Reforming the health-care system, the opioid epidemic and research

Reforming the health-care system

For decades, the American Psychological Association has advocated for health-care reform and the vital role that psychologists play in it. The organization's most recent activities have focused on defending the Affordable Care Act of 2010, which gave 32 million Americans access to health insurance.

Accessibility is being improved. The bill extended Medicaid and established health insurance exchanges, which provide individuals with complete coverage and financial assistance with premiums and copays and deductibles. The Affordable Care Act also mandates that insurance plans cover mental health and substance abuse disorder treatments, including behavioral health therapy, and expands mental health parity to small group and individual market policies.

The ACA also opened up new opportunities for psychologists in the private health-care system and in public health programs, thanks in part to strong advocacy by APA and the APA Practice Organization (APAPO), and prohibited insurers from denying coverage or raising premium rates due to pre-existing conditions.

Patients' safety is paramount. Throughout 2017, psychologists spoke out against every new attempt by Congress and the Trump administration to repeal or weaken the Affordable Care Act's protections, destabilize insurance markets, and abolish or change Medicaid for millions of Americans. The American Psychological Association (APA) and the American Psychological Association (APAPO) teamed up to release more than 25 ACA Action Alerts and Information Updates. Every time, our members rose to the occasion, sending nearly 60,000 messages to Congress pushing them to keep the statute in place.

APA and APAPO government relations employees led the push on various responses. President Trump's executive order on association health plans and short-term insurance plans, as well as the president's decision to discontinue cost-sharing reduction payments, were all targets of this lobbying. In addition, the American Psychological Association expressed out against a number of legislative initiatives, including the American Health Care Act, the Better Care Reconciliation Act, the Graham-Cassidy-Heller-Johnson proposal, and the "skinny" repeal.

Taking the next step. The American Psychological Association (APA) firmly supports bipartisan efforts to stabilize the nation's health insurance marketplaces, cut consumer costs, and expand mental health care access. The American Psychological Association and its professional organization, the American Psychological Association and its professional organization, the American Psychological Association and its professional organization, the American Psychological Association and its professional organization, the American Psychological Association and its professional organization, the American Psychological Association and its professional organization, the American Psychological Association and its

Visit www.apa.org/advocacy/health/affordable-care.aspx for additional information.

Reforming the immigration system

President Trump has promised to build a wall along the Mexican-American border, has issued a travel ban that affects six predominantly Muslim countries, as well as North Korea and Venezuela, has terminated the Deferred Action for Childhood Arrivals (DACA) program, and has implemented a slew of other anti-immigrant policies. The American Psychological Association has a long history of lobbying for immigration policies that keep families together and prevent deportation. The acts of the Trump administration have heightened these efforts.

Risks to mental health. Threats to immigrants and their families, according to research, have severe psychological consequences and are associated to an increased risk of overall health problems. Deportation can cause parents and children to be separated for long periods of time or all at once. The trauma that children feel as a result of this event often causes them to have trouble trusting adults and institutions, and puts them at risk for housing and food instability, as well as post-traumatic stress disorder and other negative consequences.

The APA has taken action. The organization conducted a congressional briefing on the Dream Act of 2017 and wrote a letter to Congress in support of the bill, which would give undocumented teens and young adults who were brought to the United States unlawfully as children a road to citizenship. The letter and briefing both briefed Congress of the most recent research on the mental health risks of family separation. In addition, APA has made statements urging President Trump to protect DACA, as well as letters protesting family separation at the border to then-Secretary of Homeland Security John F. Kelly. The American Psychological Association also leads an immigration working group in which psychologists and policy specialists interact to develop appropriate immigration policy.

APA also seeks to educate and mobilize the public and members about DACA's importance. Then-APA President Antonio E. Puente, PhD, wrote an op-ed in support of the Dream Act in USA Today in December. In January, the American Psychological Association (APA) sent an Action Alert to its members, urging them to write to members of Congress in support of the Dream Act. More than 250 letters had been sent at the time of publication. The American Psychological Association will continue to push for DACA until it becomes law.

Opioid apocalypse

The opioid epidemic was designated a public health emergency by President Trump in 2017. According to the national Centers for Disease Control and Prevention (CDC), 91 Americans die each day from opioid overdose, and the number of children entering the child welfare system is rising as a result of opioid use among parents. The abuse and overprescribing of opioids for pain management has fueled this public health crisis: Between 1999 and 2010, the number of prescription opioids sold to pharmacies, hospitals, and doctors' offices approximately doubled. According to the CDC, the number of deaths from opioid overdose has doubled since 1999.

A place to start. The President's Commission on Combating Drug Addiction and the Opioid Crisis released a detailed list of recommendations in November to help prevent and cure opioid addiction. While the American Psychological Association commended this much-needed effort, it is merely the first step. These recommendations have yet to receive committed funding from Congress.

Needs that are urgent. The American Psychological Association (APA) is encouraging Congress and the administration to take the following steps to combat the opioid crisis:

Launch a public awareness campaign to raise awareness about the hazards of opioids.

Mental health practitioners should support research into and promotion of nonpharmacological pain management options.

Decriminalize the use of opioids and establish federal drug courts for nonviolent offenders that prioritize treatment and rehabilitation over jail.

Allow governments to bargain for lower naloxone pricing, a life-saving medicine that can reverse the effects of an overdose.

Increase funding for the National Institutes of Health's (NIH) research on successful therapies, as well as the Substance Abuse and Mental Health Services Administration's (SAMHSA) prevention and treatment services.

Increase the number of people trained in evidence-based addiction treatment.

Increase enforcement of the Mental Health Parity and Addiction Equity Act of 2008, which requires insurers to cover substance use disorders on the same basis as physical illnesses.

Increase financing for mental health counseling in schools and other social service systems that are experiencing a surge in demand as a result of the epidemic.

Visit www.apa.org/advocacy/substance-use/index.aspx to learn more about how you can help. Go to www.apa.org/helpcenter/opioid-abuse.aspx for resources on dealing with opioid addiction.

Grants for research

The lifeblood of psychological science is federal financing. The National Institutes of Health (NIH), the National Science Foundation (NSF), and the Institute of Education Sciences (IES) all fund research in a wide range of scientific disciplines, including psychology, in order to advance their missions of improving health, expanding basic scientific knowledge, and improving education. Overall, research funding is higher than it was in 2013, when the National Institutes of Health (NIH) lost $1 billion. However, through 2021, the expenditure restrictions enacted as part of the Budget Control Act of 2011 would lower overall spending.

The APA's top priority. The American Psychological Association's advocacy efforts are centered on improving total research funding budgets, with a particular emphasis on behavioral and social sciences funding. APA participates in broad funding coalitions, such as the Coalition for National Science Funding (to increase the NSF budget), the Ad Hoc Group for Medical Research (focused on the NIH), the Coalition for Health Funding (focused on all Public Health Service agencies), and the Friends of IES, to amplify its message (focused on education research). APA also writes joint letters to members of Congress, meets with congressional staff and members, sends out Action Alerts to members of Congress, and participates in collaborative social media events to encourage Congress to fund APA's priorities.

What's to come. APA wants Congress to do the following, among other things:

Support major, long-term increases in the research budgets of the National Institutes of Health, the Centers for Disease Control and Prevention, the National Science Foundation, the Department of Veterans Affairs, the Department of Justice, and the Department of Education in FY 2018. Oppose budget cuts to the National Science Foundation's Directorate for Social, Behavioral, and Economic Sciences. Sequestration must be ended, and a balanced strategy to deficit reduction that does not rely entirely on discretionary spending cutbacks must be adopted. Allow agencies to select the best qualified scientific advisers and avoid imposing partisan or ideological standards on research findings.

2018 is looking up. Because the federal government was still operating on temporary financing authority when the Monitor went to print in late January, the funding landscape for psychological science was still unknown (a continuing resolution). Before voting on any appropriations bills, the House and Senate leadership must agree on overall funding levels.

Visit www.apa.org/advocacy/federal-funding/index.aspx for more information and to get involved.

Development of the workforce

The next generation of psychologists must be prepared to work in these settings as health care in the United States continues to adopt integrated primary care. More psychologists are also desperately needed to address high-need, disadvantaged regions.

To meet these demands, the American Psychological Association (APA) has worked to establish and support federal programs that increase access to care and provide essential training for psychologists and graduate students, particularly the Graduate Psychology Education (GPE) Program and the Behavioral Health Workforce Education and Training (BHWET) Program.

Funding is critical. While the organization has made tremendous success in raising funding for these programs, there is still much more to be done. GPE presently funds 31 programs that provide training for psychology practicum students, interns, and postdocs working to address the behavioral health needs of vulnerable groups such as seniors, children, ethnic minorities, and veterans. The Health Resources and Services Administration of the Department of Health and Human Services funds the program, which was launched in 2002 following years of agitation by APA. The program has increased from $2.7 million in FY 2013 to $8.9 million in FY 2017 thanks to APA's efforts. APA has requested a $10 million raise for next year.

The American Psychological Association also lobbied for financing for the BHWET Program, which was legally authorized as part of the 2016 21st Century Cures Act. The initiative aims to develop the behavioral health workforce by supporting interdisciplinary training for students, graduate students, teachers, and field supervisors. It supports 12 disciplines, including psychology. The APA's strong advocacy efforts resulted in two significant program expansions: eligibility for PhD programs in health service psychology and the inclusion of patients of all ages rather than only youths. As a result of these developments, grant funding for PhD psychology training increased from $875,000 in 2014 to more than $5 million in 2017.

Threats are still present. Despite a scarcity of psychologists in many at-risk regions, the Trump administration may target these programs for deletion.

Loan forgiveness for government employees

The average student loan debt of today's psychology graduate students and early career psychologists is $110,000, putting many graduates off entering lower-paying public-service positions.

The Public Service Loan Forgiveness (PSLF) Program grants debt forgiveness to psychology students and others who commit to employment for 10 years in government or the nonprofit sector. Working in public health, supporting veterans, or providing behavioral health services to underserved populations are all possibilities. One of APA's major priorities is to keep the PSLF Program alive.

The program is in jeopardy. If Congress passes the PROSPER Act, which was cleared by the Committee on Education and the Workforce in the United States House of Representatives in December, the PSLF Program would be eliminated for new borrowers.

The PSLF Program is also up against the US Department of Education, which announced last year that it may discontinue offering debt relief to some students, even if they had already begun training and were banking on loan forgiveness. Many of these students would be prevented from pursuing graduate studies in psychology if the PSLF Program was eliminated or changed, putting behavioral health care in the most vulnerable communities in jeopardy.

Forgiveness is a battle. To defend PSLF, APA signed a letter to Education Secretary Betsy DeVos, along with 35 other concerned organizations, urging her to keep the program's founding pledge.

In addition, APA Action Alerts sent 1,700 messages to Congress opposing the program's removal, and the association worked on its own and with a coalition of 50 other groups to educate members of Congress about the program's importance. As part of that effort, APA assisted Republicans in gaining support for a bill that would have revived the program. APA is building on this bipartisan demonstration to seek reauthorization of the program, despite the fact that the amendment failed.