The health care debate: Five things psychologists need to know

Making sense of the multiple policy reports on health care reform.

News organizations publish multiple stories every day about the state of health care policy in America. It can be difficult to make sense of all the reports, but here are the top five things psychologists need to know about health care reform.

  1. Practicing psychologists and their patients who rely on the Affordable Care Act (ACA) health insurance exchanges could have lost coverage if Congress had passed the most recent bill to repeal and replace the ACA, former President Barack Obama’s signature health law.

    Thousands of psychologists in private practice, like Claire L. Barron, PhD, in Kansas, and Susan Sanderson, PhD, in Missouri, are covered through the ACA exchanges because they don’t have access to group health plans.

    The Congressional Budget Office projected the latest attempt to repeal the law, legislation sponsored by Senators Lindsey Graham, R-S.C., and Bill Cassidy, R-La., along with Dean Heller, R-Nev., and Ron Johnson, R-Wisc., would have destabilized the individual health insurance market, pushed states to weaken health insurance protections, and resulted in millions of Americans losing coverage.
  2. Sept. 30, 2017, was the deadline for Congress to use special procedural rules to pass legislation to repeal and replace the ACA during the federal fiscal year 2017.

    APA and the Practice Organization strongly opposed the Graham-Cassidy proposal. The bill would have replaced Medicaid and the ACA’s marketplace subsidies with smaller block grants; let insurers charge higher premiums for individuals with pre-existing conditions; and removed requirements that insurance companies cover mental health services. The bill’s sponsors withdrew the legislation from consideration at the end of September.
  3. Psychologists’ Medicaid and Medicare patients could still lose coverage for essential services.

    Over the coming weeks, the House and the Senate will work to approve a fiscal year 2018 budget resolution. Both chambers' initial proposals would enable more than $1 trillion in cuts to Medicaid and ACA subsidies over the next decade, and more than $400 billion in cuts to Medicare, in order to offset the cost of tax cuts.

    The ACA has made it possible for more psychologists, like Sheri Anselmi, PhD, in California, to see Medicaid patients. “Prior to the ACA it was not possible for a small business owner to serve individuals with Medicaid (and survive financially) because the reimbursement was so low and the number of sessions was very limited,” Anselmi told the Practice Organization.
  4. Psychologists should be concerned about President Donald Trump’s executive order on association health plans.

    Association health plans (AHPs) are health plans established to provide coverage to multiple employers or groups under a single policy, and would be exempt from both state insurance laws and most ACA requirements, including the requirement to cover mental health and substance use disorder services. Setting up health plans, like AHPs, exempt from such requirements would destabilize the existing health insurance markets.
  5. Congress should act to stabilize the insurance market.

    Senators Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., developed bipartisan legislation (PDF, 74KB) to reinstate payments to insurance companies to cover the cost of deductibles and copayments for low-income enrollees. These cost-sharing reduction payments were halted by President Trump. Enacting the Alexander-Murray proposal would help stabilize the individual health insurance markets and significantly reduce premiums. 

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