Background
President Biden enacted the Consolidated Appropriations Act (CAA) of 2023. Several measures related to Medicaid and the Children’s Health Insurance Program (CHIP) are outlined in the mentioned document. This includes, among other things, making sustainable a government solution to offer one-year postpartum insurance in Medicaid and CHIP, linking the necessity of complete coverage during the COVID-19 healthcare emergency to it, and beginning its winding down after March 31, 2023 (Park et al., 2023). It also involves mandating that all states provide children with 12 months of continuous enrollment in both Medicaid and CHIP.
My personal connection to the mentioned policy is founded on the vision of making healthcare services in the country affordable for society. The Act contains crucial provisions for reducing the number of fees within the Medicaid and CHIP framework, which clearly align with my ideas in the field. The development of appropriate financial pillars of the healthcare system is a basis for such affordability, and fundamental laws and policies in this vein are to be explored and investigated.
Identify
President Biden approved the omnibus spending bill for the fiscal year 2023, and the National Association of Social Workers (NASW) seems to support the formulated policy. This $1.7 trillion budget plan serves as a year-end congressional vehicle for legislative initiatives and will fund the state through September 2023, the summation of the current fiscal year. A handful of the critical policies and initiatives that the NASW has pushed for, within the scope of the CAA, are listed below.
First, it is a two-year extension of telehealth. Second, it is preventing a portion of the Medicare reimbursement reduction for CY 2023. Third, it is the expansion of financial aid and loan forgiveness for psychological health professionals. Fourth, a total of $153 million was allocated to the Behavioral Health Workforce Education and Training (BHWET) initiative, representing a $30 million increase from the previous year. Fifth, it is the fact that $20 million, an increase of $10 million, will assist municipalities in establishing portable mental health crisis intervention teams. Sixth, a $10 million investment will be provided as grants to states to help them implement equity (National Association of Social Workers, 2023).
Nevertheless, the NASW states that extending the child tax credit was one of the goals left out. Then, a whole year was devoted to continuing to advocate for and promote the Improving Access to Mental Health Act and several other reforms to laws governing psychological health and drug use disorders. Numerous of them were covered in the bipartisan discourse draft on psychological health treatment from the Senate Finance Committee (National Association of Social Workers, 2023). Congress excluded this from the final omnibus package. The Improving Access to Mental Health Act was not included in the final measure, despite the NASW and its congressional supporters’ valiant efforts at every turn.
To find a way forward in the 118th Congress, the NASW is actively collaborating with both the Administration and its supporters on Capitol Hill. Only a handful of the essential measures for mental well-being proposed by various committees in both houses of Congress actually passed. Sens. Debbie Stabenow and John Barrasso, the primary proponents of the Improving Access to Mental Health Act, recently introduced the Mental Health Access Improvement Act, which broadens the scope of Medicare personnel to include marriage and family specialists and mental health professionals. These clauses were included in the omnibus. Despite NASW’s supporters’ best efforts, the S.870/H.R. 2035 measures were not included in the final omnibus package.
The Improving Access to Mental Health Act is expected to be passed by the 118th Congress. According to the NASW, it remains dedicated to capitalizing on the enormous momentum created by the 117th Congress. Hence, it would be reasonable to conclude that the NASW, in general, supports the approach applied in the CAA. However, the organization identifies several gaps that it claims need to be addressed in the near future.
Describe
The primary goals of the field of social work are to enhance well-being and support the fulfillment of everyone’s fundamental needs, with a focus on addressing the needs and empowerment of those who are vulnerable, marginalized, and experiencing distress. According to the National Association of Social Workers (2022), the simultaneous emphasis on a person’s welfare in a societal environment and the well-being of the general public is a historical and defining aspect of social work. Awareness of the environmental influences that produce, influence, and alleviate issues in life is essential within the scope given.
The NASW’s formulated ethical framework allows for considering its position regarding the CAA in connection with the organization’s Code of Ethics. The first ethical principle is that “social workers’ primary goal is to help people in need and to address social problems” (National Association of Social Workers, 2022, para 21). The issue of affordable medicine in the country is a pressing concern that needs to be addressed. The NASW advocates for the reduction of related fees, which justifies its interpretation of and attitude towards the Act.
The following ethical principle is dedicated to respecting the significance of every person. It is formulated as “social workers respect the inherent dignity and worth of the person” (National Association of Social Workers, 2022, para 27). The core idea of healthcare is to maintain the health of the population, regardless of individuals’ backgrounds, including their race, socioeconomic status, and affiliation with minority groups.
All lives are important, and it is crucial to provide affordable medical opportunities to save as many of them as possible. The latter ideas are closely related to the principle of challenging social injustice (National Association of Social Workers, 2022). Access to healthcare and its affordability should be provided to everyone on an equal basis. The mentioned pillars serve as a foundation of NASW’s position regarding the Act.
Elaborate
- In what ways does the CAA alleviate the financial burden for the nation within the scope of healthcare?
- What are the prerequisites to consider the Act as a tool for addressing social injustice in the US?
- To what extent do children benefit from the changes implied by the CAA? Why?
Apply
There is evidence that the Act undermines Medicaid’s continuous coverage requirement, a crucial aspect, as it alleviates the financial burden on society, as shown in the numbers below (Canady, 2023). According to Park et al. (2023), during the COVID-19 health crisis, states are now entitled to a 6.2 percent increase in their national Medicaid matching rates. During this time, the CHIP match rate also rose by 4.34 percent. States are prohibited from reducing availability or making it more difficult for eligible families to register as a precondition of the increase.
Additionally, they must continue to offer coverage; they are not permitted to forcibly disenroll any Medicaid beneficiaries who were previously enrolled or had just enlisted during the public health crisis. As a result, Medicaid enrollment has increased by 30%, and the incidence of children (as well as adults) without insurance has decreased, reversing prior concerning patterns in coverage that showed a decline in insured children (Canady, 2023). This perspective is a significant advancement, supported by the NASW.
The following point addresses the requirements for Medicaid and CHIP for children. Although states have always had the opportunity to extend Medicaid and CHIP services to children enrolled in their programs for up to a year of uninterrupted eligibility, currently, only 24 states have done so for all children enrolled in both programs (Loughran, 2023). Some states have limited the availability of continuing eligibility to certain children or those enrolled in specific state CHIP programs. There were no children who were continuously eligible for these programs in 17 states and the District of Columbia (Park et al., 2023). All states must fully adopt a year of constant coverage for all children under the age of 19, according to the Act.
Even though this clause would not need to be implemented until the necessity for continuous coverage is abolished, in the long term, it would significantly reduce the likelihood that children will experience coverage gaps throughout the year, which can help mitigate a portion of the insurance deficits among children that will undoubtedly occur when the complete coverage requirement ends (Canady, 2023). This will be even among children who remain enrolled but forfeit their coverage due to technical disenrollments. In fact, under the existing statute, states may choose to adopt this continual availability option earlier than perpetual eligibility is required in 2024.
References
Canady, V. A. (2023). Omnibus bill supports key MH policies, advances service access. Mental Health Weekly, 33(1), 4–5.
Loughran, M. (2023). Health provisions of the Consolidated Appropriations Act, 2023: Part 1 Medicare payments. Reed Smith.
National Association of Social Workers. (2022). NASW code of ethics.
National Association of Social Workers. (2023). End of year federal spending bill includes support for mental health and other NASW priorities.
Park, E., Dwyer, A., Brooks, T., Clark, M., & Alker, J. (2023). Consolidated Appropriations Act, 2023: Medicaid and CHIP provisions explained. Georgetown University Health Policy Institute.