When Republicans in the U.S. House of Representatives scuttled the American Health Care Act in March, the defeat was good news for APA, its members and the public it serves.
If enacted, the bill would have resulted in a loss of health insurance coverage for 24 million Americans by 2026, almost doubling the percentage of uninsured Americans, according to Congressional Budget Office estimates. It would also have eliminated the essential benefits package that insurers in the health exchanges set up by the law are currently required to provide, including mental health and substance use services.
But the bill's demise doesn't mean psychology's work is over. In addition to continuing to safeguard the Affordable Care Act, APA is urging Congress to reject the proposed 2018 budget President Donald Trump released in March.
To pay for a $54 billion increase in defense and homeland security—a 10 percent boost—the so-called "skinny budget" would result in what APA President Antonio E. Puente, PhD, calls "harsh cuts to vital domestic programs." And that means psychologists need to ramp up their advocacy efforts, says Ellen Garrison, PhD, senior policy advisor to APA's chief executive officer.
"While APA is relieved that no further action is anticipated on the American Health Care Act, we need to remain vigilant on health care and other fronts," says Garrison. "The voices of our psychology advocates are now needed to preserve funding for key federal programs that support psychological practice, science and education, and safeguard human welfare, which are threatened in the president's proposed 2018 budget."
Here are answers to common questions about the budget and other priorities:
How would the president's proposed budget affect scientific research?
Science funding would take a devastating hit, says Pat Kobor, a senior science policy analyst in APA's Science Directorate. The proposed budget would slash research funding for the National Institutes of Health by an unprecedented 18 percent, or $6 billion, in one fiscal year. The budget also proposes reorganizing NIH to focus resources on the administration's priorities, consolidating some areas and reducing administrative costs. All this attention, notes Kobor, "is unlikely to be positive."
Other scientific agencies fare even worse in the proposed budget. The Environmental Protection Agency, for instance, could suffer a 31 percent budget cut. Its international climate change programs would be halted, and funding for its Office of Research and Development would be slashed by half.
The fate of other scientific agencies remains unknown.
The proposed budget includes no details about the National Science Foundation. Nor does it include the Office of Justice Programs, which funds key research at the Department of Justice. Although the budget calls for reorganizing the Centers for Disease Control and Prevention (CDC), it doesn't provide details or note how deeply specific CDC programs would be cut. And it's not yet clear whether the proposed increases in funding for the Department of Defense and Department of Veterans Affairs would trickle down to science programs in those agencies.
How would the proposed budget affect APA's other priorities?
The proposal imperils the future of psychology's workforce.
The proposed $403 million cut in the health professions training programs run by the Health Resources and Services Administration, for example, could eliminate the Graduate Psychology Education program, the only federal initiative specifically devoted to the education and training of psychologists. With the almost 19 percent proposed cut in the overall budget for the Department of Health and Human Services (HHS), the Minority Fellowship Program could also be at risk.
The budget would also slash safety net programs and other initiatives aimed at the nation's most vulnerable populations.
The proposed cuts to HHS's budget, for example, could jeopardize Head Start, which promotes school readiness in young children from low-income families. The proposal also cuts $200 million from the budget of the Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants and Children, which provides food and health-care referrals to infants and low-income women who are pregnant or breast-feeding, for example. The 13 percent proposed cut to the Department of Housing and Urban Development would likely mean the loss of services for homeless people, many of whom have untreated mental disorders.
Is action still needed to protect and improve the Affordable Care Act?
There's still a need to be on the lookout for threats to the Affordable Care Act, says Doug Walter, JD, associate executive director for government relations in the APA Practice Organization.
For one thing, says Walter, the American Health Care Act may not be truly dead yet. Despite the failure of its repeal-and-replace plans, House Republicans are already considering taking another run at repeal. Congress could also resurrect its repeal-and-replace efforts after the midterm elections in 2018, he says.
Plus, the administration could still undermine the Affordable Care Act, Walter warns. With an executive order to reduce the Affordable Care Act's financial burdens as much as possible, the administration has already encouraged the Internal Revenue Service to soften enforcement of the requirement that most uninsured Americans pay a penalty. The penalty helps ensure that it's not just older, sicker individuals who sign up for coverage, which encourages insurers to stay in the system.
Congress and HHS Secretary Tom Price could also take action to weaken the Affordable Care Act. For instance, Congress could use the appropriations process to defund the subsidies that help make coverage affordable for low-income individuals. Secretary Price is already encouraging governors to use the Medicaid waiver program to make Medicaid coverage less accessible via premiums, work requirements and other measures. And while the Secretary can't remove mental health and substance abuse services from the list of essential benefits the Affordable Care Act requires insurers in the health exchanges to provide, adds Walter, he could reinterpret what those benefits mean.
In the meantime, says Walter, APA and the Practice Organization plan to focus on improving the existing law. "We're hoping that now we can have a more moderated discussion with stakeholders—our members, other health-care providers, consumers and insurers—on how to make the Affordable Care Act most effective."
How can I make my voice heard?
At the Monitor's press time, APA and psychologists around the country were gathering for advocacy training at APA on March 21 and the March for Science on April 22, Earth Day. APA is an official partner of the march, a nonpartisan effort in support of scientific research and the use of scientific evidence to improve people's lives. (A full report and photos of the march will appear in the June issue of the Monitor.)
On a more ongoing basis, psychologists can join in the grassroots efforts sponsored by APA and the APA Practice Organization. APA Advocacy and the APA Practice Organization Legislative Action Center offer information about impending legislation, advocacy how-to guides, contact information for elected officials at the federal and state levels, and more.
