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Whatís at Stake in the 2012 Elections?

By Beth Anne Hendrickson, NAMI Policy Intern

What does this yearís election season have to do with mental health? The answer is everything. Candidates elected into office during this time of critical health care debate and reform will make decisions with lasting impact on access to mental health treatment and services. New reforms make mental health parity a requirement and care more affordable, but these policies are still being debated. We need leaders who are ready to move forward to ensure that individuals receive the full effect of intended benefits. For people living with mental illness and their families, much is at stake in these elections. Now is the time for you, NAMI voters, to weigh in and tell candidates, “Mental health care gets my vote!”

We have the opportunity to impact how the nation and health systems view mental illness.

Exercising the right to vote is important in each election, but there are several opportunities in the 2012 elections that make this campaign season imperative to mental health: the timing, NAMI policy priorities, local leadership and the opportunity to connect with candidates.

Timing Is Everything

Reactions to the Supreme Courtís June ruling upholding the Patient Protection and Affordable Care Act (PPACA) range from cheers to backlash, and everything in between. The debate itself is more than hype and headlines, though. The hot-button issues align with the heart of NAMIís advocacy priorities: protect public mental health funding, expand access to care, and make prompt, effective mental health care available to all in need.

For mental health advocates, these coverage, access and care concerns are nothing new. NAMI, NAMI State Organizations and NAMI Affiliates have been working to advance mental health issues in national, state and local policy for decades. Although the fight for better mental health care is ongoing, these issues are currently in the spotlight, making this election a moment of opportunity to connect with candidates.

The PPACA debate has built a platform for mental health advocates to promote better mental health policy to a wide audience across the political spectrum, including candidates who want to know voter priorities. That means we have the opportunity to impact how the nation and health systems view mental illness.

Candidates and incumbents up for re-election need to become aware of NAMIís mental health policy priorities and form positions on these issues, which affect millions of Americans.

Policies in Limbo

Key legislation and funding measures currently in debate add to the significance of the elections. The bipartisan initiatives included in PPACA mark key victories toward a uniquely American solution, being good for business while reforming a health care system that inefficiently drains the budget and ill-serves those who need care.

Candidates and incumbents up for re-election need to become aware of NAMIís mental health policy priorities and form positions on these issues, which affect millions of Americans.

Yet as the health care debate blazes on, principles that are the foundation of health care reform could be in jeopardy, lost in ďwho said whatĒ political clash. With this pivotal moment in health care reform, current and future policy-makers need to know what issues take priority in the debate for voters, including mental health. NAMIís trifold policy agenda sets forth key focal points to get the message across to candidates: protect mental health funding, expand coverage, and improve and increase access to mental health services.

Priorities: Protect Funding

Because federal, state and personal pocketbooks are stretched thin, officials at all levels seek to cut excess spending. It is vital to communicate that mental health services have been seriously eroded during the recession and cannot be cut further without serious consequences for individuals, families and communities. The stress of hard economic times should provide incentives to strengthen, not drain, necessary mental health supports. Short-term skimping on the care and services Americans need to live healthier, fulfilling lives undercuts recent advances in recovery-oriented care that now offer a brighter future to people living with mental illness.

Medicaid: Under fire in the wake of the Supreme Courtís decision on PPACA is the plan to expand Medicaid to cover all Americans with incomes at or below 133 percent of the Federal Poverty Level. Medicaid, a federal- and state-funded health coverage program, currently provides health care services to children, parents and adults with disabilities living in poverty. Medicaid covers more mental health service costs than any other insurer, public or private, and helps children access critical early-prevention care.

The June Supreme Court ruling struck down penalties for states not complying with the PPACA provision extending Medicaid coverage to all individuals with incomes at or below 133 percent of the federal poverty line. Medicaid expansion would provide health care coverage to more than 17 million more Americans.

To some, the decision has provided wiggle room for states not only to refuse to expand Medicaid, but to continue to trim current programs. Budgets remain tight, and states are worried about their ability to pay for Medicaid while maintaining quality of service for more members once federal funds scale back.

The new Medicaid qualifications mean that many more Americans would receive coverage (although a slimmer set of benefits) through what is already Americaís broadest insurance program. This worries states, which are feeling budget crunches and looking for ways to shave excess spending. While federal funds would pick up the entire tab for new enrollees for the first few years, states would eventually be required to pay 10 percent of expansion costs in addition to an average of 43 percent for current Medicaid enrollees.

As this article goes to print, 13 states are making plans for hefty Medicaid cuts. Some states are tightening eligibility, making it harder for people to qualify for Medicaid. In states not expanding Medicaid, people with incomes below the Federal Poverty Level could be most disadvantaged. These individuals would not qualify for Medicaid but would be required to purchase health care, even though there is no provision for federal insurance subsidies in private health insurance exchange plans for incomes below 100 percent of the Federal Poverty Level.

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