Monday, July 24, 2017

Update on the US Senate Effort to Repeal and Replace Obamacare

CHADD Public Policy Committee
The Senate has been preparing to vote on the Better Care Reconciliation Act (BCRA), which would repeal significant portions of the Affordable Care Act (ACA or “Obamacare”) and replace them with alternative policies. However, when it became apparent BCRA might not have sufficient support among Republican senators, Senate Republican leaders began to consider a repeal of many ACA provisions without specific replacement policies (the Obamacare Repeal Reconciliation Act of 2017 or “Clean Repeal”).
Senate leaders plan to bring the legislation up for a vote any day, although it is not clear which bill will be considered. It is possible that amendments may be offered for BCRA, or they might fall back on Clean Repeal, legislation that the Republican Congress passed in late 2015, but was vetoed by then-President Obama.
Because CHADD does not know exactly which bill the Senate is planning to vote on, we don’t know exactly how to advise our members. However, we can report what BCRA looks like now and how it could affect individuals with ADHD. We can also report what the Clean Repeal bill provides and how it could affect individuals with ADHD.
The Better Care Reconciliation Act (BCRA):
The Congressional Budget Office (CBO) has released official estimates about the version of BRCA posted on the website of the Senate Committee on the Budget on July 20, 2017. The CBO estimate shows that BCRA would reduce the deficit by $420 billion over ten years. CBO further estimates that BCRA will result in 15 million fewer people having health care coverage in 2018. By 2026, this number would increase to an additional 22 million Americans lacking insurance, compared to current law.
BCRA makes a number of changes to Medicaid and private health insurance that would, on the whole, make it harder for many families to access ADHD treatment. Most notably, BCRA substantially cuts federal funding for Medicaid, which is a primary payer for millions of children with ADHD. Over time these cuts would lead to reduced benefits, decreased access to health care providers, and would make it harder for families to access ADHD treatment. It would also roll back the Medicaid expansion, which allows many adults to access ADHD treatment. In the individual marketplaces (what is often called "Obamacare"), most families would receive less assistance paying for their insurance premiums, and the insurance they pay for would offer less coverage. This too could substantially limit access to ADHD treatment for millions of families across America.
BCRA could benefit some families. For example, it extends premium subsidies to individuals below the poverty line but who do not qualify for Medicaid and it allows families to obtain premium subsidies if a parent’s employer provides coverage only for the parent. Proponents of the legislation also tout its potential to reduce insurance premiums; however, these effects are still somewhat speculative. Decreases in premiums may be caused in part by insurance plans declining to offer certain benefits, including coverage for expensive prescription drugs, behavioral health services, and mental health care. Although Obamacare required plans to provide coverage for these “essential health benefits,” BCRA would make it easier for states to opt out of providing these mandated benefits. Recent amendments offer additional funding that may reduce premiums for some, but the effects on coverage are uncertain.
Some of the other changes could also impact individuals with ADHD. BCRA mandates a six month "lock-out" period for re-enrolling in health insurance after a period of not being covered. However, the Senate Parliamentarian has ruled this provision violates to the so-called Byrd Rule, which means it could not be enacted without Democratic support (which is unlikely). Individuals with ADHD who obtain health insurance in the individual market would need to pay very close attention to deadlines to avoid coverage lapse. Similarly, BCRA limits the period for which Medicaid coverage can be retroactively applied when a Medicaid eligible individual seeks treatment before enrolling in Medicaid.
BCRA is similar in many respects to the American Health Care Act (AHCA), passed by the House of Representatives in June, and different in other critical ways. Read CHADD's analysis of the AHCA. Read a side-by-side comparison between BCRA, the AHCA, and existing law - especially how it affects mental health and pre-existing conditions.
Obamacare Repeal Reconciliation Act of 2017 (Referred to here as “Clean Repeal”):
CBO has also released official estimates about the Clean Repeal legislation posted on the website of the Senate Committee on the Budget on July 19, 2017. The CBO estimate shows that Clean Repeal would reduce the deficit by $473 billion over ten years. The CBO also estimates that Clean Repeal will result in 17 million fewer people having health care coverage in 2018. By 2026 this number would increase to about 32 million additional Americans without coverage, compared to current law. CBO further estimates that by 2020 about half of the U.S. population would live in areas with no insurer that offered insurance for individual policies purchased through the marketplace or directly from insurers; and that would increase to about three-quarters of the population by 2026. In addition, the CBO estimates the cost of average premiums for individual policies purchased in marketplaces or directly from insurers would increase about 25 percent more than projected under current law by 2018 and would double by 2026.
Clean Repeal would repeal many provisions of the ACA or Obamacare but would retain many of its insurance rules. After Clean Repeal, all plans sold on the individual markets, as well as Medicaid plans, would still be required to cover essential health benefits (EHBs), which include treatments for mental health, behavioral health and substance use disorders. Health insurers would still not be permitted to deny health insurance coverage or charge higher premiums based on having a “preexisting condition,” like ADHD diagnosed before an individual buys health insurance. These protections would continue to help individuals with ADHD. However, the legislation would immediately repeal the penalties for individuals who do not maintain qualifying health insurance coverage (including coverage under government programs like Medicaid) and for employers with 50 or more full-time employees who do not provide qualifying health insurance to their employees. CBO estimates that elimination of these penalties would cause premium costs in the individual marketplace to rise for individuals, such as those with preexisting conditions who needed to retain coverage, and could cause employers to stop offering group plans for employees. These results could make it much more difficult for families and individuals with ADHD to obtain insurance coverage. Starting in 2020, the legislation will repeal Medicaid expansion which has allowed many adults in some states to access ADHD treatment; and premium subsidies that help individuals purchase insurance in a marketplace will also be repealed. This could significantly limit access to ADHD treatment for millions of families nationwide. 
*             *             *
CHADD is dedicated to protecting access to ADHD treatment for families across America. While our members may have different views on the repeal and replacement of Obamacare, CHADD has serious concerns that these bills, if either were enacted, would create significant hardships for many children and adults with ADHD. For these reasons, CHADD has been on the record with Congress and joined organizational sign-on letters in opposition to the legislation.

While CHADD encourages its members to do their own research on the current proposals, we are disseminating the action alert below for those who are interested in making their voices heard in the legislative process. The action alert was prepared by the Mental Health Liaison Group (MHLG), a coalition of which CHADD is a member. The Senate is expected to vote on one of these measures this week, and as early as Tuesday.

Action Alert on Health Reform

What are key changes in the BCRA?
  • Allows insurance companies to offer bare-bones plans with no mental health coverage, as long as they offer a single plan that covers mental health and substance use services. This is a giant step away from parity, or fair coverage of mental health conditions.
  • Provides $45 billion in short-term grant funding to states for the opioid crisis. This is a drop in the bucket compared to the Medicaid funding that will be lost under the bill.
  • Provides a complicated “stability” fund to states. These funds don’t make up for cuts to Medicaid and loss of mental health coverage—and there’s no guarantee they’ll be spread evenly among states or will help people who lose or can’t afford coverage.
What’s unchanged in the BCRA?
·        Leaves fewer Americans with coverage for mental health care;
·        Takes away insurance protections for people with mental health conditions;
·        Effectively ends Medicaid expansion;
·        Cuts and caps Medicaid funding, which will make it harder for people to get medications and mental health services; and
·        Allows states to adopt work requirements for people covered by Medicaid (including those with mental illness) who are not on federal disability (SSI/SSDI);

Want to know more? Read Kaiser’s summary of the revised BCRA. 

What’s next?
Next week, the bill could come up for a vote and pass—unless 3 Republican Senators vote NO.

What to do this weekend (and week of 7/17):
Regardless of whether your Senators are opposed to or supportive of the BCRA, your alerts and social media posts will help emphasize the impact of the bill on people with mental illness.

Note: If you live in a state with Senators who are considered moveable, please put extra effort into reaching out (Alaska, Nevada, W. Virginia, Ohio, Louisiana, Kansas and Arizona). 
  1. Send an alert to your members
  2. Post on social media using #Act4MentalHealth
  3. Tweet directly at your Senators or post on their Facebook page

Alert and social media images




Advocacy alert

Subject line: This bill hurts.
Text: The Senate delayed a vote on the Better Care Reconciliation Act (BCRA), but they are back at it—and they are moving fast. A vote could happen any day.
They have revised the bill and it isn’t better, it’s worse.
New language would let insurance companies offer bare-bones plans with no mental health coverage. This is a giant step away from parity, or fair coverage of mental health conditions.
There will still be less financial assistance and fewer protections for people who buy individual health insurance plans through the marketplace.
The bill still cuts and caps the Medicaid program, which will make it harder for people to get psychiatric medications, case management, mental health services—and even hospital care.
Millions will still lose their Medicaid coverage, including 1 in 10 veterans who rely on Medicaid for health and mental health services.
The bottom line: this bill hurts people with mental illness. But, the fight is not over. Together, we are powerful. Together we can #Act4MentalHealth. Tell your Senators to vote NO on the BCRA.

Facebook post
The Senate has revised the Better Care Reconciliation Act (BCRA) and it isn’t better, it’s worse. The bottom line: this bill hurts people with mental illness. But, the fight is not over. Together, we are powerful. Together we can #Act4MentalHealth. Tell your Senators to vote NO on the BCRA. http://ow.ly/wMIB30dEgF6 

Tweets
Oppose any bill that leaves fewer people with mental health care. Together, we must #Act4MentalHealth http://ow.ly/wMIB30dEgF6

We know that the toughest fights are worth it. Tell your Senators no on #BCRA! http://ow.ly/wMIB30dEgF6 #Act4MentalHealth 

The Senate health reform bill hurts people with mental illness. Tell your Senators: Vote NO. http://ow.ly/wMIB30dEgF6 #Act4MentalHealth


Friday, April 7, 2017

CHADD Is Working with The Mighty!

We're thrilled to announce a new partnership that will bring CHADD's resources in front of The Mighty's wide-reaching readership. We will now have a home on The Mighty and appear on many stories on the site.

The Mighty is a story-based health community focused on improving the lives of people facing disease, disorder, mental illness and disability. More than half of Americans are facing serious health conditions or medical issues. They want more than information. They want to be inspired. The Mighty publishes real stories about real people facing real challenges.

Here’s an example of the kind of ADD/ADHD stories on The Mighty: A Letter to the Teacher of My Son With ADHD, From a Mom With ADHD.

We're dedicated to helping people with ADD and ADHD in their lives. With this partnership, we'll be able to help even more people.

We encourage you to submit a story to The Mighty and make your voice heard.


Wednesday, October 26, 2016

You Asked, CHADD Delivers: Online Teacher Training Now Available

by Michael MacKay, JD, MS, CPA


While you can find students with ADHD in every classroom across the country, teachers have limited resources to help them understand, teach, and manage students with ADHD. They receive little pre-service or in-service training in this area. In response to this knowledge gap and pressing need, CHADD has updated its teacher training program and made it available on a state-of-the-art online education platform.

Teacher to Teacher: Supporting Students with ADHD is now available on Pepper, the country’s leading online professional development platform for educators. (Read the press release.) For the first time, educators will have unlimited, on-demand access to the Teacher to Teacher course through self-paced online learning.

Teacher to Teacher helps educators identify common ADHD-related learning problems and learn about proven classroom techniques, interventions, and the latest research to enhance school success for students with ADHD. Designed by teachers for teachers, the program assumes that teachers are overworked and in need of practical classroom tools. Parents who need assistance on how to effectively advocate for their children at school can take the training as well.

CHADD’s next goal is to get the word out to make sure that all schools and teachers across the country are aware of this educational resource.

Last summer, the Office of Civil Rights at the US Department of Education issued a letter clarifying schools’ obligations to students with ADHD. This was seen as necessary because of the numerous complaints the department was receiving about what was actually occurring in the public schools. We all know that what was implemented was a far cry from what the legislators intended, and this letter shows that our voices were heard. The letter:
•    Explains that schools must evaluate a student when a student needs or is believed to need special education or related services.
•    Discusses the obligation to provide services based on students’ specific needs and not based on generalizations about disabilities, or ADHD, in particular.
•    Clarifies that students who experience behavioral challenges, or present as unfocused or distractible, could have ADHD and may need an evaluation to determine their educational needs.
•    Reminds schools that they must provide parents and guardians with due process and allow them to appeal decisions regarding the identification, evaluation, or educational placement of students with disabilities, including students with ADHD.

This is a wonderful improvement for our ADHD community, and we are pleased that CHADD’s Public Policy Committee assisted in its development. It remains to be seen how it will affect what actually occurs at our schools with our children, however. CHADD, of course, will continue working with the US Department of Education in monitoring compliance.

While the new guidance clarifies the obligations, it is not at all clear how individual schools and teachers will find the resources (primarily time) to comply and accomplish the aims of the legislation (and its clarification). This is hardly a new issue for schools (or other publicly funded services where more is demanded yet resources are constrained). The relevant question then becomes how can we help, what can we do to assist in accomplishing these, oh so necessary and appropriate goals. The scenario of 30 students with 10 percent having special needs is all too common and typically presents the teacher with a decision as to how to allocate time, knowing that not all 30 students will be comparably served, as required by the teacher’s own sense of equity as well as the law.

With Teacher to Teacher: Supporting Students with ADHD available on-demand to every teacher in the country, all educators will now have access to the best practices and strategies.

If you want to learn more, visit the Teacher to Teacher page on the CHADD website or email Trish_White@chadd.org. Share this blog or the T2T flyer with your child’s teacher and school. Help us get the word out!


Michael MacKay, JD, MS, CPA, is the president of CHADD.

Friday, September 16, 2016

ADHD Is "Nothing To Be Ashamed Of," Says Simone Biles



guest post by Karen Sampson Hoffman, MA

When computer hackers revealed that Olympic gold medalist Simone Biles had tested positive for Ritalin, she was upfront and unabashed about her diagnosis.

“I have ADHD, and I have taken medicine for it since I was a kid,” she wrote in a Facebook post to her fans. “Having ADHD, and taking medicine for it, is nothing to be ashamed of, nothing that I'm afraid to let people know.”

The president of USA Gymnastics supported her with a statement that Biles received therapeutic use exemptions for her prescription medications from the International Gymnastics Federation, the US Olympic Committee, and the US and World Anti-Doping Associations—and that there was no violation.

Biles won four gold medals and one bronze medal at the Rio 2016 Olympic Games this summer.  She had previously chosen not to disclose her ADHD but did so earlier this week because her medical information, along with that of other top Team USA Olympians, was published online without her consent.

Her situation is a familiar concern for many people who have decided to keep their ADHD diagnosis to themselves, says Matt Cohen, JD, a member of CHADD’s public policy committee. 

“People have the right to make their own decision about the privacy they maintain and to what degree,” he says.

It can become necessary to discuss your diagnosis when someone else shares your information without your consent, just as Biles experienced. Cohen says that it’s not very often, however, that another person will reveal someone’s ADHD diagnosis, either at work or among friends.

“I deal with many people with ADHD who tell me their stories,” he says. “The circumstances where there are unwanted disclosures are relatively rare. But the potential consequences can be so great that it can be invasive and damaging to the person involved.”

If a colleague discloses your diagnosis, addressing it directly is often helpful, says Cohen. This may be with your supervisor or human resources manager. If possible, talking with the colleague about the disclosure can bring a positive resolution, since most people don’t disclose with intent to cause harm. Even an accidental disclosure can have negative results, however.

Accidental disclosure can put people in a difficult situation, Cohen says. “Do they ignore it? Do they talk to their employer to resolve it? Do they take it to the person and try to resolve it? If it leads to your being stigmatized or discriminated against, that leads to a hostile environment,” he says. “The employer needs to take action in this case, or the employee may have legal grounds for action. There are very good protections for employees on paper. But in daily life, once the information is out there, people may find ways to harass someone that you can’t prove are discriminatory.”

In Cohen’s experience, most people voluntarily disclose their diagnosis to the human resources department or their supervisor and have good experiences, particularly when it comes to receiving workplace accommodations to enable them to be successful employees. However, he adds, it is risky for some employees to make that disclosure, and so they need to carefully consider the possible consequences.

“I have lots of respect for the desire for privacy and not to disclose,” he says. “But the flip side is, I have a number of clients who are reluctant to disclose and then don’t disclose until things are going badly in their lives.”

When the disclosure is made among family and friends, Cohen says it can be just as problematic because of lingering stigma related to ADHD and mental health. Taking a proactive approach often works best.

“I think it’s important for people to advocate for themselves,” he says. “It’s often useful to try to provide education about the disorder and how it affects you. I think there’s still an enormous amount of misleading information about ADHD and prejudice about it. The more that can be done to undo those misconceptions, the better.”

Biles’ response to the computer hackers’ disclosure was a good way to handle the situation, Cohen says. Her Olympic success can help to dispel some of the lingering myths about ADHD and how it might impede someone in work or school. 

“Simone Biles is a positive example of someone who can be affected by the disorder in her life and still be successful,” says Cohen. “People have the right to make their own decision about the privacy they maintain and to what degree. She is an example that you have a right to privacy, but ADHD is not something to be ashamed of. I hope she can be an inspiration for other people who have ADHD.”


Are you looking for strategies for handling your ADHD symptoms at work, regardless of your choice to disclose a diagnosis? Read Workplace Issues or watch our Ask the Expert interview with Melanie Whetzel of the Job Accommodation Network, ADHD in the Workplace: Finding Success.

Karen Sampson Hoffman, MA, is a senior health information specialist at CHADD's National Resource Center on ADHD and editor of its weekly e-newsletter.

Tuesday, July 26, 2016

Education Department Issues Guidelines to Protect Students with ADHD



guest post by the CHADD Public Policy Committee


Today the Office of Civil Rights of the US Department of Education (OCR) issued guidance to every public school district in the country about the implementation of Section 504 for students with ADHD. CHADD provided significant input to OCR as OCR was developing this guidance. CHADD, through its public policy committee and its professional advisory board, had ongoing and active discussion with the OCR. We shared the concerns of our members about the implementation of Section 504 and the effects on their children. We provided scientific research and knowledge about ADHD as well as our recommendations for best practices for educating students with ADHD in school and ideas about how to improve the implementation of Section 504 to benefit students with ADHD.

A 2014 survey of CHADD’s membership reinforced our concerns that the Section 504 process in the schools was clearly not working. Parents reported major violations in every step—from referral, to evaluation, to development of a student’s Section 504 Plan, to its implementation and, unfortunately to the frequent suspension and expulsion that became the outcome. The lack of appropriate referral, evaluation, and eligibility practices was particularly problematic, as it suggested that there are likely many children with ADHD that may need Section 504 protection that were not being referred or found eligible for a 504 Plan. In addition, implementation of these plans was especially troubling, with two thirds of parents reporting the plan was not implemented in the classroom.

The statistics and anecdotal reports from parents were consistent with the concerns that parents and professionals involved with CHADD frequently report. The individual stories, albeit brief, were heart wrenching and provided a painful human dimension to the statistics. These students with ADHD were being denied a free and appropriate public education and an equal opportunity for participation in school. The safeguards of the Section 504 regulations were not providing adequate protection from the problems these children experienced.

CHADD urged stronger action from the US Department of Education to ensure that school staff would understand both their obligations under Section 504 and the symptoms of ADHD and best practices for responding to it. Equally important, we urged stronger guidance and enforcement from the OCR to ensure that appropriate safeguards and supports are put in place for all students with ADHD that are or should be eligible for the protections of Section 504.

In its press release announcing the issuance of this guidance, OCR reported that more than one out of every nine complaints alleging discrimination on the basis of disability in elementary and secondary schools that OCR received in the past five years involved students with ADHD. OCR stated the most common of these complaints concerned “academic and behavioral difficulties students with ADHD experience at school when they are not timely and properly evaluated for a disability, or when they do not receive necessary special education or related aids and services.” This verifies the seriousness of CHADD’s concerns about noncompliance with Section 504.
                                                                                                                                 
We applaud the Office of Civil Rights of the Department of Education for their efforts to make sure that the civil rights of students with ADHD are protected in our public schools. We appreciate the guidance on implementation of Section 504 that they have developed for all school districts nationwide.

CHADD will continue to provide feedback to the OCR about the effectiveness of the new guidance. CHADD will continue to provide science-based research findings that address the educational needs of students with ADHD, and CHADD will continue to be a leader in providing high quality teacher training, so that ADHD students and teachers too, will be partners in education.

Ingrid Alpern, JD, LLM
Matthew Cohen, JD
Jeffrey Katz, PhD
CHADD Public Policy Committee