TCIV: Policy gains are at risk in 2017

The most important goal for behavioral health stakeholders under the Donald Trump administration will be to maintain the legislative ground they’ve just recently gained in Washington. Many favorable new initiatives and unprecedented federal funding to support them are at risk in the next four to eight years, said Carol McDaid, principal of Capitol Decisions, speaking at the Treatment Center Investment & Valuation Retreat Monday in Scottsdale,  Ariz.

“There’s been Incredible movement on legislation in the last 12 months,” she said.

For example, in July of this year, the Comprehensive Addiction and Recovery Act passed with overwhelming bipartisan support to further a package of programs for treatment and recovery.

In the coming days, the 21^st Century Cures bill with $1 billion in funding to address the opioid crisis is also expected to make its way to president’s desk with bipartisan support, McDaid said.

Within in its provisions, the Cures bill aims to force health insurance companies to provide better proof of their compliance with parity laws—exactly the kind of enforcement that many believe has been lacking. It will also drive increased integration for addiction and mental health treatment and create a new assistant secretary position to head SAMHSA.

“SAMHSA has always been the red-headed step child,” McDaid said. “The intent is to lift up the visibility of SAMHSA and make it more important in its impact for behavioral health conditions and how we treat them.”

Although the funding in the Cures bill is authorized—not appropriated—she believes the first $500 million could appear in a continuing resolution, due to make its way through Congress in the next few days as well. From that point, stakeholders will need to step up advocacy and fight for the remaining support.

“It will be an incredible boon for our field if we figure out our strategy and tactics in this environment to actually do some good with this, so let’s roll up our sleeves,” she said.

The outlook

McDaid said the legislative outlook for 2017 and beyond is difficult to predict, but the Trump administration will make good on its vow to eliminate most or all of the Affordable Care Act (ACA). Although there are number of political moves that could dismantle ACA quickly, it could take three to five years for Congress to launch the replacement strategy, she said.

“Trump is not necessarily on the [Speaker of the House Paul Ryan] train in terms of his healthcare reforms, but we have to see how this shakes out,” she said.

Most at risk in the repeal effort is Medicaid expansion, coverage of behavioral health as an essential health benefit and parity. Regardless of the path forward, behavioral health leaders must leverage relationships at every level of government to better communicate the impact proposed policy moves would have, McDaid said.

“The days of sitting around and complaining are over, and I hope that you will get engaged in a meaningful way,” McDaid said.