PRA Public Policy Post-Election Breakdown

Federal Balance of Power: All About the Senate
Whether you were a political watcher keeping close tabs on every new poll or someone who wished all those political ads on television would soon be replaced by cereal commercials, the 2012 presidential and congressional elections have come to an end. President Obama won re-election with a decisive Electoral College margin and by more than 3 percent of the popular vote. The republicans continue to control the House of Representatives, and it appears John Boenher (R-Ohio) will continue as Speaker while the democrats solidified their hold on the U.S. Senate, and Majority Leader Harry Reid (D-Nevada) and Minority Leader Mitch McConell (R-Kentucky) are expected to remain in those leadership positions. Noteworthy in the Senate is that democrats do not hold 60 seats – the “super majority” required to bring an end to debate on an issue (known as “cloture” to overcome threats of filibuster). We have a democratic president, solidly republican House (with rules that give great power to the majority), and a Senate where all the between-party negotiating takes place… so what does that balance of power mean?

Feds Look for Billions in Cuts this Year
Pick up any newspaper and you can read about the impending “fiscal cliff” that the federal government faces at the end of the year, as well as expiring tax cuts that would raise taxes on the middle class (and everyone else, including businesses). In the health care sphere, physicians are also facing a 30 percent cut in Medicare reimbursement unless there is action to avert implementation of the Sustainable Growth Rate (SGR) formula by Congress. In short, Congress is looking under every sofa cushion for billions and billions of dollars to shore up the overall federal budget as well as Medicare – the doc fix alone is estimated to cost $22 billion. So discretionary spending, including proposed cuts to SAMHSA and other programs that PRA members care about, are definitely in contention and it is very likely that everyone who receives federal dollars, from heath care to the pentagon, are going to be hit with cuts by the end of the year just to have the feds be able to make ends meet.

Health Care Looking Forward: ACA, Entitlements
The Obama administration is full steam ahead on implementation of the Affordable Care Act. Anything they can do without further authorization from Congress (which is most of what needs to be done) will happen as quickly as federal officials can move. Expect those state exchanges, including the federal “fall-back” options (for states that chose not to develop their own exchange or cannot be ready in time) to accelerate in release of rules and parameters in order to be up and running by January 1, 2014. Activity on the state level, for those developing state-based exchanges, is also likely to ramp up, including identification of plan design elements ranging from designation of essential benefits and network adequacy requirements. As an essential membership benefit, PRA will strongly encourage, and work to assist, our membership with weighing in on these important decisions at the state level (or even in the mix of identified services). Weighing in on important decisions will be critical to ensure coverage through exchange plans going forward.

The feds have also spent time talking about “entitlement reform” by which they mean Medicare and, likely, Medicaid. While there have been proposals in earlier years (such as the Paul Ryan plan to bring vouchers to Medicare), it is likely that discussions will be renewed and policy makers will be looking for new ideas to take these programs into a new decade – and save money for the government. PRA is already thinking creatively about how to position ourselves within the context of this debate – as providers of services that are essential to many in need.

In short, the election may be over, but the federal and state governments have their work cut out for them. PRA intends to be right in the mix with our membership working to ensure that the important work done by our members in the community can continue as new regimes of healthcare unfold. We invite you to join us by joining the Public Policy Committee. Please contact Greg Morrison to sign up for the committee.

About the Author: Cherilyn earned her law degree from George Mason University School of Law in Arlington, Virginia and a bachelor’s in Government from Smith College in Northampton, Massachusetts. She provides high-end public policy leadership, advocacy direction and management, and broad-based strategic leadership and governance consultation to PRA.

About PRA’s Public Policy Committee: PRA’s Public Policy Committee consists of eleven members, four of which sit on PRA’s Board of Directors. The committee meets once a month via teleconference to discuss PRA’s public policy agenda and the activities PRA can engage in to further support the psychiatric rehabilitation community. The committee’s activity includes, organizing PRA’s involvement in the annual Capitol Hill Day, working with legislators, and supporting legislation that advances the availability and practice of psychiatric rehabilitation.