A Tale of Two Courts
Not unlike in the Charles Dickens novel "A Tale of Two Cities" it was the best of times, it was the worst of times for the Affordable Care Act (ACA). Last month, two Appeals Courts in different jurisdictions came to different conclusions about the legality of individuals continuing to receive Premium Tax Credits used by individuals and families to pay for their insurance premiums. The subsidy amount varies by family size and household income (up to 400% of federal poverty). About 7 million people receive this subsidy. The Urban Institute has projected that by 2016, about $36 billion in subsidy would be paid out.
This only adds to the confusion as consumers use their newly acquired Marketplace (Exchange) insurance programs. The main message, for now, for families receiving this assistance is that NOTHING will change and the funds will NOT have to be paid back. Between now and the next open enrollment period (scheduled to start on November 15th), we're hopeful some clarifications will be forthcoming. But, we may indeed have to await US Supreme Court review of these rulings.
Let's look, briefly, at the case in the District of Columbia which hinges on a seven-word phrase in the ACA and is used to argue that premium subsidies are available only "through an Exchange established by the State." Thirty-four states have a federally facilitated Exchange (including Arizona), and approximately seventy-five percent of the people nationwide who qualify for premium subsidies live in one those states. If the restriction were to be applied nationwide it could arguably gut the ACA. The other option would be for more states to assume the role of running the Marketplace (Exchange). The federal government has asked for a full Appellate Court review of this decision. Just so you know, most Appeal Courts are composed of three judges, not the full nine-judge complement.
On the same day, just hours after the DC Court's ruling, the Fourth Circuit Court of Appeals in Virginia ruled that a federal law should not be interpreted by reading a single line out of context. Rather, "a reviewing court should not confine itself to examining a particular statutory provision in isolation" as the "meaning-or ambiguity-of certain words or phrases may only become evident when placed in context." The Court placed the disputed seven-word phrase in context and found it clear that Congress intended the subsidy provisions to apply to all Exchanges.
Are we out of the woods? Not yet. We have had a roller coaster ride since the bill's passage in 2010, when we celebrated, finally, an effort to have health insurance coverage for everybody. We knew it was a narrow win and that the 2012 election was, in essence, a referendum on the ACA. We've had one US Supreme Court decision in favor of the ACA, a rocky rollout last fall, dozens of votes to repeal the law in the US House of Representatives, and now ongoing federal court challenges about coverage and subsidies. Madame Defarge, what are you knitting?
This is very important in Arizona. Over 120,000 people are now covered by our state's federally facilitated Marketplace, 77 percent of whom have received a premium tax credit, according to an analysis by St. Luke's Health Initiative. It is essential to keep tabs on the twists and turns of these court challenges.
Mental Health America of Arizona wishes to thank Johnson & Johnson Health Care Systems, Inc. for their 2014 corporate support. Hopefully, they're just the first of this fiscal year's patrons who will assist us in our efforts: "To promote the mental health and well-being for all Arizonans through education, advocacy, and the shaping of public policy."
Cheryl Fanning has been working in the Arizona behavioral health system for over forty years, ever since graduating from the ASU College of Nursing with her BS in Nursing. Her first job in the field was in Child Psych at the Arizona State Hospital. From there, she worked as a public health nurse in Flagstaff, AZ before returning to the Phoenix area to work at the Westside Project (a joint effort of the Maricopa County Health Department and ADHS to provide a community based mental health program in the State). Following Westside, she worked for ADHS/DBHS for fifteen years during which she went back to school and received a Master's in Business Administration. She moved to Ohio for four years to serve as the Director of the Ohio Study Committee on Mental Health Services, evaluating the deinstitutionalization of the Ohio mental health system. Upon her return to Arizona, she worked for two RBHAs: CPSA in Tucson and Cenpatico, serving Gila, Pinal, Yuma, LaPaz, Graham, Greenlee, Cochise and Santa Cruz Counties. She is currently doing private consulting and completing an RN Refresher program in order to be more prepared to implement integrated treatment which deals with an individual's physical as well as mental health care.
Cheryl's involvement with MHA-Arizona began over thirty years ago when she served as the Director of the Arizona Community Support System grant while working at ADHS/ DBHS. She was proud to work with advocacy groups in the State to come together to expand the Arizona behavioral health system to serve people with serious mental illness. This advocacy effort was kicked off with the first Seeds of Crisis Conference organized by the Mental Health Association (as it was then called). For years, MHA AZ was known for bringing together some of the best leaders in the nation to educate providers, peers, families and other community stakeholders through the annual Seeds Conferences. Cheryl is pleased that the MHA AZ Board is once again bringing back these educational conferences.
As a family member of a person receiving services in the system, Cheryl has also been a long time member of NAMI Arizona. She has been glad to serve as a representative of the NAMI Arizona Board of Directors on the MHA AZ Board. She is committed to bringing the two organizations together and making sure peer and family voices are heard within the System. She encourages all to join in the vital work to improve the Arizona Behavioral Health System.
We're back again reminding you that the Primary registration deadline has passed in case you weren't registered, but you still have until October 6th
the register for the General election. The General election is November 4th
The other important thing to remember is: if you're registered for the Primary election you need to mail-in your ballot if you're on the Permanent Early Voting List. Those of you who are Independents can select to vote either Democratic or Republican this time around and you can do that with your mail-in ballot or when you go to the polls on August 26th
Need help making decisions among the candidates? The following websites may help you in addition to the Voter Education Guide for statewide and legislative candidates pamphlet that was prepared for the Primary election and mailed to voters' homes.
- Children's Action Alliance has election information check out their website here or this portion of their site They also have information for Independent voters, legislative scorecards from the 2014 legislative session ("Who's for Kids" and "Who's Just Kidding"). The results of a questionnaire from the state legislature can be found here.
- An interesting website can be found about who is running in statewide elections and has some links to their election websites, but the state legislative links aren't that helpful. Check out here.
Plenty of "stuff" out there to help you out, but it does require taking time to look stuff up and becoming knowledgeable. In addition, there will be campaign materials mailed to you, radio and TV ads, and even some calling.
As FDR said, "Nobody will ever deprive the American people of the right to vote except the American people themselves and the only way they could do this is by not voting."
Ready for this?--School has started!! That means no more lazy days by the pool or escapes to San Diego beaches. Well, maybe not for those with school-aged kids anyway. The calendar is filling up, so it's time to shop for trainings, events and the like to improve your skills or sometimes just go have fun.
Please share your events with us so we can let folks know what's going on.
- First Things First Early Childhood Summit on August 18-19 here in Phoenix. Late registration fee is $270. To register, check out this link.
- "Using Motivational Interviewing Skills in Counseling Groups" is being offered by the Center for Applied Behavioral Health Policy. First session is Monday & Tuesday, August 25th-26th in Phoenix and on Thursday & Friday, August 28th-29th in Tucson. Cost is $159 for the 2-day sessions including lunch and includes CEU hours. Link to for Phoenix session and Tucson session.
- Southwest Interdisciplinary Research Center's Community Engagement & Outreach Core will be hosting information insights webinars on Thursdays at 11 am-12 pm, Arizona Time. The sessions are: August 21st on "Collecting & Using Information to Know What Works"; August 28th "Information for Influence: Supporting Policy & Advocacy Efforts"; and September 4th on "Can Collect Data!" For more information contact Wendy.Wolfersteing@asu.edu
- Hispanic Leadership Institute Pinal's application deadline is Friday, August 29th with sessions beginning Thursday, September 25th. This is a 10-week program of weekly classes held mostly in the evening and mostly at Central Arizona College. The program fee is $300 for all sessions and includes materials. For more info and to apply online check it out here.
- Hispanic Leadership Institute-West Valley's application deadline is Friday, September 12th with sessions beginning Wednesday, October 8th. This is a 10-week program of weekly classes held mostly in the evening at Estrella Mountain Community College. The program fee is $550 for all sessions and includes materials. The program fee for nonprofit organization participants is $450. For more info and to apply online check it out here.
- African American Leadership Institute's application deadline is Friday, September 6th with sessions beginning Tuesday, September 30th. This is a 10-week program of weekly classes held mostly in the evening at South Mountain Community College. The program fee is $550 for all sessions and includes materials. For more info and to apply online check it out here.
- October 1st, Seeds Conference, "Intersection of Behavioral Health & Criminal Justice" at ASU West, 4701 W. Thunderbird. Registration is now open at this link and the fee is $79 which covers parking, breaks, lunch and CEUs. The event is a collaboration between MHA-AZ, ASU Center for Applied Behavioral Health, David's Hope, and Arizona Justice Alliance.
We'd like to acknowledge a reader who pointed out correctly that the Maricopa and the planned Greater Arizona RFP integration plan applies only to SMI clients. In addition, state-only SMI clients will continue to receive their more limited behavioral health benefits from the RBHA. Thank your for clarification.
We invite your participation and sharing of this newsletter by forwarding to your friends and colleagues. If they wish to receive the free newsletter, encourage them to simply click on the link here
. Let's share the word. Let's get involved.
Eddie L. Sissons