Now that the voters have spoken, what’s next for Congress and President Obama – and what does it all mean for behavioral health?
MentalHealthcareReform.org editor Rebecca Farley sits down with the National Council’s Linda Rosenberg, President & CEO and Chuck Ingoglia, Senior Vice President for Public Policy, to learn more.
Rebecca: Let’s get started with the question on everyone’s minds: was the election an affirmation by the public of the Affordable Care Act?
Chuck: My sense about the election is that it was not an explicit affirmation of the Affordable Care Act. However, the implications of the election are that the ACA is going forward. There was a lot of hemming and hawing on many levels, of states not wanting to pay attention to the particular provisions. First they were waiting to see what would happen with the Supreme Court, then it was, what will happen in this election…
Linda: Right. But for the general public, I don’t think the question of what will happen to particular provisions was high on their priority list. The public was divided in three groups. One wanted the ACA to go away, another group was neutral or liked it, and a small group didn’t think it went far enough. And now, after the election, there is still the same kind of split. I think what the election did affirm is that most people believe in an active role for the federal government and part of that active role is to care about healthcare.
Rebecca: So, in the new year, do you think we’ll continue to see the same gridlock in Congress and the same reluctance to implement the ACA at the state level?
Linda: The one place that Republicans really made gains in this election was in governorships – so I’m not sure that all of the grandstanding will go away that quickly. But I do think that much of it was going to erode anyway once the Supreme Court upheld the law. There was another big trend in the election that we should look at, that was very important: the emergence of Latinos as a voting bloc and of the young and of Asian Americans. That makes me ask, what are the implications of this shift in terms of our member organizations? What kind of penetration have they had among those groups in their communities, both around education and prevention, as well as around treatment?
I don’t know the answer, although I have some suspicions about it. I think for someone from my generation, this was almost a wake-up call. We are in a post-Baby-Boomer era, and what does that mean for how you design and deliver services?
Chuck: There’s a whole movement around being responsive to customer needs and segmenting markets. How do our members think about designing services and a customer experience that is attractive to those three populations?
Linda: Exactly. And really, younger people believe in this activist role of the federal government, but then they want it locally customized. People want services delivered how and when they want it, because the internet has done that. Last night, I ordered something in the middle of the night on Amazon. I don’t have to wait for an office hour, or for the department store to be open. What does that mean for how we’re going to deliver services? Among our 2000 member organizations, how many are experimenting with using the internet for delivery of services, or new and innovative delivery changes that really look to the future?
Chuck: So part of the answer might be, if you’re thinking about expanding, to do some focus groups, figuring out what’s important to different kinds of segments in your market and then making determinations about whether you want to rise to the occasion to meet those kinds of needs.
Rebecca: Back to the elections…
Linda: I think the new Congress will reach some solutions. They’ll continue some gridlock, and there will be posturing, and they’re all going to quarterback what went wrong, and next time the Republican party will have a comeback. The public is fickle. This election doesn’t mean the Republicans won’t emerge again in two years and do very well in the congressional elections.
Chuck: Think back to 2008, where all the press was predicting the end of the GOP. That didn’t come to pass, did it?
Linda: The GOP will get on board with younger people and with other groups, and they’ll work it all out. In the short run, Obama has a moment – as do the Democrats – to move an agenda. I think the public expects that Congress will come to some kind of deal on both entitlements and tax increases. It may not happen in the next month or two. They may kick the can again. But it will be very shortly.
Chuck: I think all eyes in Washington are on a two stage process for addressing this supposed fiscal cliff…
Linda: Which is all their creation, by the way.
Chuck: What we’re hearing now is that it’s a “glide path,” not a “cliff.” There are some serious issues Congress has to address: preventing the cut in Medicare payment to physicians while also preventing sequestration, while reducing federal spending. I think we’re going to have a two stage process. We’re going to have something now that stops sequestration but then puts in a more serious deficit reduction requirement for the next Congress.
Linda: Our fight will be around Medicaid.
Chuck: I think there’s’ a lot of concern about how Medicaid will be used to pay for any of these things. There is a lot of organizing happening around that and we’re going to rely a lot on our members in the next Congress to talk about the importance of Medicaid. The tricky thing is that some of the provisions that will be discussed might not directly affect us, but anything that reduces federal Medicaid money to states will have an impact on our system.
Linda: Our fight is always for social justice, for people who don’t speak for themselves. We need to make sure that Medicaid doesn’t get block granted, and that’s going to be our fight. There will be people on both sides of the aisle interested in doing that as a deficit reduction strategy.
Rebecca: So, what is the future of behavioral health in Congress?
Chuck: Over the last few elections, we’ve lost behavioral health champions in Congress. This election cycle was no different. We’re going to need to continue to identify and nurture congressional champions, make relationships with our new Members of Congress. That’s why we sent out a post-election toolkit to help our members make those connections. Because at the end of the day people caring about our issues is nice, but people willing to fight for our issues is even better – and we’re going to need that into the future.
Linda: Let’s talk for a minute about the Federally Qualified Behavioral Health Centers concept. Somebody might say, do you really need that? Doesn’t the ACA do enough? How would you respond to that?
Chuck: The ACA makes tremendous advances in our understanding of mental health disorders and fulfills our wish of behavioral health being part of healthcare. Yet, in a way, that’s also where its biggest danger lies – because we don’t have the same legislative, regulatory, and financing protections that other safety net providers in this country have. One of the reasons that hospitals and rural health centers and FQHCs feel so confident and are so well positioned under health reform is because they still have a lot of federal protections. Some of these other changes are invisible to them – whether it’s the expansion of managed care or other kinds of payment structures – because they’re still guaranteed that they’re going to get paid for their costs. Community behavioral health organizations don’t have any of those comparable kinds of protections.
Even though we’re part of healthcare, we’re still regulated and funded so differently from the rest of healthcare. The Excellence in Mental Health Act would equalize much of that. It would bring in national standards that we could build upon. It would also create equal footing with other parts of the safety net in terms of reimbursement, which I think could actually foster better care coordination and partnerships.
Linda: The opportunity to continue the education of the public around mental illnesses and addiction is vital. And people are more open to it than ever before. We’re ready. Let’s rock and roll!