Health Care Reform Efforts in Question

Rosa DeLauro leads rallyU.S. Rep. Rosa DeLauro, D-Conn., rallies the crowd at a November gathering to protest an amendment to the health care reform bill that would limit abortion coverage.

At NASW News deadline, House and Senate Democratic leadership were negotiating a compromise health care reform bill that includes certain provisions of the Dorothy I. Height and Whitney M. Young Jr. Social Work Reinvestment Act, or SWRA.

As 2009 came to a close, Democrats in both houses of Congress mustered just enough votes to pass health care reform legislation: 220-215 in the House (one Republican, Rep. Ahn "Joseph" Cao, R-La., voted in favor of the bill) and 60-39 in the Senate.

"NASW is very pleased that both the House and Senate bills contain key provisions which address many of the critical changes we believe are needed to improve the public's health, and, specifically, to start moving towards a system that focuses on keeping people healthy and is affordable for all," NASW Executive Director Elizabeth J. Clark said in a Jan. 11 letter to House Speaker Nancy Pelosi, D-Calif., and Senate Majority Leader Harry Reid, D-Nev.

However, NASW staffers weren't quite ready to pop open the champagne bottles. It remained to be seen how differences between the two versions -- the House's inclusion, and the Senate's absence, of a public health insurance option, for example -- would be ironed out before President Barack Obama would receive a "clean bill" for signature. The Democrats' January loss of the Senate seat left vacant by the passing of Sen. Ted Kennedy, D-Mass., complicated prospects.

NASW supports the creation of a public plan to compete with private insurance plans in the new national health insurance exchange and continued to advocate for its inclusion in the final bill, as it would help make health care more affordable for consumers and employers.

In her letter, Clark pressed congressional leaders to ensure that certain provisions passed in either the House or Senate wouldn't end up on the cutting-room floor, including language similar to that of the SWRA. The provisions NASW is pushing for are:

  • social work education and training grants in mental and behavioral health;
  • a demonstration program for academic institutions, including schools of social work, to develop and implement academic curricula that integrate quality improvement and patient safety in the clinical education of health professionals;
  • state health care workforce development grants to increase the number of skilled health care workers, including social workers;
  • health care workforce loan repayment programs for providers, including social workers, of mental and behavioral health services to children and adolescents who agree to work in a health professional shortage area, medically underserved area or with a medically underserved population;
  • geriatric education center grants to support training in geriatrics, long-term care and chronic care management;
  • the establishment of a national health care workforce commission tasked with, among other things, evaluating education and training activities to determine whether the demand for health care workers is being met; and
  • the exclusion of clinical social worker services from coverage under the Medicare skilled nursing facility prospective payment system and consolidated payment.

NASW lobbied hard to derail one provision -- language inserted into both the House and Senate bills that would prohibit insurance plans from covering abortion services for consumers who purchase the plans with government subsidies.

As part of the Coalition to Pass Health Care Reform and Stop Stupak!, NASW and other national groups organized a Capitol Hill protest in opposition to the abortion limits. The Dec. 2 event took place days before the Senate would initially vote against the limits (Reid ultimately included the abortion limits in the Senate bill to shore up the 60 votes needed to pass it).

Barbara SoltBarbara Solt: “The government should not be intruding on” access to abortion.

The "Stop Stupak Lobbying Day," named after U.S. Rep. Bart Stupak, D-Mich., who drafted the abortion limits contained in the House bill, drew several lawmakers and hundreds of abortion rights supporters, including NASW member Barbara Solt. She said she felt especially compelled to speak up for the "poorest of the poor, who really don't have a lot choice when it comes to many things in life."

"It's certainly not the first choice," said Solt, referring to the decision to have an abortion, "but there are times when it may be the only respectable and humane choice to make, and I feel very strongly that the government should not be intruding on that."

Said NASW Executive Director Clark: "While we have concerns about some limitations in the House and Senate versions, we are also well aware of the positive impact health reform can have on the future of our nation and its residents. NASW eagerly looks forward to the day when the nation finally provides access to high quality, affordable health care for all Americans."

The House bill is H.R. 3962 and the Senate bill is H.R. 3590.

A feature story in the January issue of the NASW News detailed efforts to improve access to quality health care among American Indians. The Senate joined the House in passing the Indian Health Care Improvement Reauthorization and Extension Act as part of its health care reform bill.

"I'm very appreciative that it passed and that the leadership recognizes the needs of the American Indian population," said Michael Bird, a social worker and member of the Santo Domingo Pueblo in New Mexico. "It's just sad it took this long for the government to act. A lot of ground and a lot of lives have been lost in the meantime."

Bird added that much still needs to be done to reduce the health care disparities in American Indian communities. "That will require an ongoing commitment from the U.S. government."

Clark's letter to congressional leadership affirmed: "Social workers in communities across the country are actively participating in the day to day effort to ensure that vulnerable populations have access to and receive quality health care. We advocate for the equitable delivery of services for all people regardless of financial status, race, ethnicity, disability, religion, age, gender, sexual orientation or geographic location."