I once worked with a tough-minded and experienced corporate attorney who, at the climax of a contentious decision-making process, reminded participants that there were two ways to solve a problem: “There’s the easy way,” he said, unfolding one hand, “and there’s the hard way,” he said, unfolding the other. Then, he challenged all to take the hard way, which demanded more preparation, effort, and follow-through, yet provided a more stable and predictable long-term solution.
For health reform, 2012 was all about going “the hard way.” Yet, after stormy and divisive debates, it brought the apparent resolution of three highly charged and contentious national decisions: First, the Supreme Court decided in June to uphold the constitutionality of the insurance mandate in the Affordable Care Act (ACA). Second, the Court upheld the Medicaid Expansion, but decided that states could choose to implement it. Third, American voters decided to narrowly elect President Obama to a second term in November.
Though one more national decision—regarding the fiscal cliff—is needed to close an already eventful political year, the clarity offered by these three decisions signals an important break in our chilly political weather. My hope is that it is the start of a warming trend that will rapidly thaw the frozen decision-making and regulatory machinery in Washington, DC and in state capitals across the country. There’s promising evidence of such warming already:
• November 20 saw the release of a flurry of regulations regarding insurance market reforms promised in the ACA, namely, an end to discrimination based on pre-existing or chronic conditions; additional guidance for states on the design and comparison of Essential Health Benefits (EHBs) required in insurance plans; and guidance for employers on how to establish and maintain non-discriminatory employee wellness programs.
• Post-election, Republican governors who initially opposed or took no position on the ACA’s Medicaid expansion seem to be doing the pragmatic thing: taking another look. A case in point: Florida Governor Rick Scott—an opponent of the ACA and the Medicaid expansion prior to the election—has sounded a more conciliatory tone in light of election results that saw Florida voters reject a state constitutional amendment to block the ACA’s insurance mandate. The Administration has continued to signal its patience and flexibility with regard to states’ concerns about the Medicaid Expansion as well.
• Mental health and addiction treatment benefits required by the ACA are taking shape in the EHBs that are required from all states by late December. Though these benefits will vary somewhat from state to state, the act of defining them at last puts something of a health benefits floor in place for nearly all Americans come 2014. Now, to see those long-awaited final rules for implementing the Mental Health Parity and Addiction Equity Act, the regs that we hope will put parity to work in the insurance marketplace …
• According to Statereforum.org, 18 states have established or intend to establish state health insurance exchanges and five more have announced intent to partner with the federal government in the development of an exchange. Of the remaining 27 states, 25 are likely to adopt a federally developed exchange by decision or by default. Only Alabama and Mississippi have declared post-election opposition to state insurance exchanges, based on a declared inability to fund them. I'll bet someone can come up with the money ...
And outside of government, another positive decision: I was delighted to see the National Council announce a new “Criminal Justice” track for its 2013 Conference. Given the enormous proportion of non-violent mentally ill, addicted, and homeless individuals who enter the criminal justice system, I can think of no behavioral health efforts that can do more to bring hope, health, restoration, and measurable financial impact to justice-involved people and their communities nationwide. Learn more and get involved!
Our team at Behavioral Healthcare thanks you for your leadership in the field—and your readership—this past year. We wish you and yours a wonderful holiday and wish all an easier way forward in the New Year.
Dennis G. Grantham, Editor-in-Chief