1. NAMI’s Federal Policy Agenda in the Trump Administration
Presentation to the NAMI Keystone PA Conference
March 13, 2018
Andrew Sperling

2. Is the Glass Half Empty or Half Full?

3. 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

4. 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

5. 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
March 12, 2018 announcement on school safety inititaives includes:
Integration of mental health, primary care, and family services, as well as support for court-ordered treatment, and
Review of FERPA & HIPAA to assess clarifications to improve coordination between mental health, school officials, and law enforcement.

6. Status of “Repeal & Replace” of the ACA
American Health Care Act (HR 1628) passed the House on May 5,
Better Care Reconciliation Act rejected 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Tax penalty for the ACA individual mandate repealed as part of the December 2017 tax cut legislation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)

7. 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?

8. 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

9. ACA in Pennsylvania
All insurers remained in the exchange for 2018; rates increased an average of 30.6%, mostly due to CSR funding elimination (increases were projected to be 7.6% had CSRs been in place for 2018)
2018 exchange enrollment – 389,081 in private plans, down almost 9% from 2017 (due in part to shorter enrollment period in December 2017) – end of enrollment penalty coming in 2019
711,000 enrolled in Medicaid expansion in 2018

10. 2-Year Bipartisan Budget Agreement
Agreement reached February 7, FY 2018 “Omnibus” spending bill must be completed by March 23
Increases defense and non-defense discretionary spending by nearly $300 billion for the next two years above the current Budget Control Act (BCA) caps and eliminates the threat of an across the board sequester cut
Increases in Opioid and Mental Health Funding: Includes $6 billion in additional funding over the next two years to address the opioid epidemic and fund mental health services
Funding for the National Institutes of Health (NIH): Includes an additional $2 billion for NIH over the next two years, which could increase funding for the National Institute of Mental Health (NIMH)

11. 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

12. Mental Illness Research at NIMH
Current FY 2017 funding level - $1.601 billion, up $160 million since FY 2014
FY 2018 President - $1.244 billion
FY 2018 House bill - $1.625 billion
FY 2018 Senate bill - $1.724 billion
BRAIN Initiative - $260 million for FY 2017

13. Mental Health Services at SAMHSA
Mental Health Block Grant currently funded at $563 million, level funding now in both the House and Senate FY 2018 bills
Most other programs at SAMHSA are likely to be level funded going forward 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

14. Supportive Housing at HUD
Section 811 currently funded at $146 million – only enough funding to renew existing units
Draft FY 2018 House bill includes a $30 million increase for Section 811 “mainstream” housing vouchers, in addition to $10 million in FY 2017
McKinney-Vento Homeless Assistance currently funded at $2.383 billion, draft FY Senate bill includes a $70 million increase

15. Mental Health Services and Research at VA
House passed FY 2018 bill (HR 2998) funds overall VA health care at $69 billion, including:
$8.4 billion in mental health care services (nearly a $1.4 billion increase in two years),
$186 million in suicide prevention activities,
$316 million for TBI, and
$7.3 billion in homeless veterans treatment, services, housing, and job treatment.

16. Other NAMI Legislative Priorities
Behavioral Health Information Technology Act (S 1732 & HR 3331)
Protecting Jessica Grubb’s Legacy Act (S 1850) & Overdose Prevention & Safety Act (HR 3545)
Reforms 42 CFR Part 2 to allow for harmonization with HIPAA and integration of behavioral health treatment records
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

17. Other NAMI Legislative Priorities
Strengthening Protections for Social Security Beneficiaries Act (HR 4537)
Unanimously passed the House February 5,
Strengthens the Social Security Representative Payee program
FDA Reauthorization Act (HR 2430, now P.L )
Renews the Prescription Drug User Fee Act, known as PDUFA VI

18. Take Action & Get NAMI Advocacy Alerts:
NAMI 2017 Convention
June in New Orleans
Joint National Council-NAMI-MHA Hill Day
April 25 in Washington