Today is World Mental Health Day. As social workers we are all aware that mental health conditions impact 1 out of every 4 people. People impacted by mental health conditions include our friends, our family members, our clients, and even ourselves. In fact, social workers provide 60% of mental health care across the nation according to the National Association of Social Workers. Now more than ever we should all be aware of our own mental well-being and those around us.
For many people with mental health conditions, receiving appropriate and timely services is like putting together a jigsaw puzzle. A number of factors can impact your access to care including: your income, location, diagnosis, age, and more. However, there were historically even more barriers to care before the Affordable Care Act (ACA). To keep it simple, today I’ll share two ways that the ACA has impacted how Americans get mental health treatment with the goal of long-term recovery.
2. Removal of Pre-Existing Conditions Limitations
When you hear the term “pre-existing conditions”, most people think of major physical conditions like cancer, diabetes, or heart disease. However, the term can also include some mental health and substance use conditions. From the mental health side, a person was usually labeled with a pre-existing condition if they were living with serious and persistent mental illness. The ACA included mental health and substance use conditions as pre-existing conditions and specifically stated that Marketplace plans cannot deny someone for those conditions. This was a huge change for people with mental health and substance use conditions, who were routinely denied care for a diagnosis. Now people with mental health diagnoses are guaranteed access to insurance with denial because of their diagnosis. Insurance coverage is known to increase someone's likelihood of seeking treatment, thus helping them moving toward recovery.
This is a simplified drop in the bucket on how the ACA impacted mental health care. For another day… Medicaid is the single payer of mental health and substance use care in the country. We’ll touch on this specifically in an upcoming post.
- Alison Mohr Boleware, MSSW
By Allan Cole, professor and senior associate dean for academic affairs in the Steve Hicks School of Social Work at the University of Texas at Austin (originally published in the Austin American-Statesman, posted with permission)
Sixteen words from my doctor changed my life: “What worries me is that I think you are in the early stages of Parkinson’s disease.”
I was 48 years old.
Recently, I stopped by my local Walgreen’s pharmacy to pick up my Parkinson’s medication. As I waited in line, a woman told the pharmacy tech, “I absolutely have to have those pills,” pointing to a small white bag in the tech’s hand. “I can wait on the other two till next time. I’ll get them when I get my check.” She seemed to have made these kinds of choices before.
I imagined that trying to decide which medicine to prioritize felt like having to choose between food and water, or between clothing and shelter. As the tech got the revised order ready, the woman walked slowly to an adjacent aisle. A different pharmacy tech called me to the counter. I told him my name, and he turned around and began looking for my prescription in alphabetized bins. If I had no health insurance, my meds would cost me $700 a month. In some places, that’s an entire month’s worth of housing. I prepared my $10 co-pay, all the while thinking about the woman waiting for what she could afford and what she had to do without.
One month later, I stood in the same line. A man about my age was at the counter. His tanned skin, torn jeans and dirty work boots suggested that he’d just finished his construction job. Hearing that his medication would cost $560, he dropped his head. “I can’t pay that,” he said, and he promptly walked out.
If the Graham-Cassidy plan becomes law, these scenarios will play out more often.
The Senate’s latest version of a “repeal and replace” plan for the Affordable Care Act would give individual states responsibility for providing coverage to Americans with low to moderate incomes. Though many governors oppose it, particularly in states that expanded Medicaid under Obamacare, block grants would be awarded and states would be left on their own to decide on coverage levels and strategies, with little federal oversight.
While some states are safer bets than others to provide adequate and affordable coverage, any plan should include mandates for covering the cost of prescription medications. Prescribed drugs keep chronic illnesses in check and delay or help avoid catastrophic expenses associated with a medical condition spiraling out of control. The idea that it is frugal to trim costs on prescription medications is simply short-sighted and untrue.
But as Graham-Cassidy takes shape, many other questions abound. These include whether the working poor, those with pre-existing conditions, or those whose employers opt not to provide health benefits will, in effect, have no affordable options for coverage, including coverage for prescription medications. With respect to pre-existing conditions, a recent analysis by the nonpartisan Kaiser Family Foundation found that approximately 1 in 4 people have pre-existing conditions that would have made it difficult for them to get health insurance prior to the Affordable Care Act becoming law. If its protections for pre-existing protections were repealed, then 52 million people under the age of 65 would have difficulty getting private coverage. Any new plan must include viable coverage for all, regardless of existing conditions.
I am fortunate. My job provides my family with a measure of security that many in our country lack, whether they have Parkinson’s disease or another illness. I have health insurance and a prescription plan. I don’t have the same worries that the two souls at Walgreen’s endure.
But we all have a moral responsibility to advocate for a health care plan that covers our nation’s most vulnerable people. We have a responsibility, through taxes, to help pay for it. All members of a just society share this responsibility.
While the nonpartisan Congressional Budget Office will not have time to properly evaluate the Graham-Cassidy plan before it’s rushed to a vote, many economists have noted a concern that, if it passes, millions of Americans risk having inadequate health care coverage.
We must insist that our elected officials vote against this plan. Sixteen words or fewer could change anyone’s life.
by Anna Stelter, LMSW, MPH
After several failed repeal attempts over the summer, the Affordable Care Act (ACA) remains in place. As the next ACA open enrollment period approaches, outreach and marketing efforts have been ramping up. That is, until this past week, when the Trump administration announced a 90% cut to its overall ACA advertising budget, then abruptly stopped making payments to nonprofit organizations who provide in-person assistance to enroll uninsured populations in coverage. Many of these organizations, who employ trained outreach and enrollment staff called Navigators, had to immediately suspend operations, or seek emergency funding from local governments and hospitals.
Critics warn scaling back outreach could spell disaster for the Affordable Care Act’s marketplaces and enrollees, and represents a deliberate attempt to torpedo Obamacare from within. The Trump administration has suggested the advertising & outreach volume funded in past years isn’t needed any longer, and has remained quiet on whether it plans to resume payments to Navigator organizations anytime soon.
How could a diminished federal role in outreach spell trouble for the Affordable Care Act marketplaces? And what does the federal government’s rollback of enrollment support mean for enrollees this year?
1. Jeopardizing coverage gains. Strong outreach efforts communicate key pieces of information to the marketplace’s current and potential enrollees, such as open enrollment dates, the availability of financial assistance, and the requirement to have coverage or pay a penalty.
Without advertising and outreach, for example, many consumers might not be aware this year’s open enrollment period – lasting from November 1 to December 15 in most states – will be about six weeks shorter than in previous years. And as plan offerings change in the marketplaces, some of the 12 million consumers already enrolled may be able to save money by shopping for a new plan, or might have to re-enroll in a different plan if their current plan has been discontinued.
2. Destabilizing marketplaces. The stability of ACA marketplaces is directly linked to the overall health status of the population enrolled. Older and sicker enrollees are more expensive to cover, and a healthy marketplace needs enough younger and healthier people enrolled to balance out the cost of the highest-risk consumers. An enrollee mix comprised of too many sick patients raises costs for all enrollees, and has contributed to some insurers leaving the ACA marketplaces after finding themselves on the hook for financial losses.
ACA marketplaces have done well reaching and enrolling “low hanging fruit;” that is, people who are knowledgeable about and eager for coverage. For many of these enrollees, eagerness for coverage arises from an expected need for health services, suggesting a less healthy underlying population. In contrast, marketplaces have not been as successful enrolling healthier, but chronically uninsured populations. These tend to be younger, working age, low- and middle-income adults who may not perceive they need or can afford insurance.
Marketing and outreach efforts targeted specifically toward healthy individuals can communicate the value of coverage for maintaining good health — not simply paying for care in a crisis -- and remind consumers of the risks associated with choosing to stay uninsured. Illinois’ marketplace, Get Covered Illinois, released a (pretty humorous) series of ads aimed specifically at younger consumers who may be tempted to pass on health insurance:
3. Neglecting vulnerable populations. In most states, the healthy, young, and uninsured people marketplaces covet also tend to belong to groups who have historically faced disparities in coverage rates: people of color, limited English proficient, immigrant, and LGBTQ populations. The ACA provided an opportunity to reduce longstanding disparities in coverage rates for these groups, including many individuals who have never enrolled in coverage before.
Source: Reducing Racial and Ethnic Disparities in Access to Care: Has the Affordable Care Act Made a Difference? The Commonwealth Fund, August 2017.
To enroll culturally and linguistically diverse populations successfully, marketplaces have observed a need for in-person assistance in consumers’ preferred languages. Among populations that may be enrolling for the first time, health insurance terms and pricing can be confusing, and many have little to no experience using coverage to obtain care. These enrollees often require multiple “touches,” or instances of assistance, to have their questions answered and complete enrollment. Marketplaces also rely on in-person assisters to quell fears and address challenges unique to immigrant populations; many eligible immigrants who express interest in marketplace coverage worry their personal information could be used to identify and deport undocumented family members, who are not eligible to enroll.
Since the ACA began enrolling consumers in 2013, community-based organizations funded with federal and state grants have filled an important role building awareness of the marketplace in areas they serve. They employ Navigators who work to deliver culturally and linguistically appropriate enrollment assistance, review and vet advertising messages and materials developed by the marketplace, and partner with other community institutions like schools, libraries, and local health clinics to expand pathways to enrollment. With federal payments to Navigator organizations now on hold, it remains unclear if these cohorts of trained assisters will be sustained. The Trump administration suggests licensed insurance agents and brokers may be able to pick up some of the slack short-term, though they are not necessarily embedded in communities where need is greatest. Since brokers and agents are compensated by health plans, they also do not have to remain neutral in advising a consumer which plan to select.
The bottom line: the administration's recent decisions have introduced significant uncertainty into 2017 enrollment efforts. Unless state and local entities are able to step in with other resources to support organizations conducting outreach, a significant reduction in enrollments could be ahead, with vulnerable populations positioned to be hit hardest.
When we weren't cheering for the Longhorns or sipping a cold beverage outside on a patio, here's what the 70%ers read over the long weekend.
Health Issues Stack Up In Houston As Harvey Evacuees Seek Shelter
Public wants GOP to work with Dems on health care
Once the Water Recedes, the Mental Health Problems Emerge
5 Controversial Ideas for Shoring up Health Insurance Markets
Child therapists fear new Texas policy will deepen funding cuts
It's not Obamacare anymore. It's our national health-care system.
If you're a licensed social worker (or a retired social worker who has been licensed), the Red Cross needs YOU! To learn if you're eligible to serve as a Disaster Health Services volunteer during the aftermath of Hurricane Harvey, check out this posting for Red Cross Disaster Health Professional Recruitment.
This Thursday, September 7th from 2:00 PM - 3:30 PM the Coalition on Human Needs (www.chn.org/) will be hosting a webinar titled "Using the New Poverty, Income, and Health Insurance Data: A Practical Guide."
Here's the information, as described by CHN:
On September 12th and 14th, the Census Bureau will release its annual poverty, income and health insurance survey data. Don’t miss CHN’s handy preview to show you how to use the local, state, and national findings. You’ll get brilliant predictions and insights about trends. You’ll learn about the wealth of information available, and how it can help make your case for public investments in vital programs. Whether your organization wants to comment on the findings at the time of release or use them all year long, this webinar will give you the tools you need.
RSVP Here: chn.peachnewmedia.com/store/seminar/seminar.php?seminar=98560
Jared Bernstein, famed economist seen/read often on MSNBC, The New York Times, The Washington Post, and his blog On the Economy, and Senior Fellow at the Center on Budget and Policy Priorities. He will preview what the data is likely to show, and the policy implications.
Deborah Weinstein, Executive Director of the Coalition on Human Needs, provides practical information about how to get the information you need (local, state, and national) from the Census survey data, and how to use it to advocate for programs and fight cuts.
Ellen Teller, Director of Government Relations at the Food Research and Action Center, will be the moderator, deftly ensuring that the speakers answer as many of your questions as possible.
Will Francis, LMSW
Government Relations Director,
National Association of Social Workers,
Cossy Hough, LCSW
Clinical Assistant Professor, The University of Texas at Austin,
School of Social Work
Anna Stelter, LMSW, MPH
Health Policy Analyst
Texas Health Institute
Alison Mohr Boleware, MSSW
Mental Health Policy,