The first vote on the Senate health care repeal and replace bill, the Better Care Reconciliation Act, has failed but there are many votes to go before the fate of the Affordable Care Act is decided.

As the debate to repeal and replace the Affordable Care Act continues, it is important for us as clinical social workers to keep our focus on the way that all the bills that have been considered would affect patient access to mental health and substance use treatment.  The elimination of essential benefits would return insurance plans to the days when they could pick and choose benefits and often left out mental health coverage. Another group that will be harmed if the essential benefits are eliminated are women - maternity and gynecology benefits were also typically not covered before the ACA.

The bill that will actually be voted on is still not clear. However, the plan to repeal the mandated payment for those who do not choose to get insurance, now being called the "bare-bones" plan or the "skinny repeal" plan, is gaining steam and will severely erode the funding base for those covered by the ACA in Medicaid and the individual market. 

There is still great confusion about the plan that will eventually be voted on, but here is a message that will keep CSWA's concerns in front of your senators:

"I am a member of the Clinical Social Work Association and a constituent.  Please make sure that mental health needs remain covered as they are in the Affordable Care Act.  Make sure that the maternity and medical needs of women remain covered. Finally keep Medicaid expansion without caps and the mandated payment in place.  We need all these components to avoid serious risks to coverage of the health and mental health of our citizens."

To contact your senators, go to https://www.senate.gov/senators/contact/ and enter your state.  To contact Republican senators most likely to support our views, go to https://www.trumpcaretoolkit.org/    and contact as many as possible.

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

Dear CSWA Members,

As discussed in yesterday's post (below), the US Senate voted 51-50 today to proceed with debate on repealing and/or replacing the Affordable Care Act.  This debate could include discussion of the American Health Care Act, the House bill which has passed to the Senate, the Better Care Reconciliation Act in the Senate which has failed to pass twice, or be a simple repeal with a replacement to follow.

The AHCA and the BCRA are much more similar than they are different. Both would seriously undermine access to mental health treatment by removing essential benefits; remove mental health parity from Medicare; cut access to Medicaid using caps and/or block grants; and possibly create plans which would eliminate coverage of pre-existing conditions.

There is a new wrinkle in the announcement by the Senate Parliamentarian, Elizabeth MacDonough, that some of the provisions in the bills may require 60 votes to pass, as opposed to the 51 currently being sought.  That would significantly change the likelihood that the bills could be passed.

I will be sending messages over the 20 hours of debate allowed, which will probably take no more than a few days, to send to your Senators. There will be many amendments that are yet to be announced. 

This has been a marathon campaign and we need to keep fighting the changes being proposed that would harm our work as clinical social workers and our patients' access to treatment.

Dear CSWA Members,

As you know, a vote on a health care bill that would allow debate on whether to repeal and/or replace the Affordable Care Act has been scheduled in the Senate tomorrow.  There is no clarity from leadership exactly about what will be in the bill. Therefore, it is difficult for CSWA to give specific guidance any what message to give your senators.  Here is a summary of the possible bill that will be voted on.

1. A bill that will repeal the ACA without replacing it, with the goal of passing a replacement prior to the 2018 elections.
   
2. The Better Care Reconciliation ACT which will include caps on Medicaid, eliminate the essential benefits, and allow some pre-existing conditions to be the basis for denying insurance.
3. The American Health Care Act which was passed by the House a month ago and has much of what is in the BCRA.
4. A bill which has not been discussed and will some new version of the bills above.

The CBO score on the BCRA, which came out last Monday, had the same 22-23 million that would lose insurance as the AHCA. 

All the bills we have heard about are damaging to access to mental health treatment, mental health parity, and coverage for Medicaid enrollees who need mental health services.

I will let you know more when the actual bill is finally revealed.  In CSWA's view, this process is an example of bad governance.  It seems very politically based and has little to do with people getting good health care or actually improving the ACA.

Dear CSWA Members,

As you know, a vote on a health care bill that would repeal and/or replace the Affordable Care Act has been scheduled in the Senate tomorrow.  There is no clarity from leadership exactly about what will be in the bill. Therefore, it is difficult for CSWA to give specific guidance any what message to give your senators.  Here is a summary of the possible bill that will be voted on.

1. A bill that will repeal the ACA without replacing it, with the goal of passing a replacement prior to the 2018 elections.
   
2. The Better Care Reconciliation ACT which will include caps on Medicaid, eliminate the essential benefits, and allow some pre-existing conditions to be the basis for denying insurance.
   
3. The American Health Care Act which was passed by the House a month ago and has much of what is in the BCRA.
   
4. A bill which has not been discussed and will some new version of the bills above.
   

The CBO score on the BCRA, which came out last Monday, had the same 22-23 million that would lose insurance as the AHCA. 

All the bills we have heard about are damaging to access to mental health treatment, mental health parity, and coverage for Medicaid enrollees who need mental health services.

I will let you know more when the actual bill is finally revealed.  In CSWA's view, this process is an example of bad governance.  It seems very politically based and has little to do with people getting good health care or actually improving the ACA.

Dear CSWA Members,

There has been an unexpected development since Friday when Sen. McConnell had announced his intention to vote on the BCRA to repeal and replace the Affordable Care Act tomorrow.

Sen. McCain has had surgery for a blood clot above his left eye which will mean he cannot attend the Senate this week.  This means that the vote on BCRA is more fragile than it had been, though Sen. McCain's vote was not a certain yes or no.

We have a little time to work on stopping this bad bill.  Please continue to call your Governors and Senators to let them know you oppose it.

ADDITIONALLY - ask the senators who are no votes (all Democrats, Ron Paul and Susan Collins) or leaning no to come together as a group to request a new process - that the bill get bipartisan support to receive the thoughtful open transparent process it deserves.

lease review the issues which I sent out in my posts of June 12 and June 19 which detail how these bills are harmful to people with mental health needs including the possible loss of essential benefits, including mental health and substance use for states who choose waivers to Medicaid; the extreme cuts to Medicaid, with the bulk of lost insurance being people covered by Medicaid; and the end of required coverage for pre-existing conditions for state that choose waivers for Medicaid.

Also – please call Sen. Susan Collins (R-ME) to thank her for her principled opposition to this bill at (202) 224-2523.

The main political issue is whether there are three senators willing to vote against this deeply flawed bill.  We need to continue to oppose this bill with the senators who are wavering on their vote, mainly the more moderate Republicans.

Here is the message I am suggesting with the contact information for these Senators:

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 
• 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 oppose the Better Care Reconciliation Act of 2017. Please join with other Senators who have concerns about this bill and develop a bipartisan group to give it the thoughtful open transparent process it deserves.  [Your name, degree, contact information]

If you wish to contact other Republican Senators, you can do so by going to https://www.senate.gov/general/contact_information/senators_cfm.cfm where you will find all the phone numbers for U.S. Senators.

One other way to oppose this bill is to contact your Governor and ask your Governor to let your state’s senators know that your Governor opposes this bill.  The same message can be used.

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

Dear CSWA Members,

We are approaching our final chance to stop the Better Care Reconciliation Act. Even if you have called the Senators listed below, please call them again to oppose this bill.  The CBO score will come out on Monday, July 17, and the bill will be voted on Tuesday, July 18.

Please review the issues which I sent out in my posts of June 12 and June 19 which detail how these bills are harmful to people with mental health needs including the possible loss of essential benefits, including mental health and substance use for states who choose waivers to Medicaid; the extreme cuts to Medicaid, with the bulk of lost insurance being people covered by Medicaid; and the end of required coverage for pre-existing conditions for state that choose waivers for Medicaid.

Also – please call Sen. Susan Collins (R-ME) to thank her for her principled opposition to this bill at (202) 224-2523.

The main political issue is whether there are three senators willing to vote against this deeply flawed bill.  We need to continue to oppose this bill with the senators who are wavering on their vote, mainly the more moderate Republicans.

Here is the message I am suggesting with the contact information for these Senators:

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 
• 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 oppose the Better Care Reconciliation Act of 2017 which will not protect the coverage needed for mental health disorders, substance use disorders, and will severely cut Medicaid coverage. These policies would increase costs for everyone by increasing the use of emergency rooms and law enforcement as the place that these disorders will be addressed. BCRA will cause emotional suffering for those who need help. [Your name, degree, contact information]

If you wish to contact other Republican Senators, you can do so by going to https://www.senate.gov/general/contact_information/senators_cfm.cfm where you will find all the phone numbers for U.S. Senators.

One other way to oppose this bill is to contact your Governor and ask your Governor to let your state’s senators know that your Governor opposes this bill.  The same message can be used.

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

Here is an update on the Better Care Reconciliation Act of 2017 in the Senate.

There are seven Republican senators who have announced that they will not vote it in its present form.  This means that the bill cannot pass.  Majority Leader Mitch McConnell has said he may “be forced” to work with Democrats to shore up the individual markets if the bill is not viable.

CSWA believes that a bi-partisan approach to health care is by far the best solution.  Please do not take for granted that your senators will take this approach, even if they are Democrats.  Call your senators today with the following message:

“I am a member of the Clinical Social Work Association and a constituent.  Please support a bi-partisan effort to improve the Affordable Care Act by shoring up the individual market subsidies.  The mental health of our citizens will be jeopardized without this support.”

You can find telephone numbers and email addresses at https://www.senate.gov/general/contact_information/senators_cfm.cfm

As always, let me know when you have contacted your senators.  Please let me know if you have any questions.

Dear CSWA Members,

The Senate Better Care Reconciliation Act of 2017 has been put on hold until after July 10, due to the fact that four senators have announced they will not vote for it. This means it will not pass the Senate. 

Adjustments to the bill will be considered after next week’s recess. This means there will only be 15 days to consider the bill, an amended version of the American Health Care Act from the House, in July.  Leadership in the Senate has said that the bill must be voted on before the August recess.

Many thanks to all the CSWA members who have contributed to the tidal wave of resistance to the BCRA.  Please try to meet with your senators next week or attend town halls to express the importance of coverage for Medicaid expansion; maintaining mental health and substance use treatment as a required benefit; and coverage of pre-existing conditions.

Dear CSWA Members,

The Congressional Budget Score (CBO) for the Senate amendment to the House bill HB 1628 was released today, and as many have predicted, it is as potentially damaging, in some different ways, for the poor with mental health problems, as House bill is. Of course this populations are known to have higher mental health needs (33%) than the country as a whole.

The Better Care Reconciliation Act of 2017, the Senate bill to replace the ACA, will mean that 22 million people will lose health care by 2026, with 18 million losing it next year.  This is almost exactly what the CBO score for the House AHCA bill, which predicted 23 million would lose health insurance, said.

Please review the issues which I sent out in my posts of June 12 and June 19 which detail how these bills are harmful to people with mental health needs including the possible loss of essential benefits, including mental health and substance use for states who choose waivers to Medicaid; the extreme cuts to Medicaid, with the bulk of lost insurance being people covered by Medicaid; and the end of required coverage for pre-existing conditions for state that choose waivers for Medicaid.

The main political issue is whether there are three senators willing to vote against this deeply flawed bill.  We need to continue to oppose this bill with the senators who are wavering on their vote, mainly the more moderate Republicans.

Here is the message I am suggesting with the contact information for these Senators:

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 oppose the Better Care Reconciliation Act of 2017 which will not protect the coverage needed for mental health disorders, substance use disorders, and will severely cut Medicaid coverage. These policies would increase costs for everyone by increasing the use of emergency rooms and law enforcement as the place that these disorders will be addressed. BCRA will cause emotional suffering for those who need help. [Your name, degree, contact information]

If you wish to contact other Republican Senators, you can do so by going to https://www.senate.gov/general/contact_information/senators_cfm.cfm where you will find all the phone numbers for U.S. Senators.

One other possible way to oppose this bill is to contact your Governor and ask your Governor to let your state’s senators know that your Governor opposes this bill.  The same message can be used.

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

Dear CSWA Affiliated 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.