ACA, AAMFT, and CAMFT continue to work with and others in Washington to get LPCs and LMFTs included as eligible providers in Medicare. Bills pending before both the House and Senate would do it. And that change would be beneficial for consumers and taxpayers alike.
Donald Trump was elected President of the United States yesterday in what has been labeled a stunning upset. While much of the broader social discussion today will focus on how Trump’s victory happened, as psychotherapists we now must consider how President Trump will impact our profession.
Mental health is not mentioned in Trump’s health care reform paper or on the health care page of his campaign web site. So for this post, we look to his other stated policy goals to see how mental health care would be impacted.
I’m at the AAMFT Leadership Conference in Washington, DC, where Division leaders from across the country have spent the last three days visiting our federal representatives. Priorities this year include Medicare inclusion and adding MFTs as named providers within the Elementary and Secondary Education Act (otherwise known as No Child Left Behind). Before I go to the details on the visits, some words of praise: this was the first time that AAMFT’s California Division and CAMFT, an independent organization of California MFTs, have combined efforts on their federal advocacy visits, and it went swimmingly. CAMFT’s lobbyist and leaders were kind, cooperative and helpful throughout, and I hope their experience of AAMFT was similar. Legislators and their staff people seemed impressed with the level of cooperation. As to the key issues, here is where we currently stand:
Medicare. As we were starting our second day of hill visits to California representatives on Thursday, we were greeted with bad news: the inclusion of MFTs as providers under Medicare, which had been part of the House health care reform package but not the Senate package, was pulled out of the reconciliation bill that will be voted on as early as next week. There is a slim chance that MFT inclusion in Medicare could still be accomplished this year through a different piece of legislation, but at this point that appears unlikely. On a more positive note, though, there remains significant bipartisan support in both chambers for adding MFTs in Medicare, as it would improve access to mental health care for seniors and those with disabilities. For a video of Senator John Barrasso (R – Wyoming) discussing the importance of this issue, click here.
School programs. MFTs can provide services to school populations under the Elementary and Secondary Education Act (ESEA), but because we are under the somewhat vague category of “other providers,” most programs do not seek to include MFTs when they apply for federal grant funding under ESEA. Adding MFTs as specifically named providers would improve the availability of behavioral health services for children. It also comes at no cost, which is helpful in seeking bipartisan support. Currently, these changes are in a House bill (HR1710) that has sponsors from both parties. I always enjoy the Leadership Conference for the trips to the Hill as well as the opportunities to connect with divisions from around the country. I’ll have another update from the conference in the next few days.
At this point, it’s too early to know exactly what a final health care reform bill will look like — there are still several different proposals coming out of several different Congressional committees. However the final legislative package winds up looking, if health care reform is passed, most MFTs are likely to benefit. The only questions are “How?” and “How much?” Individual MFTs can gave tremendous impact on the answers to those questions.
Individual health insurance coverage. Most MFTs work either in private practices and/or in small businesses (including nonprofit organizations) that may or may not offer health benefits. For these therapists, insurance is often both expensive (see Kaiser Family Foundation chart, left) and difficult to come by. AAMFT does its part in helping members locate insurance options, but can’t do much when it comes to controlling costs. Health care reform is almost certain to help this large proportion of MFTs by making health care more affordable and removing barriers to coverage (e.g. pre-existing medical conditions).
Medicare reimbursement. Multiple House and Senate bills this year include provisions that would make MFTs eligible for reimbursement through Medicare. These bills may eventually be absorbed into the large-scale reform bills — indeed, one such bill (HR3200) already includes specific provisions for bringing MFTs and LPCs into Medicare — and if so, it will be vital that the provisions for including MFTs are kept. However, Medicare inclusion is currently less certain. AAMFT, AMHCA, ACA, and CAMFT are working together to counter the inaccurate claims of opponents, and are likely to need your help in the coming weeks to preserve this important part of health care reform. Stay tuned. The profession has made great strides in the past several years toward Medicare reimbursement, and with luck, this will be the year when our work pays off.