Briefing Focuses on Health Care Reform

Edolphus “Ed” Towns“Social workers will face a wide range of challenges that have far-reaching implications for the profession,” U.S. Rep. Edolphus “Ed” Towns, D-N.Y., said at a Feb. 16 briefing on implementation of the 2010 Patient Protection and Affordable Care Act.

Towns, a social worker, convened a panel of five experts, including Asua Ofosu, manager of NASW’s government relations department, and Stephen Gorin, executive director of the NASW New Hampshire Chapter. The other panelists were Robyn Golden, director of older adult programs at Rush University Medical Center in Chicago and co-chair of the National Coalition on Care Coordination; and Kevin Maloney, professor at Boston College Graduate School of Social Work. James Zabora, dean of the National Catholic University School of Social Service, served as moderator.

“Throughout the history of our country, social workers have played an important role in providing groundbreaking strategies and solutions that enhance the overall well-being of Americans,” Towns said. “However, many times, our work is not valued as much as other professions.”

The year-old Affordable Care Act does much to bring social workers to the fore of health care services, the panelists said.

To start, the law addresses the education and training needs of social workers. It makes available scholarships, grants and loan repayment programs for “social work students specializing in, and providing services to, special high needs populations such as children, the aged and underserved minority populations,” Ofosu said.

Golden said it also creates several programs for improving care “in which social work should be playing a key and vital role,” such as those that reduce unnecessary hospital readmissions and keep patients as independent as possible within their communities.

Gorin, who edits NASW’s Health & Social Work journal, discussed the law’s promise of more coordinated, patient-centered care and access to mental and behavioral health services.

In his editorial in the February issue of Health & Social Work, “Repealing and Replacing the Affordable Care Act: Prospects and Limitations,” Gorin said social workers have a stake in defending the act that Republicans in the House voted to repeal. “Many of our clients, and perhaps we, are likely to be among the 32 million individuals who will receive coverage under the law.”

He noted that repeal of the ACA would undermine Medicare — what he called a “critical social insurance program” — and threaten “what remains of our welfare state.”

Maloney said social workers should take some credit for the health care community’s shift in focus to increased coordination and patient-centered care.

“Social work is built on a tradition of empowerment,” he said. “The current emphasis on participant direction clearly builds from the very set of ideas and principles Jane Addams pioneered at Hull House. Furthermore, much of the research that laid the foundation for this paradigm shift was led and implemented by social workers.”

In addition to highlighting the benefits of the law, panelists also expressed concern that the law would further strain the social work workforce when newly insured Americans begin to utilize services unless more is done to grow the profession.

“[T]he provision of social work services cannot be an unfunded mandate,” Golden asserted. “The profession’s contributions to health care’s bottom line, such as reductions in unnecessary health care utilization and promotion of wellness, need to be financially acknowledged through the funding of new health care positions for social workers.”

During a Q&A session, panelists and attendees discussed ways in which social workers could ensure that policy makers appreciate social workers’ role in health care delivery.

Golden pointed to Rush University Medical Center’s enhanced discharge planning program for older patients as an example of how social workers’ involvement in health care delivery improves outcomes and controls costs.

As part of the enhanced discharge planning program, social workers conduct post-discharge telephone assessments with at-risk older adults and coordinate post-discharge care. The result is more patients are following up with their doctors after discharge and fewer patients need to be readmitted to the hospital.

In other news, the U.S. Department of Health and Human Services issued a final rule Feb. 18 rescinding most of the Bush-era regulation that allowed health care providers to refuse to participate in services they find religiously or morally objectionable. HHS called the so-called “conscience clause” regulation “unclear and potentially overbroad in scope.”