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Let’s End Sleepless Nights for Underinsured and Uninsured—Help Make Healthcare Reform Work
By Joel E. Miller,
AMHCA Executive Director & CEO

Unless you have been hiding in a cave in Afghanistan, you know that over the last few months, the launch of—the federal website established to enroll eligible Americans for health insurance under Obamacare—got off to a pretty rocky start. 

And as famous baseball philosopher Yogi Berra once said, “That is an overwhelming understatement!” 

The problems with the website launch were substantial, but it appears as of early December that the website is operating with considerably fewer problems and enrollment numbers are climbing significantly each day. That is good news. Still, it’s too soon to tell if those troubles will be merely a footnote in the implementation of healthcare reform, or continue to nip at the Obama administration’s heels over the next few years.
Just one year ago, on Dec. 14, 2012, we were shocked by—and we mourned—the needless deaths of 20 innocent children and six incredible school employees in Newtown, Conn., at the hands of a troubled young adult.

Now, one terrible tragedy has turned into another: As society, we have failed to act to prevent similar incidents—witness the tragedy at the Navy Yard here in Washington, D.C., in September.

We owe those innocent Sandy Hook Elementary School victims more than just our prayers and mourning. They also deserve our collective actions to find and implementnewsolutions to address the needs of people with mental illness, as well as ending gun violence in America. They would expect nothing less.

—Joel E. Miller

The angst over the website by both supporters and those opposed to implementation of the Affordable Care Act (ACA) essentially sucked the oxygen out of Washington, leaving many legislative and policy issues unattended since Oct. 1, when the website troubles began. AMHCA’s Jim Finley provides an excellent report (see page 24 in this Advocate) on where things stand on key bread-and-butter issues affecting clinical mental health counselors, which have taken a back seat to due to problems with the health reform website launch.

But as I have highlighted in the October and November issues of the Advocate, the ACA is all about helping uninsured people with chronic conditions such as depression and other serious mental health conditions obtain sustainable and consistent coverage. 

It is critically important that the law is implemented successfully.

I know many hard-working people who struggle to pay medical bills because they do not have health insurance. Millions cannot obtain health coverage due to pre-existing conditions such as depression. Many people who have lost their job-based coverage have to make incredibly tough decisions between paying the rent, food, or prescription medications. No one in this wealthy country should have to make those kinds of decisions. Too many Americans are forced into bankruptcy due to high out-of-pocket medical care expenses and costs associated with mental illness. 

And too many parents are spending too many sleepless nights worrying about their kids getting sick and how they’ll pay for needed healthcare. 

It is hard for me to fathom how major, well-funded organizations can be working on the ground in many college towns and other locales with the primary message that young adults should not obtain health insurance through the Affordable Care Act. It is unconscionable. The vast majority of young adults who enroll will find affordable coverage with a comprehensive benefits package, and protection against catastrophic costs if a major illness strikes. 

Imagine a parent telling a child not to obtain affordable health insurance coverage when it is available and offered. It would be the height of irresponsibility!

It would be one thing if those groups with their misguided message had an alternative plan to address the uninsured problem and high healthcare costs. But they don’t. Which brings me to a key point about the name of the healthcare reform law—the Affordable Care Act.

The United States spends more on healthcare than any other developed nation (18 percent of the gross domestic product, or $8,300 per capita in 2012). Spending on healthcare is rising far more rapidly than other costs in our society. And that is why we have so many people uninsured. Many Americans simply cannot afford health insurance because of high and ever-increasing premiums—even when coverage is offered in the workplace, where workers must share the cost of the premium to help the employer pay for healthcare.

One way the Affordable Care Act attempts to reign in healthcare expenditures is by encouraging the development of new models of care delivery that promote better patient outcomes and reduce 
unnecessary utilization.

New models of care delivery are essential to improve the value delivered by the behavioral healthcare system. The ACA includes provisions to test new models of delivering and paying for health services with the goals of reducing unnecessary utilization and healthcare expenditures, while improving individual health outcomes and overall population health. 

The ACA gives the Centers for Medicare and Medicaid Services the authority to test new models of behavioral healthcare that expand access to needed services; incentivize providers to improve quality and individual and community health outcomes; involve patients more directly in their own care; reduce redundant, ineffective, and inefficient utilization; and moderate rising healthcare costs.

Some states have many different pilots or demonstrations under development, both in the public and private sector, including, but not limited to, multi-payer patient-centered medical homes, new payment models, value-based insurance designs, and broader population health interventions. Our article in this issue on “New Care Delivery Models” (see page 6), catalogues some of the different initiatives and successful efforts being implemented by states. 

States need to continually examine the way they provide and pay for behavioral healthcare services, and should ensure that clinical mental health counselors are included in new delivery models—and that those models being used are achieving optimal indi-vidual and population health outcomes, while providing care in the most efficient manner possible. Strong, independent evaluations are needed to iden-tify what works, for whom, and in what environment. 

We need your assistance in identifying if state governments are investing in a centralized tracking system to monitor and disseminate new models of payment and delivery reform across their state.

It is critically important for clinical mental health counselors to emphasize their key attributes and training. New integrated-care delivery enterprises like Health Homes that are promoting prevention and wellness should be contracting with CMHCs, who serve as primary mental health providers on the frontlines.

So engage health plans, purchasers, and employers who are trying to create healthy organizations and achieve sustainable successes in improving the quality of mental health services and the quality of life for patients. Engage all stakeholders about how clinical mental health counselors can improve quality and help enhance outcomes. 

This is your time!