Putting the wheels in motion to repeal the Affordable Care Act (ACA) will be one of the top items on the agenda for Congress when it reconvenes on Jan. 3, with legislation likely to be waiting on President-elect Donald Trump’s desk when he takes office Jan. 20. How the dominos fall from there remains to be seen, and it’s on behavioral healthcare advocates to make their voices heard starting this week, according to speakers on a National Council for Behavioral Health conference call Thursday.
Al Guida, president of the government relations and public affairs practice Guide Consulting Services, said key pieces of any ACA-repealing legislation are threefold: Eliminate the individual mandate for the provision of getting health insurance, repeal the Medicaid expansion and eliminate subsidies for buying insurance on the ACA exchanges.
About 29 percent of all people covered through the ACA expansion have a diagnosable mental illness, substance use disorder or both, Guida said. With respect to individuals with substance use disorders, 1.2 million of the 10 million covered through the ACA Medicaid expansion have an addiction disorder.
Repealing the ACA is likely because it will require just 50 votes in the Senate and Republicans hold a 52-48 edge in Senate seats. Changes would not go into effect for anywhere from six months to two or three years, says Chuck Ingoglia, National Council’s senior vice president, public policy and practice improvement. Where things become complicated is passing legislation that replaces the ACA, which will require 60 votes in the Senate. Building that kind of consensus in less than three years will be an uphill battle.
“It took Congress 17 years to replace the formula used to pay physicians in the Medicare program,” Ingoglia said. “So the idea that we could have bipartisan agreement on a replacement plan in six months or two or three years seems hard to believe. The question becomes what happens between the vote for repeal and replace? What is the effect on the insurance market? Some states’ Medicaid expansion was predicated through legislation on the government continuing this. There are a lot of implications going forward.”
So, what can providers do to protect their services in what will likely be a dramatically shifting health insurance landscape? Speak out and be strategic in how you use your voice, says Rebecca Farley, National Council vice president, policy and advocacy.
“We still have shared goals with the legislators in office,” Farley said. “It’s up to us to learn to talk a different language with our colleagues in Congress about how to achieve those shared goals.”
Farley offered the following recommendations to providers who want to make their voice heard on Capitol Hill:
- Learn the lingo. When talking with legislators, put your concerns in a relatable frame of reference, she said. “When you talk about the services you provide, it’s common to talk about it in terms of the impact on consumers, families or communities,” Farley said. “A different way—and an equally valid way—to talk about your services is to frame it in the context of yourself as a business with employees and bringing tax revenue into your community. It’s a different lens on the same issue, which is the need to support and invest in organizations that provide services. Think about how to talk about what you do in ways that might resonate with legislators who are making these decisions.”
- Head for the hill. Farley advocated making a trip to the next annual Hill Day, to be held Oct. 2-3, in Washington to lobby legislators. The National Council plans to bring more than 600 advocates to Capitol Hill.
- Schedule some facetime over the holidays. Members of Congress will be heading back to their home districts for the remainder of the month, and Farley said it’s a worthwhile endeavor to make an introduction. “Meeting in your district is a fantastic time to start to make your case and get to know your legislators and educate them on the importance of investing in your services,” she said. Providers who are unable to schedule a face-to-face meeting can still make an impression on their legislators by writing letters of introduction that express who they are and what impact their services have in their community.
- Collect data. Providers should be collecting data on the impact of their services, as well as the cost and value of their programs. “Now, more than ever, is the time to talk about our work in economic terms,” Farley said. “How many employees do you have? How many jobs could be lost if the Medicaid expansion goes away? How many individuals with opioid addiction has your organization served since the advent of the Medicaid expansion, and what would happen if the Medicaid expansion disappeared? Think in concrete terms of data.”