Now that we have completed the first frenetic week of the new administration, it will be very important to pause, reflect, and determine our next steps. The hoped for output from this exercise will be development of a laser-like focus on what is important, while ignoring all the noise.
A few moments’ reflection will assure you that the proportion of noise to substantive action is quite high in the new administration, e.g., crowd size at the inauguration vs. the Affordable Care Act (ACA). Therefore, we will require a filter to assess noise vs. substance. Almost always, the noise has been accompanied by statements that are at variance with what is known to be factually true.
Hence, a reasonable filter would be the fact test: Do the assertions comport with what is commonly known to be true? If they don’t, the assertions can safely be ignored because the media will point out the falsehoods and make known the true situation. In the end, truth will win out, and the noise will be debunked.
Direct our efforts
At the same time, on substantive matters, it will quite be important to attend to the new administration’s focus, e.g., the ACA, immigration, Medicaid, etc., but also to direct our advocacy effort toward those who actually can address our concerns, e.g., the Congress, the governors, the courts and public opinion.
A good example is the current furor over repeal of the Affordable Care Act. Although the new administration has issued an executive order on removing ACA mandates, the actual authority to change much of the ACA lies with the Congress and the courts. Hence, our efforts need to be focused there. As the Congress has begun to consider ACA repeal, the advocacy community has spoken loudly and strategically to the Congress about repeal and replace. As a result, the latter thinking now has gained some ascendency in the ACA dialogue on the Hill. That will need to continue.
Clearly, our advocacy over the next four years must be an all hands on board exercise, 24/7. The Women’s March of last Saturday is a wonderful example. We all can become involved in such actions.
The behavioral health community has a very spotty record of advocacy, i.e., demonstrations, testimony to county councils, state legislatures, the Congress, or even fundamental consensus building in our own communities. That must change going forward.
We also will want to identify new allies for our advocacy. Several examples come readily to mind. These include the insurance, health and hospital industries, the broader disability community, the community of older persons, to name just a few. These are groups with which we have not worked in the past. Now we will need to seek out opportunities to do so.
Substantively, we must defend the gains made in insurance coverage and access under the ACA, protect Medicaid from conversion to a capped block grant, and support the continuation of Medicare as a public insurance program. Each is very important for a different reason. The newly insured under the ACA disproportionately include persons with mental health, substance use, and ID/DD conditions. Medicaid has become the largest payer of services for these disability groups. With the very rapid and accelerating growth of the population of older persons, Medicare will be essential going forward.