy=state&Sort=ASC or http://www.senate.gov/states/ .  A possible message would be "I am a constituent and a member of the Clinical Social Work Association. As you consider the American Health Care Act passed by the House, please take a collaborative approach.  Passage of a bill that will provide the mental health and substance use treatment that our citizens need depends on it"

As always, let me know when you have contacted your senators.

Keep our patients in mind as you consider what we need moving forward and remember that we have many miles to go before this campaign is over.

Let me know if you have any questions.

Laura W. Groshong, LICSW, Director, Policy and Practice

Clinical Social Work Association
The National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY

===========================================================================================

May 3, 2017

Dear CSWA Members,

The twists and turns of the administration's attempt to replace the Affordable Care Act continue.

The third serious effort to drastically change the ACA is gaining steam, a plan that would include most of the problems outlined last week (below) with an even bigger decrease in Medicaid coverage. The new Upton-Long Amendment to add more money to high-risk pools would not nearly offset the cuts to coverage for many with pre-existing conditions (https://www.ama-assn.org/ama-warns-proposed-changes-ahca-do-not-remedy-bill-s-shortcomings ).

Thank you so much for all the messages that you have sent.  Please take time to contact your legislators, especially the moderate Republicans mentioned in the Trump Toolkit at https://www.trumpcaretoolkit.org/ and any other legislators in your state one more time about the harm that the current AHCA bill will cause. Once again, message should read: “I am a constituent and member of the Clinical Social Work Association.  Please do not vote for HR 1628 which would restrict access to mental health and substance use treatment for millions of Americans.”

As always, please let me know when you have sent your messages.

Laura W. Groshong, LICSW, Director, Policy and Practice

Clinical Social Work Association
The National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY