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Substance Use Disorders and Mental Health in National Healthcare Reform

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Title: Substance Use Disorders and Mental Health in National Healthcare Reform


1
Substance Use Disorders and Mental Health in
National Healthcare Reform
  • Paul Samuels
  • Legal Action Center
  • October 21, 2009

2
What Well Discuss Today
  • National healthcare reform
  • Overview of what reform looks like
  • Review of key addiction related-provisions in
    current legislation
  • Polling results Strong public support for
    including addiction in reform
  • Continuing efforts

3
Current Health Insurance Coverage Picture
  • Source Percent
  • Source StateHealthFacts.org

4
Status of the National Healthcare Reform Process
  • All three healthcare reform committees in the
    House have passed bills
  • Education and Labor
  • Ways and Means
  • Energy and Commerce
  • Senate HELP passed bill in July
  • Senate Finance passed bill October 14th

5
Healthcare Reform Covering the Uninsured
  • Medicaid expansions
  • Everyone (including childless adults) under
    certain income would be eligible
  • Senate Finance and House bills133 FPL
  • All bills include sliding-scale subsidies for
    those up to 400 FPL to buy/take up offers of
    insurance
  • Individual Mandate
  • Employer Mandate (HELP and House bills but not
    Finance)
  • Health Insurance exchange for small employers
    and individuals to buy insurance

6
Benefit Design in Healthcare Reform
  • All bills create essential (minimum) healthcare
    benefits package for the exchange (small employer
    and individual plans)
  • Includes comprehensive services
  • Benefits broadly defined in legislation
  • Creates independent health advisory board to make
    specific recommendations
  • Senate HELP and House bills also require large
    employer plans to meet minimum benefit standards.

7
Insurance Market Reform
  • Eliminate annual and lifetime limits
  • End preexisting condition restrictions
  • Guarantee issue/renewability
  • Limit rating variation
  • Allowed only for age, geography, family
    enrollment, and (in Senate bills) tobacco use.
    Insurers would not be allowed variation based on
    health.

8
Insurance Market Reform (contd)
  • Health insurance exchange for small group and
    individuals
  • Transparency and competition
  • Public option (House and HELP)
  • Financed through premiums
  • Bronze/Silver/Gold plans
  • To compete with private insurance to lower costs

9
Cost Savings/Financing Healthcare Reform
  • Prevention/wellness efforts
  • Develop national health and wellness promotion
    strategy
  • Eliminate cost-sharing for preventive services
  • Medicaid/Medicare reforms
  • Public option to compete with private insurance
    to drive down costs?

10
Building on the Successes of Parity Ensuring
Addiction Prevention, Treatment and Recovery and
Mental Health are Included
  • Wellstone Domenici Mental Health Parity and
    Addiction Equity Act
  • Requirements
  • Regulations
  • Greater understanding of addiction as a
    preventable, treatable disease
  • Parity debaterole of scientific research,
    discussion of stigma and discrimination
  • Recognition of addiction as a health condition

11
Building on the Successes of Parity Ensuring
Addiction Prevention, Treatment and Recovery and
Mental Health are Included (contd)
  • Additional partnerships in the broader healthcare
    community
  • Strengthened relationships with Congressional
    staff on key Committees of jurisdiction
  • Timing
  • Public support

12
SAMHSA Core Consensus Principles for Reform
from the Mental Health and Substance Abuse
Community
  1. Articulate a national health and wellness plan
    for all Americans
  2. Legislate universal coverage of health insurance
    with full parity
  3. Achieve improved health and long-term fiscal
    sustainability
  4. Eradicate fragmentation by requiring coordination
    and integration of care for physical, mental, and
    substance use conditions
  5. Provide for a full range of prevention, early
    intervention, treatment, and recovery services
    that embodies a whole-health approach

13
SAMHSA Core Consensus Principles for Reform
from the Mental Health and Substance Abuse
Community (Contd)
  1. Implement national standards for clinical and
    quality outcomes tied to reimbursement and
    accountability
  2. Adopt and fully utilize health information
    technology (HIT)
  3. Invest in the prevention, treatment, and recovery
    support workforce
  4. Ensure a safety net for people with the most
    serious and disabling mental and substance use
    disorders.

14
Coalition for Whole Health Health Care Reform
Principles
  • Ensure equitable and adequate addiction and
    mental health treatment coverage in all public
    and private health care plans.
  • Support policies that promote both individual and
    family recovery from mental illnesses and
    addictions as integral to overall health.
  • Commit to investing in Americas future through
    prevention, early intervention, and research on
    mental illnesses and addictions.

15
Specific Addiction-Related Provisions in the
Healthcare Reform Bills
  • Inclusion of SUD/MH in the minimum benefit
    package
  • The Senate HELP bill and three House bills
    mandate SUD/MH services in exchange and large
    group plans, Senate Finance in exchange only.
  • All bills require that group and individual plans
    adhere to Wellstone/Domenici Parity Act.

16
Specific Addiction-Related Provisions in the
Reform Bills (contd)
  • Medicaid expansion to uninsured parents and
    childless adults
  • Senate HELP bill and House bills extend full
    Medicaid benefits to expansion population.
  • Senate Finance bill require newly eligible
    childless adults to enroll in a less
    comprehensive plan, subject to minimum creditable
    coverage requirements.

17
Specific Addiction-Related Provisions in the
Reform Bills (contd)
  • Inclusion of SUD/MH prevention strategies
  • The House E L bill would require SUD/MH
    screening and brief interventions as covered,
    reimbursable preventative services in plans
    offered in the healthcare exchange.
  • The House E C bill includes SAMHSA in
    developing chronic disease prevention and
    wellness initiatives.

18
Specific Addiction-Related Provisions in the
Reform Bills (contd)
  • The Senate HELP bill includes SAMHSA in
    education/outreach campaign on benefits of
    prevention and would create National Prevention,
    Health Promotion and Public Health Council that
    includes ONDCP Director.
  • The Senate Finance bill requires SAMHSA to be
    consulted on issues related to preventing SUD and
    mental illness.

19
Specific Addiction-Related Provisions in the
Reform Bills (contd)
  • Inclusion of SUD/MH workforce development
    initiatives
  • The House E C bill would authorize workforce
    development grants for MH/SUD service providers.
  • The Senate Finance bill would include mental
    health and behavioral health workforce capacity
    as high-priority topics in the bills National
    Workforce Strategy section, but does not
    explicitly include SUD professionals/services.

20
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

21
Strong Public Support for Including Addiction in
Healthcare Reform (Contd)
  • 83 agree that, like diabetes, addiction is a
    health condition that requires ongoing attention
    and support, including Democrats (88),
    Independents (78), and Republicans (82)
  • 88 say treatment is important, including
    Democrats (92), Independents (85) and
    Republicans (87) 

22
Strong Public Support for Including Addiction in
Healthcare Reform (Contd)
  • 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. 

23
Next Steps Still a long road ahead
  • Need to meld the two bills in the Senate
  • Need to meld the three bills in the House
  • Determining the costs associated with the bills
    and how to offset these costs
  • Floor debate in both chambers
  • Pass final House and Senate bills
  • Conference what will likely be very different
    bills
  • Final Congressional votes
  • President signs into law
  • Still expected to finish by end of year
  • Implementation

24
Next Steps Senate
  • HELP passed in July, Finance last week (14-9,
    with HCRs 1st Republican vote)
  • Senate bills need to be melded. The bills differ
    in key areas, including
  • Public option
  • Employer mandate
  • Large group benefit requirements
  • Bill likely on the Senate floor last week of
    October

25
Next Steps House
  • Work continues to meld the three House bills.
    Key differences to be worked out include
  • Agreement with Blue Dogs in Energy Commerce
    Committee
  • Negotiated public option rates (rather than tied
    to Medicare rates)
  • Small business exemption raised from 250k to
    500k in payroll
  • Reduced subsides for individuals and families to
    buy insurance
  • Set federal share for Medicaid expansion at 90
    from 100.
  • House bill will likely be on House floor in the
    next month.

26
Next Steps for the Addiction Prevention,
Treatment and Recovery Field
  • As Congress crafts a final bill, well work to
  • Include SUD/MH services in the basic benefit
    package
  • Require that all plans in the exchange meet the
    Wellstone/Domenici Parity Act requirements

27
Next Steps for the Addiction Prevention,
Treatment and Recovery Field (contd)
  • Require that newly eligible Medicaid enrollees
    receive good health coverage, including SUD/MH
    coverage
  • Preserve, not preempt, State laws providing
    better coverage, rights, methods of access to
    treatment and consumer protections

28
Next Steps for the Field (contd)
  • Require that SUD/MH screening and briefing
    interventions are covered preventative services
    in healthcare exchange plans
  • Include SAMHSA and ONDCP in chronic disease
    prevention and wellness promotion initiatives
  • Include the SUD/MH workforce in health workforce
    development initiatives

29
A Moment of Tremendous Opportunity
  • Strong support both in Congress and the
    Administrationtremendous investment in the work
  • Healthcare crisis
  • Election results/public demand
  • Strong coalition of national organizations, who
    represent millions of constituents, pushing for
    reform
  • Organized and unified mental health and substance
    use disorder prevention, treatment and recovery
    communities working together for reform

30
Next Steps After 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

31
Next Steps After Healthcare Reform (Contd)
  • Remove barriers to recovery, such as
  • Employment
  • Food Stamps/TANF (cash assistance)
  • Housing
  • Higher education
  • Drivers licenses
  • Voting

32
Staying Informed on Healthcare Reform
  • Keep yourself informed about healthcare reform
    developments
  • Coalition for Whole Health documents on LAC
    website at http//www.lac.org/ under National
    Healthcare Reform link
  • Additional legislative updates from Legal Action
    Center and other field groups
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