Whats at stake for mental health and

addictions ...

Healthcare debate and the President Skinny Budget

Ongoing ... challenges of mental and addictive disorders
Impact of healthcare as a business
National Press Foundation
7/25/17
Thank You
 The National Council for Behavioral Health
2,900 Member Organizations

Serving 10 million +
adults, children and
families with mental
illnesses and/or
addictions.

mental health and addictions organizations, health centers,

hospital systems, governments and not for profits...
 The American Healthcare Debate

A PURE SOCIAL A PRIVATE

GOOD TO BE CONSUMPTION
AVAILABLE TO GOOD WHOSE
ALL ON EQUAL
TERMS AND TO
BE FINANCED
BY ABILITY TO
? FINANCING IS
PRIMARILY
AN INDIVIDUAL
RESPONSIBILITY
PAY

American The confused American

Progressives in-betweens Conservatives
Rose Garden AHCA Celebration

May 4, 2017
 What are we worried about?
Market Provisions
State waiver process to opt out of ACA
requirements
Waive essential health benefits:
remove/alter required services, including
MH/SUD
Waive protections based on health and age:
allow insurers to charge more for people
w/ pre-existing conditions & older people
(WI and SD )
Access ... If you can afford it
 Medicaid Expansion
Repeal of Medicaid expansion option for new
states
Phasing out enhanced federal match rate for
Medicaid expansion
Repeal of Essential Health Benefits
requirement in Medicaid
Net effects:
Makes it expensive and complicated for
states to continue Medicaid expansion
Undermines parity in Medicaid
Disproportionally impacts people with
addictions
 Medicaid Reform
Conversion of Medicaid to a per-
capita capped or block grant
system
Requiring eligibility re-
determination every 6 months
Net effect of Medicaid changes:
$880 billion from Medicaid over
ten years?
States and federal Medicaid funding
The glittering promises of
flexibility
 Likely waiver proposals

Rep. Tom Price (R-GA) Seema Verma

Secretary of Health and Human Services Administrator of CMS
The expansion of Medicaidwas a clear departure from the core,
historical mission of the program to serve the truly vulnerable.
Work requirements
Drug testing
Higher cost sharing (premiums, co-pays)
Special enrollment & lockout periods
Time limit on coverage
Waive essential benefits & pre-existing
conditions
Medicaid reform proposals further
crunch states and providers
25 states have general fund revenue shortfalls

Loss of Medicaid as an entitlement means major

coverage losses
Common cost-cutting actions include: enrollment
limitations, benefit reductions, rate cuts
 Medicaid
one in five Americans

Socially Clinically
vulnerable vulnerable
patients patients
(income, language,
(complex, difficult
race/ethnicity,
healthcare needs)
health disparities)

29% of mental health and addictions care

 The 2018 Skinny Budget
Limited Role for Federal Government
half of Americans believe that 40 percent of
the population works for the government
when its less than 2 percent
And that one quarter of the federal budget
goes to foreign aid when its less than 1
percent
President Trumps Skinny Budget

Hands off Social Security and

Medicare for now
Spend on military/defense
increases, infrastructure, border
wall, and tax cuts
Fund by slashing Medicaid and
discretionary programs
 Federal Budget
2015: 3.8 trillion

71% 29% (16% military)

What do we do?
 282,192,223
media impressions on stories where we/a
member were quoted

Stateline | Huffington Post | Vox

USA Today
Politico | Reuters | The Hill | CNN
Washington Post
NBC | Modern Healthcare | Bloomberg
New York Times
and more
Hill fly-ins
Targeted ads:
Alaska Dispatch News The Herald Dispatch (WV)
The Arizona Republic Portland Press Herald (ME)
The Denver Post (CO) Politico, Roll Call, The Hill
Las Vegas Review Kansas City Star: state-specific ad
Journal (NV)
The Plain Dealer (OH)

#Unite4BH
Make Sense?
Behavioral Health...
 US Burden of Disease

Almost of all adult stays in U.S. hospitals involved

mental or substance use disorders
Mental illness most common reason for SSD/SSI

24
Public
Opioid deaths are on the rise
More Americans Suffer from Addiction than Cancer
Boredom and a sense of uselessness and
inadequacylead you to just want to withdraw.
On heroin, you curl up in a corner and blank out
the world. Its an extremely seductive drug for
dead-end towns, because it makes the worlds
problems go away.
It numbs emotional painquickly and intensely.
Peter Callahan, a psychotherapist in Martinsburg
An epidemic of suicides, alcoholic liver disease,
and overdoses of heroin and prescription opioids
 Suicides
Suicide deaths jumped 24% from 1999 to 2014 and
continue to rise
 people without care...
OCD, anxiety, depression sometime
comorbid with chronic medical
conditions responsive conditions

Escalating deductibles/copays
make treatment out of reach.
Equally destructive are stagnant
insurance reimbursement that
make behavioral health cash only
businesses.
 Kaiser Health Poll
Majority of public backs equal mental health
coverage; fewer than half (38 percent)
recognize parity already law.
Americans report having had trouble getting
mental health services they needed.
Most common barrier was cost, followed by
insurance coverage issues, and confusion over
where to go for care. Least commonly
expressed reasons were that people were
afraid or embarrassed to seek help.
Resonate?
 The Business of Healthcare
Behavioral health spending $213.6 billion last
year increase of $25.2 billion, or 13.4%, since
2011.
2011 to 2015, insurers payments to hospitals,
laboratories, treatment for substance use from
$32 million to $446 million a 1,375% increase
 So Where Is The Money Going?
Venture and private equity investments: inpatient, residential, MAT

Our healthcare systems are extremely effective at generating new business

opportunities. Healthcare is one of the most vibrant and healthy parts of our
economy and has had unprecedented decades of steady growth. If effective cost-
effective healthcare delivery was more important to us than new business
opportunities we could make different design choices.
Joe Parks, MD, Medicaid Director, MO.

Where isnt the money going: Community Care

 Community Safety Net?

No parity in the safety net: Hospitals and FQHCs cost based

reimbursement
Stagnant fee for service
Medicaid managed care
Staff with low salaries and higher turnover: 2000 to 2016,
private sector employment grew by 9.8%, health care
employment grew by 42.0%.
Little to no reserves, margins or access to capital for
investment in new service lines, technology, infrastructure
Mental Illness

More BEDS
 We Know What Works
dependent on public and private grants
to expand or improve services

Diversion and Re-entry

Measurement Based Care

NATCON18 Trauma
April 23-25 | 2018 | Washington, D.C.
37
 Building a Continuum
not a quick fix
The Surgeon
Generals Report
firmly establishes
addiction as a
preventable chronic
medical condition...

funding for community treatment and recovery

supports remains dependent upon grants
 Technology
Hi Touch and Hi Tech
Solving ...

Access Engagement Big Data

Grants Are Not Enough
If you had a cancer
youd get chemotherapy, if
you had a blocked artery
youd get a stent It
wouldnt depend upon a
grant and it shouldnt
for us.

Certified Community
Behavioral Health Clinics
Excellence in Mental Health Act

NY, NJ, PA, MO, MN, NV, OK, OR

 115th Congress
H.R.3331 - Amends title XI of the Social Security Act for testing incentive
grnt payments for behavioral health providers use of certified electronic
health records. Rep. Jenkins, Lynn and Doris Matsui.
H.R. 3032 - Mental Health Access Improvement Act of 2017 - Amends title
XVIII of Social Security Act covering marriage and family therapists and
mental health counselors under part B of Medicare. Rep. John Katko
S. 1453 - Strengthening the Addiction Treatment Workforce Act - HHS
designates substance use facilities National Health Service Corps
eligible. Senators Joe Donnelly and Lisa Murkowski
S. 1169 & HR 2687- Medicaid Coverage for Addiction Recovery
Expansion Act - Amend title XIX of Social Security Act to give States
option to provide Medicaid between the ages of 22 and 64 for inpatient
services to treat substance use disorders. Senator Dick Durbin & Rep.
Bill Foster
 Youre Invited
Hill Day 2017 in partnership with 20 national organizations

Addiction Policy Forum, Association for Behavioral Health

and Wellness, Association of Recovery Schools, Clubhouse
International, Depression and Bipolar Support Alliance, Faces
and Voices of Recovery, Facing Addiction, Family-Focused
Treatment Association (FFTA), Family-Run Executive Director
Leadership Association (FREDLA), Hazelden Betty Ford
Institute for Recovery Advocacy, International Bipolar
Foundation, Legal Action Center, Mental Health America,
NAMI, NAADAC the Association for Addiction Professionals,
National Association of Social Workers, Network for Social
Work Management, Psychiatric Rehabilitation
Association, Shatterproof, and Young People in Recovery.
How influential are?
 As former Senate Majority
Leader Everett Dirksen (R-IL)
said

When I feel the heat,

I see the light.