December 22, 2012

December 21 Washington Update

Greetings from Washington.  It's been a somber but busy week in DC, with much conversation about how to prevent tragedies such as the Newtown shootings; fiscal cliff offers and counter-offers back and forth between the Speaker of the House and the White House; and child health advocates responding to several proposed regulations on implementation of the Affordable Care Act (ACA). 

Newtown and Mental Health.  It is difficult to stop thinking about last week's tragic shootings.  Today, Family Voices issued a press release calling for more support for youth with mental illness, which includes links to a number of other statements, including ones from the Autism Society and Autism Speaks about the lack of any evidence that autism spectrum disorders are linked to planned violence. 

The President has called on President Biden and some Cabinet members to develop a "set of concrete proposals" no later than January, which he said he would "push without delay."  In his remarks, the President said "We're going to need to work on making access to mental health care at least as easy as access to a gun."

Perhaps the Newtown tragedy will lead policy makers to provide more resources for mental health screening, diagnosis, and treatment (and support for families).  Mental health advocates are using this "teachable moment" to educate Congress about the resources and programs needed to address mental health needs, and are urging that funding not be cut for mental health services.  See

At the same time, many individuals and organizations are calling for laws that would restrict access to assault-style weapons and high-capacity ammunition clips.  The President of the American Academy of Pediatrics sent a letter to President Obama calling for both tighter gun laws and for action to improve children's access to mental health services.  And a recent poll indicated that support for stricter gun control laws is at the highest point in a decade. 

On the other hand, after a week of silence, the NRA suggested today that schools be protected with armed security officers and announced that it would develop a model National School Shield Emergency Response Program for every school that wants it.

"Fiscal Cliff" negotiations, Medicaid, the "doc fix" and F2F funding.  As you no doubt know, Speaker Boehner and President Obama have been trying to negotiate a "grand bargain" to avert tax increases and spending cuts scheduled to take effect in the new year.  The most recent development, Friday evening, was an offer by the President of a scaled-back deal to be enacted this year, with more negotiations to take place next year on taxes and spending cuts.  The proposal would extend existing tax rates for household income up to $250,000, suspend the automatic, across-the-board spending reductions ("sequester"), and extend expiring unemployment benefits.

While Medicaid is protected from automatic cuts under the last budget deal, advocates are concerned that a new deal will involve cuts to the program.  Advocates have been lobbying Congress to protect Medicaid, and some Members of Congress have said they would not accept any Medicaid cuts as part of a deal.

As mentioned in past updates, we are hoping to get the F2F funding extension incorporated into a "must-pass" piece of legislation, such as "doc fix" bill to prevent a reduction in Medicare reimbursement to physicians.  At this point, it is unclear whether such a bill will be enacted separately from legislation to implement any sort of budget deal that is reached in the coming weeks or months.  Thus, we are in a waiting mode with respect to F2F funding, working as much as we can behind the scenes to make sure that the F2F funding provision is included in a larger piece of legislation that is sure to be enacted.

ACA implementation. 

Essential Health Benefits.  As reported earlier, HHS issued a proposed rule regarding the establishment of "Essential Health Benefits" (EHBs) under the ACA which require each state to determine its own package of EHBs based on a "benchmark" plan.  The proposed rule raises serious concerns about benefits and cost-sharing. 

Individuals and organizations are urged to submit comments, which are due on December 26.  Instructions about how to submit comments online are below.

For additional information, see a summary of the proposed rule, information on the proposed EHB-benchmark plans for each of the 50 states and the District of Columbia, and a Guide to Reviewing the State Benchmarks.

 Exchanges.  This week HHS granted conditional approval of three other states' proposals concerning the operation of Exchanges under the ACA.  Minnesota and Rhode Island were conditionally approved today to operate State-based Exchanges, and Delaware received conditional approval for a State Partnership Exchange, meaning the state and federal governments would operate the Exchange jointly.

Applications for approval of State-based Exchanges were due on December 14, and applications to participate in a State Partnership Exchange are due February 15, 2013.  To date, 24 states have submitted applications or letters of intent to run part or all of their health insurance Exchanges, and 12 have been conditionally approved.  A list of them, along with each state's Exchange website, can be found at

All Exchanges will launch open enrollment in October 2013. To see the status of Exchange implementation in each state, see the Kaiser Family Foundation website at

As always, please feel free to contact us with any questions. 

Brooke Lehmann, MSW, Esq.



Janis Guerney, Esq.



NOTE:  Past issues of the Washington update can be found on the Family Voices home page by scrolling down in the "News Feed" section.

How to submit comments online:

  • Save the attached document to your computer. Fill in the date and name of your organization (and description if you like) on page 1, and your contact info on the last page, and re-save.
  • In section 1, enter the requested information (name, address, etc.). You will have to select a category. Scroll down to select "consumer group."
  • You can skip Section 2. In Section 3, click on "Choose File." This will take you to your computer files. Select the saved comments.
  • In Section 4, preview if you'd like and click on "Submit." That's it.