| The latest news from and for state health care advocates |
February 2013
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In each edition, we'll feature an action, victory, campaign, or interesting tactic shared by a state advocate. Send us your updates. |
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In This Issue:
Buzz around the States
Advocates from the Arkansas Advocates for Children and Families created a video of Republican governors announcing and explaining their support for Medicaid expansion. Not only does the video highlight huge advocacy victories in these states, it models commonsense messages that unite people of all political persuasions in support of the expansion.
In Harrisburg, Pennsylvania, a coalition of advocates, providers, physicians, faith leaders, and others held a rally to mark the launch of the Cover the Commonwealth campaign. The campaign aims to promote and implement the Medicaid expansion.
Utah Health Policy Project and National Women's Law Center produced an infographic showing the benefits of expanding Medicaid in Utah. It highlights how many people would be covered, the federal dollars that Utah would receive, and how much money would be saved.
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States in Focus
Medicaid Expansion Would Help Thousands of KY Veterans
Thousands of veterans without insurance or only Veterans Administration coverage stand to benefit if Kentucky expands Medicaid, according to a report from the Kentucky Center for Economic Policy.
About 22,000 veterans in the state are without health insurance. The center's executive director, Jason Bailey, said nearly 11,000 of them would be covered if the governor approves expansion. "These are Kentuckians that we see every day, that have put their lives on the line for the rest of us," he said, "and they would have the dignity and security of health coverage if the state moved forward."
Nationwide, 1.3 million veterans don't have health insurance, according to the report.
Gov. Steve Beshear has not made a decision on expansion yet, placing Kentucky among 16 undecided states. So far, 22 states have decided to expand their Medicaid programs, while 13 have opted not to. Part of the Affordable Care Act extends Medicaid eligibility to people at 138 percent of the federal poverty line. The federal government would cover the expansion cost in the first three years. After that, the state’s share is 5 percent of the total cost and rises to a cap of 10 percent by 2020. That's still what Bailey called "a good deal."
"Around 300,000 Kentuckians would get health insurance—so, we'd be healthier," Bailey said. "There would be federal dollars pouring into the state that will provide jobs for health care providers. It's just a win-win all around." Beshear says he's still weighing the cost of expansion. Some Republican lawmakers have told him Kentucky can't afford it. Bailey said he hopes the number of veterans who would be helped will "open up" the debate on Medicaid expansion.
"Potentially make it be a less ideological conversation and a more practical one," he said. "We have lots of Kentuckians that don't have health insurance, and they're real people—and in this instance, they're veterans."Beyond helping 11,000 veterans who currently have no health insurance, the report claims 7,000 family members would also receive coverage, along with 9,000 veterans who have only VA services.
The full report is online at kypolicy.us.
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Written by Tiece Dempsey, Policy Analyst, Oklahoma Policy Institute
Originally posted on OK Policy Blog, February 20, 2013
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Where the Affordable Care Act Fits into the Gun Control Debate
Since the tragic shooting at Sandy Hook Elementary School, the debate surrounding gun violence, gun control, and mental health has gained renewed prominence. Last month, President Obama laid out proposals to reduce gun violence, which include increasing access to mental health services. The affordable access to these services has been a constant barrier to some Americans in need of treatment. There have been multiple pieces of bipartisan legislation introduced since the Connecticut shooting, addressing the need for increased access and training in mental health services. Starting January of 2014, the Affordable Care Act (ACA) will help to reduce barriers to mental health services by increasing access to mental health benefits. Embracing the implementation of the ACA will be one solution to preventing another tragic mass shooting.
The ACA allows states to expand Medicaid coverage to working individuals with income levels up to 133 percent of the Federal Poverty Line (FPL). The expansion of Medicaid will potentially cover 13.4 million uninsured people with mental and behavioral health conditions. In addition to Medicaid expansion, employers with more than 50 full-time employees will now be required to offer affordable health insurance. The act also establishes insurance marketplaces for individuals who are not Medicaid eligible and don’t have access to affordable health insurance through their employer. Individuals with income levels up to four times the FPL will be eligible for premium tax credits to purchase insurance through the marketplace.
Insurance companies will be required to offer “qualified health plans” through the insurance marketplaces. While qualified health plans have not been specifically defined as of yet, they must all provide “minimum essential benefits” as defined by the ACA. Mental health services are included under the minimum essential benefits. With access to health insurance through Medicaid, an employer, or the insurance marketplace, individuals will be guaranteed the same level of mental health benefits as medical and surgical benefits.
In addition to the ACA, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) exist to ensure parity in mental health benefits. The MHPAEA aimed to create “parity” by eliminating historical differences in group health insurance coverage for mental health and substance abuse benefits and medical/surgical benefits. Getting mental health parity legislation passed and implemented has been a long and difficult journey. Efforts in achieving mental health parity date back 50 years, starting when President John Kennedy called for parity in mental health benefits for federal employee health insurance plans.
In 1997, Senators Pete Domenici from New Mexico and Paul Wellstone from Minnesota succeeded in getting the Mental Health Parity Act passed. The legislation required group health plans with 50 or more employees that offered mental health benefits to apply the same lifetime and annual dollar limits to mental health coverage as those applied to coverage for medical and surgical benefits. Efforts to improve the legislation continued for more than a decade. It wasn’t until the passage of the MHPAEA did true parity between mental health and medical/surgical benefits begin to occur.
However, there are several limitations to the MHPAEA and the ACA. The MHPAEA doesn’t require employers to offer mental health benefits. The ACA requires insurance plans sold through the insurance marketplaces to offer mental health benefits, but exempts employers who already provide affordable health insurance to their employees from offering mental health benefits if they are not currently offering the benefits. Also, when the Supreme Court ruled on the constitutionality of the ACA, the Court gave the states the option of expanding Medicaid. As of mid-February, only 21 states and the District of Columbia have decided to expand Medicaid in compliance with the ACA. As a result, those individuals who are unable to receive coverage under Medicaid will be unable to access affordable health insurance which will include mental health benefits.
Now that the gun control debate is back in the national spotlight and President Obama has committed his administration to working on solutions to curb gun violence, the MHPAEA and the ACA are two mechanisms that will ensure individuals will have access to mental health services. Both Congressional Senators from Oklahoma, Tom Coburn and Jim Inhofe agreed with President Obama’s efforts to increase mental health services as one solution to preventing gun violence. In her State of the State address, Governor Mary Fallin, emphasized the need for more resources to be put towards the Department of Mental Health and Substance Abuse Services to assist children and their families who suffer from emotional disturbances.
Unfortunately, Governor Fallin has failed to take the extra vital step in getting uninsured working Oklahomans access to needed health insurance including mental health benefits by refusing to accept federal funds to expand the Medicaid program in Oklahoma. The full implementation and acceptance of the ACA will demonstrate the country’s willingness to ensure individuals are getting the mental health services they need and hopefully avert the next tragic mass shooting.
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Ten Tips for Engaging Communities of Color in Policy Change: Lessons from a Health Equity Roundtable
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Written by Angela Jenkins, State Advocacy Manager, Community Catalyst, and Joe Martinez, Consumer Outreach Coordinator, Health Action New Mexico
Originally posted on Health Policy Hub, February 19, 2013
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A few years ago, a handful of advocates might have gathered together to discuss the issue of health equity and best practices for engaging communities of color in policy campaigns. A few weeks ago at the Health Action conference hosted by Families USA, we packed a room with advocates, foundation staff and state officials from across the country who were eager to discuss this issue and go a step further to discuss meaningful engagement of communities of color in policy change. As more and more people begin to recognize the absolute necessity of having communities of color at the table throughout each stage of policy change the advocacy community needs to ensure this change happens in a respectful, effective, and meaningful way. During the roundtable discussion moderated by Community Catalyst, the participants in the room brainstormed a list of tips for building a strong multicultural coalition and meaningfully engaging communities of color in policy change. A Lot of great ideas were shared, but here’s a “top ten” list of tips:
- Practice basic etiquette
Practicing basic etiquette and showing respect is a good idea when working with any individual or community, but when working with communities of color, it is important to think about how you are treating individuals you are working with and how your actions will be received by different cultures. To improve cross-cultural engagement, familiarize yourself with cultural etiquette and norms specific to the communities with whom you are working.
- Engage beyond education
People of color are often alienated at the policy table and used or tokenized when needed in policy campaigns. In addition, some define “engagement of communities of color” to mean education and outreach. It is important to go beyond education and to include, not use, communities of color as valued partners at all levels of policy change.
- Support meaningful engagement in policy change
It is important to support communities of color to engage in policy change and to provide individuals in these communities with the tools and assistance to engage meaningfully. However, don’t forget about or underestimate the knowledge, skills, and tools these communities bring to the table.
- Don’t ignore or forget to address racism
Whether it is personal, internalized, or institutionalized, racism still exists. It is important to recognize there will be some racism in the policy arena and even more important to address racism during the initial stages of bringing a group together. Touch base with each member to see how he or she feels about this topic to provide a safe space for sharing feelings and to help build each person’s comfort level and confidence to address racism.
- Make a commitment
Engaging communities of color is not a one-time thing that is done when convenient. It is about building a strong relationship. As is true for any relationship, this will take time, and it will be a long-term commitment.
- Find the right messenger
Find the right messenger from the communities you are working in. Sometimes the right messenger will be a grasstops leader that has been addressing health equity for a long time. Other times the right messenger will be a grassroots leader from a local church or school.
- Practice team-building
Consider this process of engaging communities of color as a team-building opportunity to provide a continuing growth of understanding on the health topics related to the Affordable Care Act. Think of this engagement as a partnership where all parties contribute. As the team-building process develops during the Affordable Care Act implementation campaign, a dynamic partnership that creates a strong base for future work together will emerge.
- Communicate effectively
Different populations and different cultures might have different preferences or abilities for communicating. Use tools for communicating that are inclusive and accepted. Think about the communications technology you will need to use for your campaigns and how you can make this technology an accessible tool for different populations.
- Provide financial support
Organizations that work with communities of color often have competing priorities and are often under-resourced. Think about investing in local organizations that represent and support communities of color or help these organizations identify potential funding sources.
- Celebrate wins
At times it feels as if there is no end in sight for health reform implementation. That’s why it is important to celebrate small milestones as well as large victories. Yes, the vision of quality, affordable health care for all is enough to keep many in this fight, but cake and balloons along the way can’t hurt.
The rich discussion at the roundtable resulted in many great tips for engaging communities of color in policy change, but we know there are many more out there. Please share other tips, strategies, materials, or insight and examples in the comments. For more information and resources on health equity, visit our Health Equity webpage.
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Health Action 2013 Materials, Videos, and Photos Online
Did you attend last month’s annual Health Action conference? Want to relive those wonderful memories you made? Make sure to recap those highlights by digging into the workshop materials on our online toolkit, checking out our photos on Facebook, and watching plenary videos on our conference webpage.
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New Resources from Families USA and Stand Up for Health Care
Take me to back issues of the Beat!
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