NAMI Four County Advocacy contact: Wendy Jennings.
419.551.0654
ADAMhs Board Advocate contact: Bethany Shirkey
419.267.3355 x 5
Follow NAMI Advocacy on Twitter, @NAMIAdvocacy for updates.
419.551.0654
ADAMhs Board Advocate contact: Bethany Shirkey
419.267.3355 x 5
Follow NAMI Advocacy on Twitter, @NAMIAdvocacy for updates.
U. S. Senate and
House of Representatives
begins its 116th session.
The 116th Congress has taken office; however, NAMI's core legislative priorities are unchanged. As specific legislative proposals are developed in Washington, NAMI will share its position and encourage our membership to contact members of the US Senate and Congress. In the meantime, the following are NAMI's core legislative priorities for the next two years.
Promote Innovation...
NAMI believes innovation is vital to reduce disparities.
We’re fighting for:
NAMI believes improving mental health care is critical to achieve better outcomes.
We’re fighting for:
NAMI believes supporting recovery is fundamental to reduce injustices.
We’re fighting for:
Promote Innovation...
NAMI believes innovation is vital to reduce disparities.
We’re fighting for:
- Integration of mental health and primary care to provide holistic treatment
- Telehealth services that increase access
- Research that improves our knowledge base
- Financing models that sustain effective, patient-centered care
NAMI believes improving mental health care is critical to achieve better outcomes.
We’re fighting for:
- Coordinated Specialty Care for First Episode Psychosis so that young people can experience recovery
- Expanded coverage with patient protections and parity in Medicaid, Medicare and commercial health insurance
- Mental health care for veterans so our service members get the help they need and deserve
- Increased use of mental health outcome measures to hold providers accountable
NAMI believes supporting recovery is fundamental to reduce injustices.
We’re fighting for:
- Supported housing that helps people get back on their feet and engaged in treatment
- Peer support services that help people know that recovery is possible
- Crisis response models that provide help, not handcuffs
How the decision ruling the ACA unconstitutional would impact people with mental illness
In December 2018, a federal district court judge in Texas ruled that the Affordable Care Act (ACA) was unconstitutional. At this time, the ruling has no impact on anyone's health care because it is being appealed and the ruling cannot be enforced while legal appeals to higher courts are being made. However, if the ruling is not ultimately reversed, it would have a devastating impact on everyone -- and not just those with mental illness. The case is now under review by The Supreme Court of the United States, which heard arguments on the case in November 2020 with an expected ruling sometime before the court's current session concludes in late spring or early summer 2021.
Following are two summaries of the ruling and its potential impact. The first summary has been prepared by our national NAMI organization. The second was prepared by the Kaiser Family Foundation.
Following are two summaries of the ruling and its potential impact. The first summary has been prepared by our national NAMI organization. The second was prepared by the Kaiser Family Foundation.
From NAMI National:
What happened?
U.S. District Court Judge Reed O’Connor in Fort Worth, TX issued a ruling in the case Texas v. United States that the entire Affordable Care Act (ACA) is unconstitutional.
What does this mean for people’s coverage?
No one will lose their coverage or have protections stripped away because of this ruling at this time.
The ruling will be appealed and could be overturned. In the meantime, the White House issued a statement that read, “We expect this ruling will be appealed to the Supreme Court. Pending the appeal process, the law remains in place."
What could this ruling mean?
The invalidation of the ACA, if upheld on appeal, would touch nearly every corner of the health care system and affect virtually every American. If upheld, this would be devastating for people with mental illness:
What happened?
U.S. District Court Judge Reed O’Connor in Fort Worth, TX issued a ruling in the case Texas v. United States that the entire Affordable Care Act (ACA) is unconstitutional.
What does this mean for people’s coverage?
No one will lose their coverage or have protections stripped away because of this ruling at this time.
The ruling will be appealed and could be overturned. In the meantime, the White House issued a statement that read, “We expect this ruling will be appealed to the Supreme Court. Pending the appeal process, the law remains in place."
What could this ruling mean?
The invalidation of the ACA, if upheld on appeal, would touch nearly every corner of the health care system and affect virtually every American. If upheld, this would be devastating for people with mental illness:
- Millions of individuals and families covered through the ACA's Medicaid expansion, including people with mental illness, would lose their coverage.
- Millions of individuals who purchase individual or small group health insurance plans would lose important protections—and could even lose their coverage. These plans would no longer be required to:
- Cover preexisting conditions, like mental illness;
- Guarantee coverage to everyone who applies;
- Charge people with mental illness the same price as others for the same plan;
- Provide parity coverage for mental health and substance use conditions;
- Cover conditions without lifetime and annual limits; and
- Cover mental health medications the same way they cover other medications.
- Medicare beneficiaries would lose free coverage of important preventive services and could see the Part D prescription drug "donut hole" reopen, imposing higher drug costs.
- Americans who have health insurance through their employer would
- Lose their right to preventive services;
- Lose coverage of children to age 26; and
- See lifetime and annual dollar limits of coverage reappear.
From Kaiser Family Foundation:
The Affordable Care Act’s changes to the nation’s health care system are so widespread that nearly all Americans would be affected in some way if a federal judge’s decision ruling the entire law unconstitutional is upheld, according to a new analysis by the Kaiser Family Foundation.
While the changes to the individual insurance market – including protections for people with pre-existing conditions, creation of insurance marketplaces, and premium subsidies for low and modest in-come people – have been the focus of political and policy debate and media coverage, the impact of the eight-year-old law reaches far beyond that relatively small slice of the health care system.
The law also...
All of the changes could be overturned if the courts uphold the ruling by U.S. District Judge Reed O’Connor this month that the ACA is unconstitutional. The analysis looks at key provisions of the law and how many people are affected by them, as well as relevant Kaiser Family Foundation (FFF) public opinion polling. Many people would lose benefits if the law were overturned, but others would gain financially. Among the highlights:
The Affordable Care Act’s changes to the nation’s health care system are so widespread that nearly all Americans would be affected in some way if a federal judge’s decision ruling the entire law unconstitutional is upheld, according to a new analysis by the Kaiser Family Foundation.
While the changes to the individual insurance market – including protections for people with pre-existing conditions, creation of insurance marketplaces, and premium subsidies for low and modest in-come people – have been the focus of political and policy debate and media coverage, the impact of the eight-year-old law reaches far beyond that relatively small slice of the health care system.
The law also...
- Expanded Medicaid eligibility,
- Imposed new requirements for employer-provided benefits,
- Expanded preventive services,
- Gradually closes the “doughnut hole” gap in Medicare drug coverage,
- Reduced Medicare payments to health providers and insurers,
- Introduced new national initiatives to promote public health and raise quality of care, and
- Imposed a variety of tax increases to fund expanded health coverage.
All of the changes could be overturned if the courts uphold the ruling by U.S. District Judge Reed O’Connor this month that the ACA is unconstitutional. The analysis looks at key provisions of the law and how many people are affected by them, as well as relevant Kaiser Family Foundation (FFF) public opinion polling. Many people would lose benefits if the law were overturned, but others would gain financially. Among the highlights:
- Nearly 13 million Medicaid enrollees in 32 states and D.C. became newly eligible for the program through Medicaid expansion. Three-fourths (77%) of the public have a favorable view of the provision giving states the option to expand Medicaid.
- Adult children are able to remain on their parents’ insurance plans up to age 26. About 2.3 million young adults gained coverage due to this provision. Eight in ten (82%) Americans view this provision favorably.
- New health insurance marketplaces make available to individuals and families insurance plans with a defined set of minimum benefits (e.g. hospitalization, maternity care, mental health, prescription drugs), as well as federal subsidies and cost-sharing reductions based on income. As of June 2018, 10.3 million individuals had coverage through the marketplaces, including 8.9 million who received premium tax credits and 5.4 million who got cost-sharing reductions. Most of the public has a favorable opinion of the law’s creation of health insurance exchanges (82%), and of providing financial help to low- and moderate-income Americans who buy their own insurance (81%).
- Insurers can no longer deny coverage for pre-existing conditions, charge higher premiums based on health status or gender, revoke coverage when someone gets sick or impose annual or lifetime limits. More than 52 million people have a pre-existing condition that could have kept them from getting coverage in the pre-ACA individual market. The ACA also capped out-of-pocket spending (at $7,900 for an individual and $15,800 for family coverage in 2019). Most Americans say it is “very important” to them that these ACA provisions remain law and seven in ten say they would want their states to establish protections for people with pre-existing conditions if the ACA’s protections are ruled unconstitutional.
- Insurers must cover certain preventive services at no out-of-pocket costs to consumers. Eight in 10 (79%) favor eliminating out-of-pocket costs for many preventive services.
- The law phases out the Medicare “doughnut hole” by gradually reducing the share of total drug costs paid by Part D enrollees in the coverage gap. Forty-three million people were enrolled in Medicare Part D in 2018. In 2016, more than 5 million Part D enrollees without low-income subsidies reached the coverage gap. Most Americans (81%) have a favorable view of this provision.in ten say they would want their states to establish protections for people with pre-existing conditions if the ACA’s protections are ruled unconstitutional.
Mental Health Parity at Risk
Deregulating the Individual Market and the Impact on Mental Health Coverage
NOTE: The following report was issued by the national office of NAMI on June 14, 2018. It includes a link to a report that NAMI worked with Georgetown University to complete that provides a comprehensive view of how persons with mental illness and substance use disorders were discriminated against in terms of health insurance coverage prior to passage of the Affordable Care Act (sometimes called Obamacare) and the risk of changing the Affordable Care Act to reduce levels and costs of mandated coverage in order to provide options of lower cost health insurance.
There is a national debate underway about the regulation of health insurers and insurance benefit standards. To reduce regulatory burdens, the Executive Branch enacted changes that weaken essential health benefit requirements, which require coverage of mental health and substance use services. The Executive Branch has also proposed regulations that will expand the availability of health plans that can discriminate against people with mental health and substance use disorders. This political position puts vulnerable Americans—especially those with mental health and substance use disorders—at risk of losing access to much-needed health care.
(Download the Report)
NAMI recently collaborated with researchers at Georgetown University on a report that provides, for the first time, comprehensive data showing barriers and gaps in mental health and substance use coverage in the individual insurance market prior to the Affordable Care Act (ACA). This report highlights just how bad things were and emphasizes the dangers of turning back the clock.
“Mental Health Parity at Risk” highlights the risk we run if we return to past practices—practices that give insurers the ability to discriminate against people with mental health and substance use conditions. The findings in this report include that, prior to the ACA:
The ACA changed coverage of mental health and substance use treatment in the individual market. Insurers had to expand coverage and remove dollar value and visit limits. If these protections are weakened, insurers will likely return to their old practices of excluding or limiting mental health and substance use treatment.
This report highlights what’s wrong with returning to an individual insurance market that lacks federal mental health and substance use benefit requirements. The bottom line: We cannot go back to a system that discriminates against people with mental health and substance use conditions.
(Download the Report)
NAMI recently collaborated with researchers at Georgetown University on a report that provides, for the first time, comprehensive data showing barriers and gaps in mental health and substance use coverage in the individual insurance market prior to the Affordable Care Act (ACA). This report highlights just how bad things were and emphasizes the dangers of turning back the clock.
“Mental Health Parity at Risk” highlights the risk we run if we return to past practices—practices that give insurers the ability to discriminate against people with mental health and substance use conditions. The findings in this report include that, prior to the ACA:
- 28 states did not require individual market health insurance plans to cover or even offer mental health services.
- Health plans looked to avoid enrolling individuals with mental health or substance use conditions by screening applicants.
- Even when individual market insurance was accessible, insurers effectively fined people with a history of mental health or substance use conditions. They did so by applying a 20–50% increase in premiums while also excluding needed mental health and substance use services.
The ACA changed coverage of mental health and substance use treatment in the individual market. Insurers had to expand coverage and remove dollar value and visit limits. If these protections are weakened, insurers will likely return to their old practices of excluding or limiting mental health and substance use treatment.
This report highlights what’s wrong with returning to an individual insurance market that lacks federal mental health and substance use benefit requirements. The bottom line: We cannot go back to a system that discriminates against people with mental health and substance use conditions.