CSWA is so committed to stopping the cruel immigrant policies of this administration toward children and families that we are going to send an action item a day for the next two weeks. If the damaging policies are still in place, we will continue. Some posts are from other groups, some are from our Government Relations Committee. Do your part and follow through with calls and emails.

As always, let me know when you have made your call or send your email.

Laura Groshong, LICSW, Director, Policy and Practice

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

Thanks to everyone who sent the Legislative Alert and CSWA Position Paper on “Rights of Immigrant Children” to their members of Congress.  I know from the almost 100 confirmations I received that we did our part to inform Republican legislators about the harm being done to immigrant children from their parents. 

LCSWs have a moral and professional responsibility to insure that any vulnerable people in our country receive the care they deserve.  It was stunning to learn that before the terrible “zero tolerance” policy, there were already 10,000 immigrant children being held in custody by the Office of Refugee Resettlement.  If one positive thing came out of the misery caused over the last 2-1/2 months, it is the awareness that there are many more children who need to be protected from the ‘shelters’ by untrained people that they are in.  The so-called “tender age” shelters for children under 5 are nothing short of child abuse and need to be stopped.

You may have noticed that social workers were named as some of the workers overseeing the welfare of the children in these shelters.  I am still trying to get confirmation of what that means.  As we know, the term is often used without any social work education behind it or any clinical social work training on human development.  Any qualified social worker who is engaging in this work is violating social work codes of ethics.

There are still unsolved problems.  There is a law that says children cannot be kept in custody (the recent policy change aside) for more than 20 days.  That could lead to further separations as immigrants wait for their court dates.  The whole issue of the “Dreamers” and DACA is in need of a plan.  CSWA will continue to work on these issues which are so connected to our values and our practices.

Please let me know if you have any questions.

Dear CSWA Members,

As you may have heard, the Senate Finance Committee moved to partially fund the tax reform bill by attaching a repeal of the individual mandate to the tax bill yesterday. The individual mandate – a penalty for mainly healthy people who choose not to get insurance – is a significant part of what makes the Affordable Care Act affordable. Ending the penalty for not having health insurance will disrupt the insurance markets and raise premiums by allowing healthy people to choose not to buy health insurance.

According to the nonpartisan Congressional Budget Office (CBO), this proposed policy –the end of individual health coverage requirements – would save the federal government $338 billion by taking health insurance away from 13 million people and raising health care premiums at least 10% higher than they are currently.  There have been other estimates that predict higher premiums of as much as 40%.

The House has already agreed to add this repeal to their own tax reform bill.

This development is one that CSWA strongly opposes.  Please notify your members of Congress at https://www.house.gov/representatives/and https://www.senate.gov/general/contact_information/senators_cfm.cfm with the following message: “I am a constituent and a member of the Clinical Social Work Association.  I strongly urge you to oppose adding a repeal of the Affordable Care Act individual mandate to the tax reform bill in the Senate Finance Committee.  Depriving 13 million citizens of health care they can afford is going to cost all of us more in emergency care and premiums.Tax breaks for the wealthy should not be at the expense of the health of many Americans.  Vote against the repeal of the individual mandate.”

As always, let me know when you have sent 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

CSWA is part of more than 200 Groups Support Alexander-Murray Bipartisan Short-Term Legislation to Stabilize Premiums, Protect Access to Insurance | View the letter submitted by the Mental Health Liaison Group (MHLG)

Laura Groshong, LICSW, CSWA Director, Policy and Practice

    One thing to keep in mind as we try to make sense of the chaotic developments over the past week is that the Affordable Care Act, with President Trump’s help, has become a political football, with winners and losers as to its fate.  The real winners and losers will be our patients who may find themselves able to continue to receive mental health services, without plans that cover mental health services, or without insurance at all.

    President Trump’s ire at the inability of the Senate – and the specific senators who opposed the three attempts to repeal and replace ACA – has intensified to the point where he decided to issue an executive order last Friday which would undermine the funding of the ACA by removing the subsidies to insurers for ACA plans, i.e., cost-sharing reductions, that make the finances work.  Since plans had to announce their rates for 2018 last week, many raised premiums up to 40%, which will price most of the ACA plans out of reach for those who need them.  There was no pressure the President to do this; insurers were willing to make the usual 8-10% increases that have funded the ACA until a few weeks ago.  The President’s ongoing threats to repeal the ACA himself had an effect on the ACA markets and led to these increases.  Some states that saw the possibility premiums would be raised a lot created funds to cover the shortfall.  A list of these states is being compiled and will be sent out shortly. There may be more states that choose to protect their citizens by finding a way to fund the ACA plans as well.  It may, however, be too late to keep rates affordable in 2018.

    What does this have to do with LCSWs?  The main way that the ACA is beneficial to mental health and substance use treatment is that they are one of the ten ‘essential benefits’ which must be covered by all plans.  This guarantees a mental health/substance use benefit.  Those of us on the younger side of 40 may not remember what plans were like before the ACA. A brief history of those bad old days – there were many plans that simply did not cover mental health because they did not have to; it was perceived as expensive; and there was no accounting for medical cost-offsets when people had access to MH/SA treatment.

    So our patients’ ability to get coverage for our services is in peril unless the essential benefits are maintained in some form.  This is where the bill being developed by Sen. Lamar Alexander (R-TN) and Sen. Patty Murray (D-WA) comes in.  As Chair and Ranking Member of the HELP Committee, they have been looking for a way to tweak the ACA for the past nine months. The Alexander-Murray deal would continue the insurer subsidies for two years, while establishing new flexibility for states in mandating penalties for those who do not have insurance and other parts of the ACA.  While it is not a perfect solution, the return to bipartisan process is almost as important as what the bill actually says.  Somehow in the course of this unfortunate path we have been on, the President now believes that Congress has failed to do its job in not repealing the ACA and it is up to him to do so in a piecemeal way.  This means that the President has become an enemy of bipartisan politics, a method to form compromise that CSWA stands firmly behind.

    Whether the Senate can find the will to bring the Alexander-Murray bill to the floor or get a vote on it is unclear at this time.  It will take some spine, some luck, and much continued encouragement on our part to get our senators to do the right thing and preserve the ACA.

    If you can meet with your senators this week, do so.  They are in district.  If not, please send them, Sens. McConnell, Alexander, Murray, McCain, Murkowski, and Collins the following message at https://www.senate.gov/senators/contact/ : “I am an LCSW and a member of the Clinical Social Work Association and [your state society].  Please support the Alexander-Murray bill and encourage Sen. McConnell to schedule it for a vote.  Without continuing the Affordable Care Act in some form, our citizens may not have access to the mental health and substance use services that they need.  We are in the midst of an opioid crisis; the majority of people affected by it also have mental health problems. Please preserve the ACA and mental health/substance use treatment as an essential benefit.”

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

I am pleased to report that the Graham-Cassidy bill has been shelved.  This is a huge victory for all people in favor of the Affordable Care Act and the way it has helped our country.  Please thank Senators McCain, Collins and Paul for standing up to this terrible bill.  And thanks to all who have worked with CSWA to make this possible.  I am traveling right now but will be sending more information tomorrow. 

Laura Groshong, LICSW, Director, Policy and Practice
Clinical Social Work Association
The National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY

www.clinicalsocialworkassociation.org

Dear CSWA Members,

Sen. John McCain has just joined Sen. Rand Paul to oppose the Graham-Cassidy-Heller-Johnson bill to repeal the Affordable Care Act making it almost impossible for the Senate to pass this bill.

Thanks to all CSWA members who sent messages to your Senators.  Please write them thank you notes if they are one of the above named group who oppose this terrible bill.

While the Senate has until September 30 to repeal the ACA with only 51 votes, the likelihood of this happening is now slim.  I will keep you posted on further developments.

You have no doubt heard about the competing bills to revise or repeal the Affordable Care Act. One is the Alexander-Murray bill be reviewed in the Senate HELP Committee which seeks to tweak the ACA but maintain the parts that allow those who have been able to gain insurance to keep it.  The other is the Graham-Cassidy bill which will essentially replace the ACA in the way that many previously proposed Republican-driven bills would have with a bill that would cause millions of ACA-covered citizens to lose care.

I know we are all struggling with health care ‘fatigue’ but we need to make one more effort to stop the bill that would severely impact access to health care.

The basic thrust of Graham-Cassidy is to turn everything over to the states for funding health care through block grants, would remove essential benefits.  It is similar to the "skinny" version of House American Health Care Act which would likely result in about 22 million people losing insurance as the other Republican bills would have.

Please go to https://www.senate.gov/senators/contact/ and send the following message to your senators.

"I am a licensed clinical social worker and a member of the Clinical Social Work Association [and/or your Society].  I have serious concerns about the way that my patients will be affected by the Graham-Cassidy bill that will repeal the Affordable Care Act.  The elimination of the essential health benefits, which include mental health and substance use treatment, will surely severely limit access to care for these life-threatening conditions to millions of Americans. The opioid crisis we face requires more, not less, funding. Before the Affordable Care Act went into effect, many desperate individuals and families went bankrupt trying to pay for the costs associated with chronic emotional disorders.   No matter what you may have heard, the costs associated with these conditions have been LOWERED over the past six years; the proposed changes to Medicaid and the elimination of universal inclusion of mental health treatment as a benefit, will be devastating to millions of Americans.  If we do not care for the most vulnerable among us, we have lost that compass. The bill being considered by the HELP Committee will be much more reasonable.  Please vote for the Alexander-Murray bill, not the Graham-Cassidy bill."

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

Our Government Relations Committee has been carefully tracking the eight attempts in Congress to repeal and replace the Affordable Care Act over the past four months. We are pleased that none of the proposed attempts has been passed by both Houses.

One of the major drawbacks to the process from CSWA’s point of view has been the partisanship that has led to only the majority party crafting the bills that were considered. Bipartisanship is the only way a reasonable bill to improve the ACA can be developed. Both Houses now have working groups that will be trying to accomplish this. It remains to be seen whether leadership will support these groups.

I want to draw your attention to part of a speech given by Sen.John McCain (R-AZ) on July 25 that supports the importance of bipartisanship eloquently.

“…I hope we can again rely on humility, on our need to cooperate, on our dependence on each other to learn how to trust each other again and by so doing better serve the people who elected us. Stop listening to the bombastic loudmouths on the radio and television and the Internet. To hell with them. They don’t want anything done for the public good. Our incapacity is their livelihood.
 
Let’s trust each other. Let’s return to regular order. We’ve been spinning our wheels on too many important issues because we keep trying to find a way to win without help from across the aisle. That’s an approach that’s been employed by both sides, mandating legislation from the top down, without any support from the other side, with all the parliamentary maneuvers that requires…. 

What have we to lose by trying to work together to find those solutions? We're not getting much done apart. I don't think any of us feels very proud of our incapacity. Merely preventing your political opponents from doing what they want isn't the most inspiring work. There's greater satisfaction in respecting our differences, but not letting them prevent agreements that don't require abandonment of core principles, agreements made in good faith that help improve lives and protect the American people...” To read or see the whole speech go to

http://www.cnn.com/2017/07/25/politics/john-mccain-speech-full-text-senate/index.html

In the dead of night this morning, an attempt was made was made to by Sen. Mitch McConnell, Senate Majority Leader (R-KY), to pass a repeal of the Affordable care act through a "skinny" version of the House American Health Care Act which had been passed by the House.  The bill, which was released two hours prior to the vote, had little "debate" and no committee hearing.  

I can't thank all of you who contacted your senators and other senators about what ending the ACA would do for access to mental health treatment enough.  The senators who prevented this disaster for millions of Americans should be thanked include Sens. Lisa Murkowski (R-AK), Susan Collins (R-ME), and most importantly, John McCain (R-AZ) who had just undergone brain surgery and made the bravest decision of his career in voting against this bill.  Please make calls to them for their principled stance.  

Also thank Sen. Patty Murray (D-WA) for her last ditch attempt to have the bill sent to the HELP Committee before the vote to approve it which, though it failed, showed the Senate how far from usual process it had strayed. Please make calls to all the senators above using the link https://www.senate.gov/senators/contact/Also thank your own senators if any of them opposed this bill.

We will see if there is any last gasp effort by the Senate to ram through some version of this bill but at this time it appears unlikely. 

As always, let me know when you have made your calls.