Yesterday, Americans made their voices heard at the polls, returning Barack Obama to the presidency. After a bitterly fought election stretching over nearly two years, Republicans and Democrats alike can now transition out of campaign mode and get back to the business of governing. What’s next for the federal government – and what does it mean for behavioral health?
Health Reform Will Not Be Overturned
With Democrats maintaining control of the Senate and Presidency, it will be next to impossible for health reform opponents to repeal President Obama’s signature legislative achievement. This means that states, providers, and consumers must move full steam ahead to prepare for the law’s major changes that will take place in 2014.
To begin, states have until November 16 to inform the Department of Health and Human Services whether they will implement their own health insurance exchange, join with HHS to establish a partnership exchange, or allow the federal government to run the exchange in their states. Click here to see the latest updates on state exchange implementation actions. States will also have to decide whether to implement the Medicaid expansion, how to structure their essential health benefits, and how to ensure that those benefits comply with the 2008 mental health and addiction parity law, among other decisions. Many states had opted to delay these decisions until after the election, waiting to see whether the election results would affect the likely survival or demise of the Affordable Care Act.
Substantial Federal Guidance Remains to be Issued
Another reason states have cited for delaying action on health reform is the federal government’s slow pace in finalizing many of the critical rules for implementation of the major pieces of health reform. One of the major remaining questions that federal regulators must answer is whether states will be permitted to carry out partial expansions of their Medicaid program – for example, expanding Medicaid to 100% rather than 133% of poverty.
With the elections over and the assurance that health reform implementation will carry on apace, we can expect to see HHS issue many of these regulations in the coming weeks and months.
Major Health Reform Decisions will be Made By States, Giving Advocates an Opportunity for Influence
With states responsible for so many major health reform decisions between now and January 2014, there has been no more important time for behavioral health providers to get involved in state decisionmaking processes. Most states have formed committees or task forces to evaluate and carry out the law’s provisions. I encourage National Council members, behavioral health providers, consumers, and family members to attend these groups’ meetings and speak up for the importance of including behavioral health at every step of the way.
Congress Must Act Quickly to Resolve “Fiscal Cliff” – or Punt Decisions To 2013
Congress won’t have much of a breather before it has to get back to work dealing with a series of looming budget issues known as the “fiscal cliff.” From hundreds of billions of dollars in across-the-board spending cuts set to take effect January 1 (including an estimated 8.2% cut to SAMHSA), to the expiration of both the payroll tax holiday and the Bush-era tax cuts at the end of December, lawmakers must decide quickly whether and how to steer the country past what the Congressional Budget Office has described as a potential setback for the burgeoning economic recovery.
Party leaders have three options: strike a grand bipartisan bargain in the waning days of the 112th Congress, pass a law delaying sequestration and the expiring tax cuts until several months into the new congressional session, or do nothing and let the components of the fiscal cliff automatically take effect. In any of these scenarios, substantial reductions to federal discretionary spending are likely as lawmakers either allow the automatic cuts to take place or replace them with a different set of more targeted cuts that achieve similar spending reduction goals.
Even after the fiscal cliff issues are resolved, a focus on reducing the federal budget will continue to dominate policy debates over the coming years. Congress must still finalize the 2013 budget and begin its work on enacting a budget for 2014. Medicaid and other funding sources for behavioral health services will continue to be at risk in these negotiations.