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August 25, 2022 | Volume 26, No. 7| Archives
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| A Call to Action, Challenges to the ACA, More Mental Health Coercion
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| In This Issue:
- MAT Act Advocacy
- Inflation Reduction Act
- Reproductive Health Update
- FY 2023 Budget
- Court Challenges to the ACA
- Mental Health Crisis Line 988
- COVID Corner
- What We’re Reading
- Good News
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Take Action to Increase Opioid Use Disorder Treatment!
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The HCH community is fighting to expand access to buprenorphine (also known as Suboxone), the medication used to treat opioid use disorder. This letter from our coalition partners asks Senate leadership to take up this issue as soon as possible this fall.
Sign your organization on here. The deadline for signing is Tuesday, August 30, at noon ET.
Background: Prescribing buprenorphine is safe, effective, and simple; however, it currently requires lengthy trainings and cumbersome prescribing restrictions known as “the X-waiver.” Repealing the X-waiver, as S. 445 will do, will expand treatment and, ultimately, save lives. For more information, see our prior policy brief on this issue.
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Signed by President Biden on August 16, the new law has two substantive health care provisions: it extends the ACA premium subsidies for those with private marketplace insurance plans, and lowers the cost of prescription drugs from Medicare (for example, by capping insulin at $35, putting a $2,000 limit on out-of-pocket prescription drug costs, and negotiating prices for some drugs in future years). The law also provides additional funding to the IRS, sets a 15% minimum corporate tax rate, and combats climate change. See the White House fact sheet for more details on this unexpected legislation.
Signed by President Biden on August 3 (see the White House fact sheet for more details), this newest order takes actions in five areas:
- Supports women crossing state lines for medical care.
- Ensures health care providers comply with federal non-discrimination laws.
- Promotes research and data collection on maternal health outcomes.
- Enforces the Emergency Medical Treatment and Labor Act (EMTALA) for emergency abortion care.
- Issues guidelines for pharmacies to fill lawfully prescribed drugs.
Some issues already have raised concerns about enforcement of EMTALA as a way to make emergency rooms abortion clinics. There also have been growing fears among providers of what treatment they can ethically provide while avoiding jail time.
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After Congress passed the Inflation Reduction Act (mentioned above), which was an unexpected accomplishment, they are now on August recess and will reconvene on September 6, 2022.
When they return, Congress is likely to focus on completing FY2023 budget negotiations because the fiscal year ends in September. The House proposed a 13.5% increase in non-defense spending, but the Senate cut that down to 12%. The Senate also nearly doubled the amount of defense spending proposed by the House. Next month’s Mobilizer will have more information about the FY23 budget.
There are a few notable upcoming bills, including expansion of telehealth provisions beyond the COVID- 19 pandemic, a more comprehensive mental health bill, and improving responses to future pandemics.
The biggest focus point will be the five remaining mid-term primary elections in September (MA, DE, NH, RI, LA), as well as the nationwide mid-term election on November 8.
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Heads up!
Legal case could end ACA preventive care services: In Kelley v. Becerra, plaintiffs object to the requirement that insurers are required to provide cost-free coverage of preventive services, such as contraceptives, cancer screenings, and STD screenings. This is being heard now in federal court; if the judge determines the provision is unconstitutional, it will likely be appealed to the Supreme Court for their 2023 session.
Background: Here is a list of the ACA-required free preventive services for adults, women, and children.
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A Closer Look: The 988 Mental Health Hotline and Involuntary Commitment
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The new mental health hotline -- 988 -- has been heralded as a major step forward in responding to mental health crises without police involvement and the use of force. However, the program does not yet live up to its promises to stop a law enforcement response to a medical need.
The National Suicide Prevention Line (NSPL) is being converted to 988 and the hotline has been covertly tracing calls and geolocating individuals for years. When a hotline worker is afraid of a caller’s statements, they do not send out social workers, mobile crisis teams, or make therapy referrals. Instead, hotline workers secretly screen callers with suicide risk assessments and then call 911 without their consent.
Countless callers described how traumatizing their experiences with law enforcement were and how they felt criminalized and no longer trusted help lines. Many individuals have lost their employment or been saddled with significant medical debt because of involuntary and unnecessary commitment. Research from JAMA psychiatry indicates that the risk of suicide increases 100 times after being released from a psychiatric unit and that calls to the NSPL have resulted in hundreds of thousands of psychiatric hospitalizations per year. Involuntary hospitalizations are precipitated by the call to 911, which 988 is supposed to prevent. However, the policy of Vibrant, the 988 provider, is to contact law enforcement to perform “active rescue” for a caller they perceive to be a danger.
People with mental illness are 16 times more likely to be killed by police and account for 25% of fatal police shootings. The new 988 hotline needs to be transparent with callers that there is a threat of police involvement and involuntary commitment. Hotline workers should be honest that they are conducting suicide risk assessments and remove themselves from any police involvement. Providers and staff can offer some alternative options to patients, such as access to warm lines that are usually staffed by peers. When someone calls on one of the worst days of their life, they should be met with help and not handcuffs.
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The CDC has updated their guidance for minimizing the impact of COVID-19. This most recent update, announced on August 11, acknowledges that COVID-19 is here to stay, lifts the requirement to quarantine upon exposure to someone with COVID-19, and de-emphasizes testing people who are not symptomatic. Most notably, it eliminates the differences in guidance for those who are unvaccinated verses those who are vaccinated.
These changes are a result of the data showing that 95% of the population have COVID-19 immunity as a result of vaccination, past COVID-19 infection, or both. Here are some highlights of the changes:
- For those unvaxxed: People who are not up to date with their COVID-19 vaccine and are exposed to someone with COVID-19 should wear a mask for 10 days and test on Day 5. They do not need to quarantine unless they become symptomatic.
- Schools: The “test to stay” policy for schools has been removed. Children who are not fully vaccinated do not need to remain home from school when they are exposed to someone with COVID-19.
- Community testing: Widespread testing may still be beneficial at times of outbreaks or periods of high COVID-19 prevalence.
- Positive cases: People who are COVID-positive, or are symptomatic and suspected to be COVID-positive, should continue to isolate for a minimum of five days (longer if they are still symptomatic) and wear a mask through Day 10 if they leave isolation.
The FDA also released new guidance that people who are exposed to COVID-19 should take three home tests (one more than the previous recommendation) to make sure they are not infected. The tests should be done 48 hours apart.
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We are often sharing bad policy news, but we’re committed to finding good policy news out there! Here are three stories we found this month that lifted our spirits:
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Did you receive Mobilizer as a forwarded email or hear about it via social media? Register now to receive our action alerts each month!
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This publication and all HCH advocacy are funded by dues from Organizational Members of the Council and by private donations. Consider joining the Council to support this work.
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