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MPA's mission is to serve the science of psychology and its applications throughout Minnesota so the interests of public welfare and psychologists are mutually enhanced.
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MPA in the halls of power in Washington, D.C.
It has been said that timing is everything…
MPA leadership happened to be in Washington DC this past weekend and early this week as the recent “replacement” for the ACA came out. It actually appeared the night before we had scheduled meetings with virtually all of Minnesota’s congressional delegation. We had met earlier with staff from APAPO, the political voice for psychologists (APA speaks for psychology) in preparation for those meetings. With the release of the proposed bill we quickly read what we could and sought to address concerns that MPA has about the legislation. Here are those concerns…
Parity in coverage for mental health care. Any replacement of the ACA needs to provide protections for parity in insurance coverage. Parity, the statute that insurance that covers physical and mental health needs must provide equality of coverage. Parity is the law of the land. The repeal of the Essential Health Benefit portion of Medicaid expansion is an attack on parity.
Included in the new bill was a capitation plan for all Medicaid services. Here is a link to learn all you may ever want to know about capitation https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/CapitatedModel.html . The short version is that is a formula under which different payment levels are assigned a set rate for the full services needed. Medicaid would then make a payment to the states for individuals that would match those rates. The issue for Minnesota is that a capitation plan can unintentionally punish state programs that are more efficient in service provision because their rates per person would be lower. This could leave little room for payment improvement through improved efficiency in service provision. Compared to many other states, Minnesota has been a leader in innovative programs to improve use, efficiency, and effectiveness of services in the Medicaid program. The impact of this change could be a reduction in services in number, frequency, duration and ultimately in the quality of the services provided.
The bill also included a phasing out of Medicaid expansion in 2020. While this is a few years in future, it means the potential end of Medicaid as an healthcare coverage option for millions of individuals across America and tens of thousands here in Minnesota.
One last point I would offer for your consideration is the reality that buried in ACA is funding for innovative service models, who very existence was to reduce costs and increase efficiency, effectiveness and quality in the provision of services for “high use” clients in the Medicare and Medicaid systems. This most recent bill appears to remove the funding for these new saving service models.
How is this all relevant to our profession? Clients without coverage are not clients, they are not going to be seeking services that they cannot pay for. When they do become clients, because of the delay of services they will likely present with a far more complex clinical profile that will likely take more time/services to effectively meet their clinical needs. We as a profession need to speak up for these clients who often are the most vulnerable and needing of services. Efficient, effective and high quality services are what we can provide, if we are given the funding to do so. For APA’s take on the bill you can go to this link http://www.apa.org/news/press/releases/2017/03/health-care-act.aspx
This bill appears likely to not go through as the leadership of the senate is sending a pretty clear message that the bill does not have any information about its costs or impacts on the states and individuals.
That does not mean that it is not worth calling your representatives with the message of a requirement for the protection of mental health parity in any bill to replace ACA. Also it seems ill considered to repeal Medicaid expansion, removing coverage from individuals who are receiving coverage now. The last “ask” would be to retain funding for innovative models of service to improve the quality and effectiveness of care while keeping costs as low as possible.
Please do call your representatives as this process moves forward. This is not a call to resist the ‘improvement of the ACA” for which there is agreed upon room for improvement. This is a call to protect our profession and our clients as this process proceeds in the coming months.
Steve Girardeau, PsyD, LP
P.S. Here we are outside Senator Franken's office