APA and psychologists across the country are
working to ensure their place in the nation’s
new health-care system.
BY REBECCA A. CLAY
The passage of health-care reform last year was a great victory for psychologists and their patients. But the work is far from done.
Now the U.S. Department of Health and Human Services
(HHS), state governments and others are working to flesh out
the details of just how the law’s many provisions will work in
practice. Some parts of the Patient Protection and Affordable
Care Act have already taken effect, including some expanded
access to insurance coverage, protections against insurance
company abuses, new resources for prevention and efforts to
improve data collection to reduce health disparities. But if all
goes according to plan and the law survives the legal battles it
has provoked, the health-care system will look very different by
the time the Affordable Care Act is fully implemented in 2019.
For instance, 32 million Americans who currently lack
health insurance will have coverage. An expansion of Medicaid
eligibility will extend coverage to 16 million new beneficiaries.
New “exchanges” in each state will offer health insurance plans
to individuals and small businesses and will include coverage
for mental and substance use treatment services on par with
medical and surgical services. The law also requires that all
individuals buy insurance and that employers either offer
coverage or face fines.
The nature of health-care delivery will change, too. Health-care reform emphasizes the integration of mental and physical
health-care services, so psychologists who are prepared to
collaborate with primary-care and other medical professionals
will thrive. New structures — including patient-centered health
homes and accountable care organizations (ACOs) — will
spring up, with the potential for psychologists to become part
of interdisciplinary teams. Payment mechanisms will change,
too, with a shift from fee-for-service to models that reward
good outcomes, bundle payments or pay for episodes of care.
The Affordable Care Act will bring new opportunities
for psychologists, including a larger patient population, new
funding for training and increased support for research. But
psychologists must participate in the process of hammering out
regulations or risk being left out, warn APA officials.
To help psychologists avoid that fate, the new State
Implementation of Health Care Reform Initiative of the APA
Practice Organization (APAPO) will guide them through the
process of getting involved as their states begin redesigning their
Medicaid programs, creating their state exchanges and more.
APA and APAPO are already working hard to ensure that
psychology’s voice is heard.
“We’re looking to promote the various roles of psychologists
and clarify how the whole health-care system will benefit as a
result of those roles,” says APA Senior Policy Advisor Ellen G.
Here’s a wrap-up of the key issues confronting psychology
as the Affordable Care Act is implemented and how APA,
APAPO and the state, provincial and territorial psychological
associations (SPTAs) are working to address them.
One of APA’s top priorities in seeking health-care reform
was the belief in the mind-body connection and the need for
integrating patients’ physical, mental and behavioral health care.
The Affordable Care Act reflects that vision by emphasizing
primary care and interdisciplinary health-care teams.
But now it’s time to make sure those redesigning health-
care delivery think of integrated care the same way APA does,
says Katherine C. Nordal, PhD, executive director of APA’s
Practice Directorate. Many health-care professionals don’t