Shortly after signing the 2010 Patient Protection and Affordable Care Act at a White House ceremony March 23, President Barack Obama dashed to the U.S. Department of the Interior, a few blocks from the executive mansion, to address a throng of health care reform advocates. Among the crowd was NASW Executive Director Elizabeth J. Clark.
“It was a celebration,” Clark told NASW News. She said representatives were in attendance from just about every group NASW worked with over the previous year to shape and help deliver on health care reform.
“The president gave credit to the audience for helping bring about reform,” she noted, “and that was very satisfying.”
Clark said she is pleased that Congress passed what she considers more health insurance reform than health care reform, describing the 2010 Patient Protection and Affordable Care Act and the 2010 Health Care and Education Reconciliation Act as “a good first step.” Congress passed the latter act to make several “fixes” to the former.
“I’m pleased that the insurance companies can no longer deny coverage to children with pre-existing conditions and that they can’t put lifetime caps on coverage for illnesses,” Clark said. “I’m also pleased that dependent children up to the age of 26 can be covered under their parents’ insurance plans.”
Clark said she is disappointed, however, that the Medicare “donut hole” doesn’t close until 2020. That refers to the point at which Medicare Part D beneficiaries must foot the entire bill for prescription drugs — once the beneficiary and the insurance plan spend $2,830 on prescriptions in 2010 — until the benefits resume, $4,550 later.
NASW “fought very hard against Medicare Part D’s passage in 2003 precisely because of the donut hole,” Clark added. “People who can’t afford it, especially seniors on a fixed income, simply won’t seek care.”
Clark also said she’s disappointed that the ban on insurance companies’ practice of denying coverage to adults with pre-existing conditions doesn’t take effect immediately. Insurers have till 2014 to comply.
Nevertheless, the social work profession has much to be thankful for, Clark noted. Embedded in the new law are several provisions that will directly benefit the profession, including key elements of the Dorothy I. Height and Whitney M. Young Social Work Reinvestment Act.
“As a former social worker I am proud to have fought to include provisions in the newly signed health reform law that will allow the social work profession to thrive in the health care system along with other health care professionals,” Sen. Barbara Mikulski, D-Md., lead sponsor of the SWRA in the Senate, told the NASW News. “As a social worker, I personally understand the significant contribution social workers make every day to our health care system.”
She added: “Allowing social workers to practice at the top of their license will greatly benefit patients and the health care system.”
Building the Workforce: The law authorizes millions of dollars to help develop the social work workforce, including $8 million in grant funding specifically for institutions that train social workers. At least four grants go to historically black colleges and universities or minority-serving institutions, the law stipulates.
It also authorizes funding for geriatric education centers to support training in geriatrics, chronic care management and long-term care for faculty in health professions schools and family caregivers and develop curricula and best practices in geriatrics. It expands the geriatric career awards to clinical social workers and psychologists.
The law authorizes grants to schools for the development, expansion or enhancement of training programs in social work, graduate psychology, professional training in child and adolescent mental health and pre-service or in-service training to paraprofessionals in child and adolescent mental health.
It establishes a demonstration program under the auspices of the U.S. Agency for Healthcare Research and Quality to provide grants to academic institutions to develop and implement academic curricula that integrate quality improvement and patient safety into health professionals’ clinical education. The term “health professional,” which appears numerous times throughout the act, includes social workers.
The law provides for competitive grants to enable state partnerships to complete comprehensive planning and to carry out activities leading to coherent and comprehensive health care workforce development strategies at the state and local levels. Grants will support innovative approaches to increase the number of skilled health care workers such as health care career pathways for young people and adults. All health professions are eligible for state planning attention, including social work.
The law also establishes a national commission tasked with assessing the health care workforce and projected workforce needs. The needs of the social work profession are among those that would be considered, and schools of social work also have representation.
Charles Robbins, associate dean of the school of social welfare at the State University of New York Stony Brook, welcomes the attention to the social work field.
“When people think about the health care workforce, they typically think about physicians and nurses, not really understanding the role social workers play in health care delivery throughout the health care continuum,” said Robbins, who is also immediate past president and member of the board of the Society for Social Work Leadership in Health Care. “This law recognizes social workers as leading providers of health care in the U.S.”
Affordable Education: The new law includes provisions that will make it easier for social work students to gain an affordable education by reducing their existing financial debt or reducing their dependence on student loans.
It authorizes $80 million over four years to establish a loan repayment program for pediatric subspecialists and providers of mental and behavioral health services to children and adolescents who are or will be working in a health professional shortage area, medically underserved area or with a medically underserved population.
The law amends the Higher Education Act to include mandatory funding for Pell Grants, as well as to increase the federal maximum Pell Grant award by any change in the Consumer Price Index.
It also amends the Income-Based Repayment program to cap student loan payments for new borrowers after July 1, 2014, to 10 percent of adjusted income, from the current provision of 15 percent; and to forgive remaining balances after 20 years of repayment, rather than the current provision of 25 years.
Jim Finley, NASW senior government relations associate, said the higher education provisions are expected to generate significant savings by ending lender subsidies to boost Pell Grant scholarships, keep interest rates on federal loans affordable and increase the number of students who enter and complete college.
“Many higher education institutions, in anticipation of this legislation, have already increased their direct federal loan lending to students,” Finley said.
“It’s very clear that with the demographic changes taking place among the U.S. population and the additional 32 million Americans who will have health care coverage as a result of this law, the demand for social workers is going to increase,” Robbins said. “Helping students to graduate with less debt is positive and productive in helping to build the health care workforce.”
Parity: The new law contains sweeping requirements for parity coverage of mental illness and substance abuse prevention, treatment and rehabilitation services. For the first time, parity benefits will be required in the basic benefit packages sold in the individual and small group markets. Among the requirements:
- All health plans sold in the new insurance exchanges must comply with the Wellstone/Domenici Parity Act and provide behavioral health benefits the same way as all other covered medical and surgical benefits.
- Plans sold in the large group market will continue to comply with the parity benefit under current law.
Other Provisions of Note: Medicaid eligibility is expanded for all Americans up to 133 percent of the federal poverty level and beneficiaries are required to receive behavioral health services at parity benefit levels.
The law postpones a 5 percent cut and extends for one year an expired Medicare provision that will hold psychotherapy rates at last year’s level. Clinical social workers’ and psychologists’ rates are restored until the end of 2010, when the provision again will need to be reauthorized.
It establishes demonstration grants or contracts for community health teams to support the patient centered medical homes. This program will establish and fund the development of community health teams to support the development of medical homes that seek to increase access to comprehensive, community based, coordinated care. Behavioral health treatment providers are among the entities eligible for community health team grants.
It also establishes grants to promote the community health workforce. This grant is eligible to public or nonprofit private entities to promote positive health behaviors and outcomes for populations in medically underserved communities through the use of community health workers. Social workers could be considered as community health workers.
What’s Next: While these provisions will have a positive impact, “there’s still much more work to be done,” Clark said. “We need to focus on the role of the profession. Social workers are on the front lines of providing essential human services, and we must ensure that we have the workforce to meet the demand.”
That’s the message Clark delivered to U.S. Department of Health and Human Services Deputy Chief of Staff Justine Sarver and HRSA Director Mary Wakefield at a March 11 meeting.
Clark also told NASW News that social workers’ role will be enhanced as a result of greater emphasis on coordinated patient care, only bolstering her argument that more social workers are needed.
Robbins said that while he’s disappointed that the law doesn’t include a public health care coverage option, “we’ve taken a profound step forward toward ensuring a much more equitable system of health care in the U.S.”