NAMI’s Federal Policy Agenda in the Trump Administration Presentation to the NAMI California Conference June 1, 2018 Andrew Sperling asperling@nami.org

Is the Glass Half Empty or Half Full?

First, the bad news … Imprecise and faulty diagnostics Mortality from suicide in the US now exceeds breast and prostate cancer Early mortality – life expectancy adults with mental illness in the US just below Bangladesh Progress on new treatments is way too slow, contrast with HIV-AIDS Too many people with serious mental illness in jails and prisons, criminal justice as the default treatment system 1/3 of the SSI rolls, ¼ of the SSDI rolls, sub-poverty level benefits Unstable housing and high representation in the chronic homeless population Not nearly enough inpatient acute care beds – emergency room board

Now, the good news … Recovery is real and achievable We know what works – early intervention can prevent long-term disability assertive community treatment, supportive housing, supported employment, assisted outpatient treatment, peer support, medication, integration of primary and specialty medical care, family psycho-education Mental health has strong bipartisan support in Congress and across the nation – passage of the Helping Families in Mental Health Crisis in 2016

Trump Administration Mental Health Initiatives Appointment and Senate Confirmation of Elinor McCance-Katz, MD as HHS Assistant Secretary for Mental Health & Substance Abuse Convening of the Interdepartmental Serious Mental Illness Coordinating Committee (HHS, HUD, DoL, VA, SSA) – Initial report and recommendations issued on December 14, 2017, NAMI CEO Mary Giliberti is on the outside stakeholder panel July 27, 2017 public meeting on parity implementation and enforcement and additional parity guidance May 11, 2018 speech on drug pricing, White House Blueprint includes: Changes to Medicare Part D including greater flexibility on “6 protected classes” and limiting formularies to 1 drug per therapeutic class Speeding approval of generic drugs, and Moving drugs from Medicare Part B to Part D

Status of “Repeal & Replace” of the ACA American Health Care Act (HR 1628) passed the House on May 5, 217-213 Better Care Reconciliation Act rejected 49-51 on July 28 Tax penalty for the ACA individual mandate repealed as part of the December 2017 tax cut legislation Cost Sharing Reduction (CSR) subsidies suspended on October 12 Association Health Plan (AHP) rule issued on January 5 Short Term Limited Duration Insurance Plan rule issued on February 20 (comments deadline April 23)

ACA “Repeal & Replace” – Lessons Learned Never a good idea to do major health care legislation without working with the other party Republicans lack consensus on replacing the ACA While the division between Senators from expansion and non-expansion states contributed to the demise of “repeal & replace,” proposals to impose a Medicaid “per capita cap” did not Will “repeal & replace” return in 2019?

What Comes Next? No more votes on “repeal & replace” are expected before November mid-term elections Bipartisan small group and individual market stabilization legislation in the FY 2018 “Omnibus” Appropriations package? Restoration of CSR subsidies through 2022, Reallocation of funding for outreach and enrollment for 2018, Streamline the 1332 waiver process for states, while maintaining critical protections Initiate a federal reinsurance program for states Trump Administration proposals issued on March 7 Expand short-term duration policies Expand Health Savings Accounts (HSAs) Increase age-related premium band from 3:1 to 5:1

2-Year Bipartisan Budget Agreement FY 2018 Omnibus Appropriations approved by Congress on March 23 Increases defense and non-defense discretionary spending by nearly $300 billion for FY 2018 and FY 2019 above the previous Budget Control Act (BCA) caps and eliminates the threat of an across the board sequester cut

2-Year Bipartisan Budget Agreement Extension of Health Care Programs: Extends the Children’s Health Insurance Program (CHIP) for an additional four years through FY 2027 and extends funding for community health centers, which expired at the end of FY 2017, for two years. Permanent Extension of Medicare Special Needs Plans (SNPs), including Dual Eligible SNPs. Repeal of the Independent Payment Advisory Board (IPAB) Accelerate closing the Medicare Part D “Donut Hole” by one year – Concerns about destabilizing the program

Mental Illness Research at NIMH FY 2018 Omnibus bill includes a $109.8 million increase, up to $1.711 billion Up $269 million since FY 2014 BRAIN Initiative (Brain Research through Advancing Innovative Neurotechnologies) - $140 million increase for FY 2018, up to $400 million with $43 million allocated specifically for NIMH

Mental Health Services at SAMHSA FY 2018 Omnibus includes $722.6 million for the Mental Health Block Grant, $160 million increase $100 million increase for the Certified Community Behavioral Health Centers Demonstration for FY 2018 Most other programs at SAMHSA are level funded for FY 2018 including: PATH - $56 million Childrens Mental Health - $119 million Primary – Behavioral Health Integration - $49.8 million Mental Health First Aid - $15 million AOT Pilot - $15 million

Supportive Housing at HUD Section 811 Project-Based: $229.6 million, with $82.6 million for new Project-Based Rental Assistance (PRA) units Section 811 “Mainstream” vouchers: $505 million, with $402 million for new “incremental” vouchers Current Notice of Funding Availability (NOFA) for up to $100 million – deadline June 18 McKinney-Vento Homeless Assistance - $130 million increase for FY 2018, up to $2.513 billion

Mental Health Services and Research at VA VA Mental Health - $8.38 billion allocation for FY 2018, a $580M increase over FY 2017. This $315 million for Vet Centers, an increase of $15 million over FY 2017 Veteran Suicide Prevention Programs and Outreach - $186 million allocation for FY 2018, with $10 million in additional funds for the Clay Hunt Pilot programs (crisis services) and an additional $10 million the Veterans Crisis Line (boosting funding to $99 million)

Opioid Legislation - NAMI Priorities Behavioral Health Information Technology Act (S 1732 & HR 3331) Passed the Senate on May 7 Reported by the House Energy & Commerce Committee on May 9 Protecting Jessica Grubb’s Legacy Act (S 1850) & Overdose Prevention & Safety Act (HR 5795) Reforms 42 CFR Part 2 to allow for harmonization with HIPAA and integration of behavioral health treatment records Passed the House Energy & Commerce Committee on May 17 by a vote of 35-17

Other NAMI Legislative Priorities Control Unlawful Fugitive Felon Act (HR 2792) Passed by the House on September 28 Eliminates eligibility for SSI for anyone with an outstanding warrant or missed court appearance Strengthening Protections for Social Security Beneficiaries Act (HR 4547) Unanimously passed the House February 5 and the Senate March 23, Strengthens the Social Security Representative Payee program FDA Reauthorization Act (HR 2430, now P.L. 115-52) Renews the Prescription Drug User Fee Act, known as PDUFA VI

Take Action & Get NAMI Advocacy Alerts: https://www.nami.org/Get-Involved/Take-Action-on-Advocacy-Issues NAMI 2017 Convention June 27-30 in New Orleans https://www.nami.org/Get-Involved/2018-NAMI-National-Convention