Advocates urge field to monitor state actions on health reform
The wait is over. The Affordable Care Act (ACA), Medicaid expansion, health insurance exchanges - these are some of the important things that now can come pouring out of the federal government, and addiction treatment policy experts who spoke with Addiction Professional on the morning after the Nov. 6 election were looking forward to the wheels finally starting to move.
"The time for people putting their head in the sand about health reform is over," says Chuck Ingoglia, vice president for public policy for the National Council for Community Behavioral Healthcare. With President Obama's reelection and with Democrats maintaining a majority in the Senate, the repeal of healthcare reform that Republican presidential challenger Mitt Romney had promised if elected is not going to happen.
"There was a lot of 'hurry up and wait' for the election," says Robert Morrison, executive director of the National Association of State Alcohol and Drug Abuse Directors (NASADAD). "All of the hemming and hawing that everyone had to do over the ACA - this is why," he says. "It shows how hard it is to navigate."
But now that the election is over, several agenda items will start falling into place quickly. At press time, leaders approached a mid-November deadline by which states had to declare whether they will establish an insurance exchange; some had been holding back until the election, says Ingoglia. Now they were having to decide to establish their own exchange or a federal partnership exchange. In either case, the federal Department of Health and Human Services (HHS) has required that substance abuse and mental health treatment be covered by the exchange, in which people who earn too much money to qualify for Medicaid but do not have coverage elsewhere can purchase insurance.
Likewise, many states had been waiting for the election results before deciding whether they will expand Medicaid, covering single men and people up to 133 to 138% percent of the federal poverty level. Some states have indicated that they would like to expand it but only up to 100% of poverty, giving higher-income people the chance to purchase subsidized insurance on the state exchange.
"We'll see more policy making now in terms of both the Medicaid expansion and insurance exchanges," says Ingoglia.
States at press time also were expecting a letter to go out from HHS to state Medicaid directors to give some guidance on how to apply parity to managed care Medicaid, says Carol McDaid, principal with Capitol Decisions.
There also has been an increased focus on the benchmark benefits that states are collecting for their exchanges, says McDaid, who expresses concern that mental health and substance abuse benefits are not included in some. "My sense is that there's going to be a look-back period," she says. This could be devastating to the provider community, she believes, because if benefits aren't actually enforced until the one- or two-year look-back, providers might not be able to come back.
"If you go without coverage for two years, you can't just build back provider networks," McDaid says. "That's why it's important for our field to do a great job of responding in a meaningful way about the damage that would be done" if substance abuse benefits aren't included in benchmark plans for the exchanges.
"This is something we've known for a long time about health care reform," says Ingoglia. "The federal government will create standards, but implementation will happen at the state level."
Finalizing essential health benefits, honing the intricacies of Medicaid expansion, all of this requires the input of providers and state associations, says Ingoglia.
Nobody is saying that political gridlock will disappear, and the fiscal cliff - the threat of sequestration, with automatic cuts including those to the Substance Abuse and Mental Health Services Administration (SAMHSA) and its programs - could kick in on Jan. …