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Why the Affordable Care Act is needed

July 9, 2012
By Barry Brogan , North Country Behavioral Healthcare Network

North Country Behavioral Healthcare Network is comprised of 19 nonprofit agencies providing mental health and substance use disorder services in New York's seven northernmost counties. We at the network join the many voices, notably physicians and hospital administrators, who see the Affordable Care Act as good for the North Country. Here's why.

The National Rural Health Association recently summarized 21 provisions of the ACA that have a significant and positive impact on the delivery of healthcare in rural America. They include work-force recruitment and retention, grant funding and more equitable reimbursement. It is also good news for a vast geographic area with high rates of suicide, alcoholism and drug abuse by requiring insurers to have adequate coverage for mental illness and substance use disorder treatment.

Here are North Country Behavioral Health Care Network's top 10 reasons why the Supreme Court got it right when they upheld the ACA and why the "repeal and replace" folks need to refocus to help fully implement this important new law.

1. ACA provides improved coverage of physical health care, which is extremely important to people with mental and/or substance use disorders because (a) they are at higher risk than the general population of having co-occurring chronic physical disorders and (b) they have dramatically lower life expectancy than people without mental illness, in significant part because of poor health and poor access to good health care.

2. Insurance reforms, such as coverage of pre-existing conditions and maintenance of coverage during long illnesses. It allows children up to age 26 to stay on parents Family H.I. plans.

3. Access to more affordable health coverage for individuals and small businesses through state health insurance exchanges.

4. Expanded eligibility for Medicaid. We expect New York state will be a leader in recognizing that individuals with insurance ultimately cost less than having large numbers of uninsured who utilize emergency and charity care.

5. The ACA expands federal "parity" provisions regarding coverage of mental and physical health conditions in employer-based health benefit plans and Medicare.

6. The ACA provides enhanced Medicare coverage of medication, reducing out-of-pocket spending on pharmaceuticals by shrinking the "donut hole."

7. The ACA emphasizes the importance of integrating and coordinating the delivery of physical and behavioral health services and provides incentives to providers to integrate care.

8. The ACA provides rate increases for medical practices recognized as "medical homes" and providers participating in one-stop "health homes" that provide coordinated care and preventive services, among other features.

9. The ACA also emphasizes preventive interventions. For example, it provides Medicare payments for preventive health care and health promotion for the first time. This provision is particularly important for people at high risk of obesity and the diseases it drives, such as hypertension, diabetes and heart disease. These are conditions that are particularly common in the North Country.

10. Finally, the ACA emphasizes services in the home and community instead of in institutions. There are new demonstration grants as well as new opportunities for Medicaid waivers for state efforts to reduce the use of nursing homes and other institutions and instead provide care for people with disabilities in their homes and communities.

We accept that the individual mandate will be enforced through a (negative) economic incentive which the Supreme Court has deemed a tax. The United States has recognized since the 1930s and reaffirmed in 1963 the importance of building a basic social safety net. The two massive government programs that resulted, Social Security and Medicare, are among the two most popular functions of the federal government, and both are supported through mandatory taxes. It is appropriate, therefore, that the expansion of health care coverage to millions more Americans also be funded through a tax on those who choose not to participate.

The comprehensive nature and complexity of the ACA means that we will be sorting out and applying the law's specific provisions long into the future. What we do know now is that it is consistent with the dramatic health care reform already under way in New York state to significantly reduce costs, enhance the quality of care and improve patient outcomes, both in the short and long term. Further, we know that insurance companies will need to be monitored and challenged if they choose to use the requirements of the ACA as an excuse to continue annual double-digit percentage increases on private health insurance plans.

"Repeal and replace" is not an option. Implement and improve is the new call to action.

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Barry Brogan lives in Saranac Lake and is the executive director of the North Country Behavioral Healthcare Network, with offices in Saranac Lake and whose members serve the residents of Clinton, Franklin, Essex, Hamilton, St. Lawrence, Lewis and Jefferson counties.

 
 

 

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