The U.S. Supreme Court ruled June 28 that the Affordable Care Act is constitutional, save for a provision regarding Medicaid expansion. The American Counseling Association applauds the ruling because it will allow implementation of the legislation — the nation’s first attempt to establish a functioning health care system providing essentially all Americans with health insurance — to move forward. For more than a decade, ACA has officially supported efforts to establish universal access to health insurance coverage. The Affordable Care Act is a common-sense approach to bridging the gaps between the nation’s public and private health insurance programs.

The ruling is also a win for the counseling profession. The Affordable Care Act will extend health insurance coverage, including coverage for mental health and substance use disorder services (including behavioral health treatment), to more than 30 million Americans who otherwise would be without coverage. The legislation will dovetail with the Mental Health Parity and Addiction Equity Act to more broadly apply mental health parity protections. It will benefit counselors by prohibiting health plans from discriminating against providers on the basis of the type of license they hold. It will also require health plans to cover preventive services, including depression screenings and counseling interventions to reduce alcohol misuse. According to the Congressional Budget Office, which isn’t known for looking at the world through rose-colored glasses, the Affordable Care Act will reduce federal deficits by $210 billion between 2012 and 2021. No legislation is perfect and, as counselors know, change can be hard, but the Affordable Care Act is a major step forward from today’s dysfunctional health care “system.”

Two parts of the law were at issue: the individual mandate that people either have to buy health insurance or pay a penalty, and the expansion of the federal-state Medicaid program. Although an individual mandate was for decades a key component of Republican health reform proposals, its inclusion in the Affordable Care Act drew partisan opposition as well as lawsuits. The Supreme Court’s ruling, authored by Chief Justice John Roberts, held that although the individual mandate is not supported by Congress’ ability to regulate commerce, the mandate falls within Congress’ power to assess taxes. In interpreting the mandate as a tax, the ruling notes that:

“[I]t is estimated that [under the Affordable Care Act] four million people each year will choose to pay the IRS rather than buy insurance. … We would expect Congress to be troubled by that prospect if such conduct were unlawful. That Congress apparently regards such extensive failure to comply with the mandate as tolerable suggests that Congress did not think it was creating four million outlaws. It suggests instead that the shared responsibility payment merely imposes a tax citizens may lawfully choose to pay in lieu of buying health insurance.”

While upholding the individual mandate, the ruling reversed in part the Affordable Care Act’s provisions expanding Medicaid coverage. The legislation requires states to expand their Medicaid programs by 2014 to cover all individuals younger than 65 whose incomes fall below 133 percent of the federal poverty line, and to cover an essential health benefits package. The federal government will pick up 100 percent of the costs of covering newly eligible individuals through 2016; after that, the federal contribution decreases to a minimum of 90 percent. States that did not meet new Medicaid expansion requirements risked losing not only this new funding but their existing Medicaid funding as well. The Supreme Court held that this penalty was too severe — although the federal government can withhold new Medicaid funding for states not meeting the new requirements, it cannot withhold funding for states’ existing Medicaid programs. The ruling thus allows states to turn down virtually complete federal financing of coverage for their low-income, uninsured residents without affecting their existing Medicaid programs.

Congressman pushes VA on hiring of counselors

ACA has gained a champion in its efforts to establish more mental health clinician positions for licensed professional counselors (LPCs) within the Department of Veterans Affairs (VA) health care system. In the last week of June, Rep. Mike Michaud (D-Maine), the ranking member on the House Veterans’ Affairs Subcommittee on Health, submitted a letter to Secretary of Veterans Affairs Eric Shinseki calling on Shinseki and the VA as a whole to begin hiring counselors in the VA medical system. The letter (see next page), which points out that Congress has empowered the VA to hire LPCs for almost six years, asks several specific questions about the steps the VA is taking to hire counselors in clinics and hospitals, as well as how it intends to fill the 1,600 new mental health clinician positions it created in April.

ACA is grateful for Michaud’s leadership on this issue. Michaud is a past recipient of ACA’s Federal Legislative Service Award, and this letter shows he is still fighting to expand access to counseling services. For more information on ACA’s work to increase the number of counseling positions at the VA, contact Art Terrazas at aterrazas@counseling.org.