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Healthcare Reform: Ignore It at Your Peril! Let AMHCA Help You Re-Position Your Practice to Thrive

By Joel E. Miller, AMHCA Executive Director & CEO

I hope that as a clinical mental health counselor, you haven’t been sitting around for the past year wondering which way the wind was going to blow on the implementation of Obamacare.

I hope you haven’t missed the information AMHCA has disseminated to lay out a road map and strategy for members to thrive in this era of healthcare reform. 

I hope you did not make a terrible decision to delay beginning to re-position your practice because of the rough and tumble start-up of Obamacare. 

The good news is that it is not too late. AMHCA is here to help you during this tumultuous period your practice may be in due to the changes in the marketplace.

At AMHCA’s 2014 Annual Conference in July we’ve arranged plenary, workshop, and leadership sessions for you on how to thrive in the new era of healthcare reform. 

You will hear guidance from experts from around the country on what you need to do right now to position your practice to be nimble in the face of massive eruptions in care delivery and financing—that are taking place with or without healthcare reform.

If you’ve put off reacting because you think it won’t be easy to make the changes necessary for your practice to survive, you’re right.

It is difficult for most health caregivers to wrap their arms around the changes in the marketplace, especially in the mental health field. But in Seattle in July, we will give you the tools you need to build your practice and your teams to advance new strategies and approaches that are timely, credible, and productive.

Our goal is to help you develop the practice of your dreams, even in the face of incredible change.

The conference is always relevant because it’s the only national conference focusing exclusively on mental health counseling. This year, because of all the changes spurred by healthcare reform, we’ve created a special focus on health care reform and CMHCs:

  • Saturday keynote address: "Leading Change in an Era of Health Reform: The Role of Clinical Mental Health Counselors," by SAMHSA Administrator Pamela Hyde, JD
  • Special Track: Attend 10 hours on the Affordable Care Act track and receive a Certificate of Attendance
  • A preconference workshop: “How the Affordable Care Act (ACA) Impacts Mental Health and Substance Abuse Providers”
  • Overall conference theme: “Thriving in the New Era of Healthcare Reform”

Register now for the Annual Conference. Please don't delay a moment. The future of your practice may depend on it. Whatever effort or expense you have to expend to attend, you can be sure the effort will be exceeded by the difference it makes to your ability to ensure that your practices survives in the new healthcare marketplace. 

Following is my brief take on why healthcare reform matters so much.

Who would have thunk it?

Just a little over six months ago, most elements of our society said Obamacare was DOA! It was declared dead again just one week into its formal launch.

The White House caught a chorus of catcalls for being incompetent as consumers could not gain access to—the national website where many Americans could shop for health insurance coverage under the Patient Protection and Affordable Care Act (ACA).

Then came the claims that contrary to what the Obama administration had promised, people had to give up their current health insurance plans and replace them with ACA plans.

To pour gasoline over the raging firestorm over insurance coverage, complaints arose that health insurance premiums were sky-high under the new plans and that many could not afford them.

Then the policy wonks weighed in and said that not enough young people were enrolling to help spread out the costs of those who had not been able to purchase insurance coverage prior to the ACA because of pre-existing conditions (such as depression) and who were now expected to enroll in droves. (Actually analysts have found that many of the older adults who enrolled in ACA are pretty healthy as well.)

The list of hand-wringing and crocodile tears of the people who criticized healthcare reform but never supported it could go on. But a funny thing happened: 

Obamacare Worked—and Is Working

There are still problems to be sure. But is there any major enterprise start-up, in the public or private sector, that started without any hiccups? It was just a few years ago that the Medicare D program got off to a horrendous start, but now it is a footnote in health policy history and seniors love the new prescription benefits. 

Has anyone bothered to see whether the slowdown in healthcare cost increases may in fact be attributed to people over 65 who finally have access to affordable meds? Being able to purchase the medication they need has offset the costs of expensive treatments, including hospitalizations, that those without insurance coverage used to be subject when their medication conditions deteriorated because they simply could afford to fill their prescriptions.

The numbers speak for themselves. Since Oct. 1, 2013:

  • More than 8.5 million people enrolled in either the state health insurance exchanges or in the federal health insurance marketplace.
  • Another 1.5 million—and possibly more—bought coverage directly through health insurance companies and managed-care plans.
  • About 3.1 million Americans have been determined newly eligible for Medicaid as a result of the program’s expansion in 25 states and DC.
  • Thanks to what is known as the “out-of-the-woodwork effect” or the “welcome mat effect,” thousands of folks have signed up in the older Medicaid program. According to many states, these poorer individuals intended to enroll in one of the new ACA coverage programs and discovered that they have been eligible for the traditional Medicaid program all along.

These enrollment numbers will continue to grow in all four areas. So I think it’s high time the naysayers conceded that under the first six months of Obamacare, it has exceeded all expectations.

And that’s despite the decision by 24 states not to develop their own health insurance marketplace or exchange—essentially defaulting to the feds to build the capacity. 

Let’s hope the states get on board and increase their outreach activities to help people enroll in the various ACA coverage options—rather than erecting barriers that keep people from getting the coverage they need, and that they’re eligible for. 

Just Say Yes to Medicaid Expansion

Those 24 states that are not participating in the new Medicaid Expansion program just need to say yes. 

  • Just say yes to enrolling more than 6 million people who are eligible—3.7 million with a mental health condition.
  • Just say yes to billions of dollars from the federal government that will help shore up state budgets that go toward treating uninsured people with chronic or serious conditions, such as people with major depression and bipolar disorders.
  • Just say yes to the billions of dollars that will come in to the state’s economy thanks to increased healthcare services that will have a major trickle-down effect. Providers will need to hire more staff—both clinical and administrative—to handle the pent-up demand for care, which leads to more consumer spending, which leads to more jobs, and so on.

And if these major reasons aren’t enough, just think about all those citizens who pay taxes, but will not receive the benefits of the ACA. If there was ever a bread-and-butter issue that should strike a chord with the voting electorate, this reason alone is reason enough to expand Medicaid in your state.

Here in Virginia, a new argument has emerged—one that has gained unfortunate traction—espoused by those opposed to the Medicaid Expansion. It goes something like this: 

The current Medicaid program needs reform, so we should not expand a program on top of the current broken one that needs basic reform in care delivery and financing. 
How broken is the current Medicaid program if 40 million people are receiving health insurance through it? Thanks to the Medicaid and Medicare programs, millions of our most vulnerable or elderly citizens have received healthcare services that bolster their health and protect them from financial ruin. 

Telling millions more who are newly eligible for coverage under Medicaid Expansion that they will have to wait until we can figure out how to make healthcare delivery more effective would be like being homeless rather than buying a home you can afford because the house needs some work. Yes, our healthcare system is in need of reforms, but we will always have health system problems. Meantime, life happens—people fall ill and they need care. They can’t put their health and treatments on hold. 

It would be immoral to tell people who are about to receive private 

A Personal Note
on Personal Ethics

When I started writing this column on the eve the Easter holiday and the Jewish Passover observance, I was struck by the ethic of our Judeo-Christian tradition—and that of many religions—of responding to basic human needs: food, housing, education, and healthcare.

I am afraid that if those states that have refused to participate in the New Medicaid Expansion Program don’t relent, they will be abandoning that credo of care and dooming many hard-working fellow citizens to lives made more difficult and short.

Health insurance is an essential good and a building block that protects families. It should never be exchanged for political expediency, especially when the well-being and human dignity of millions of people are at stake.

Medical insurance—whether private or public—serves society’s legitimate self-interest in promoting a healthy, productive citizenry. We call on all policymakers and decision-makers who oppose the Medicaid Expansion in their states to reconsider and just say yes to the new initiative.

The health of our fellows and their families is at stake.

health insurance through their employer or in the individual market that they will have to wait until we develop better practice guidelines and address the lack of coordinated care. 

And if they do have to wait for coverage, things will get dramatically worse if millions are left uninsured, especially people with a mental illness who have trouble just filling and paying for a medication for their condition.

Make no mistake about Obamacare
—it is here to stay.

The only question is how many more millions will gain coverage beginning in November when we have another open enrollment period. 

The law is in its infancy but it has accomplished four main goals:

  • Increased healthcare coverage,
  • Slowed down the rate of increase in healthcare costs,
  • Energized the marketplace to develop new care-delivery methods and enterprises such as patient-centered medical homes and accountable care organizations (ACOs), and
  • Made it easier for people to access needed care.

If you want your practice to be here to stay, then be sure to attend AMHCA’s Annual Conference in Seattle in July. With a focus on healthcare reform, AMHCA will help you re-position your practice to survive—and thrive.