Tuesday, March 28 and Monday, April 3, the College of William and Mary’s Schroeder Center for Health Policy held a series of talks with health policy experts in Chancellors Hall. The talks serve as part of the Center’s continued efforts to educate students about public policies related to healthcare.
The talks included Postdoctoral Fellow at the Kaiser Family Foundation’s Program on Medicaid and the Uninsured Heather Saunders and health policy reporter for CQ Roll Call Ariel Cohen ’14. Saunders discussed behavioral health coverage in state Medicaid programs, while Cohen detailed the policy implications of the expiration of the Public Health Emergency for COVID-19 which occurs on May 11, 2023.
Saunders provided an overview of KFF and her role within the organization. She then provided an overview of Medicaid, a public health insurance program for individuals and families with limited incomes and resources. Since Medicaid is a federal-state partnership program, benefits vary by state.
“Because of the state flexibility and what they can cover, there is variation by state,” Saunders said. “There were a lot of emerging issues around COVID and states had some flexibility through emergency authorities. We’ve also seen in recent years a lot of changes in the mental health and substance use disorder space.”
Saunders discussed the status of Medicaid expansion, which was part of the Affordable Care Act, and makes health insurance more affordable for people with lower incomes. According to Saunders, 39 states have adopted and implemented Medicaid, and two more states — South Dakota and North Carolina — have adopted but not yet implemented the Medicaid program. She noted that the 10 states yet to expand Medicaid are mostly concentrated in the South.
Saunders also showed data from the National Survey on Drug Use and Health to highlight the growing prevalence of mental health conditions in the United States, especially among Medicaid beneficiaries. She noted the major gap in access to treatment for behavioral health services, stating that less than 50% of individuals report symptoms of mental health conditions.
“When you look at differences by people of color or by other factors, we see major disparities, also big disparities in age,” Saunders said. “Young adults are the least likely of any age group to need treatment, to receive treatment, which has important implications for university settings like this.”
“WHEN YOU LOOK AT DIFFERENCES BY PEOPLE OF COLOR OR BY OTHER FACTORS, WE SEE MAJOR DISPARITIES, ALSO BIG DISPARITIES IN AGE,” SAUNDERS SAID. “YOUNG ADULTS ARE THE LEAST LIKELY OF ANY AGE GROUP TO NEED TREATMENT, TO RECEIVE TREATMENT, WHICH HAS IMPORTANT IMPLICATIONS FOR UNIVERSITY SETTINGS LIKE THIS.”
Saunders detailed findings from KFF’s Behavioral Health Survey of state Medicaid programs, which serves as a supplement to the 22nd annual budget survey of Medicaid officials. KFF’s survey provides state Medicaid officials with a list of 55 behavioral health benefits and asked them to indicate which were covered under the fee-for-service Medicaid programs for adults, as of July 1, 2022.
After discussing the supplemental survey, Saunders turned her attention back to broader themes from the budget survey, including telehealth and workforce issues. She noted that nearly half of the U.S. population, or 158 million people, live in a mental health workforce shortage area. Today, only 36% of psychiatrists accept new Medicaid specialists — a percentage far lower than other specialties.
“A lot of that probably stems from the stigma, the longstanding stigma around behavioral health services and the disproportionate value that’s placed on physical health services over mental health services,” Saunders said.
Saunders detailed state Medicaid program initiatives to address the workforce shortage, including reimbursement increases for providers, extending the workforce through peer support specialists and addressing administrative burden.
Saunders then turned her attention to telehealth. As of 2021, all reporting states in the KFF survey covered telehealth delivery of behavioral health services. She discussed the role of the COVID-19 pandemic in increasing utilization of telehealth services.
“We know that this space just kind of exploded and there was all of a sudden this need to explore telehealth where people are kind of tinkered with it before but there were administrative barriers,” Saunders said.
Unlike many COVID-19 pandemic policies, Saunders expects telehealth expansions for behavioral health to remain in effect beyond the end of the pandemic.
Saunders ended by answering several questions from student attendees and faculty members.
On Monday, April 3, Cohen discussed the policy implications of the end of the PHE.
Paul R. Verkuil professor of economics and Director of the Schroeder Center for Health Policy Jennifer Mellor spoke to the timeliness of the talk, citing the end of the continuous Medicaid enrollment provisions that have been going on for the last three and a half years.
Cohen explained how the COVID-19 pandemic has shaped her work as a reporter.
“For the past three years, the majority of my life has been taken up by COVID-19,” Cohen said. “The United States is at a major inflection point for the healthcare system and how federal health care policy is shaped. The COVID-19 Public Health Emergency was a very unique reaction and shift in how the federal government provides health care to its citizens.”
Cohen stated that record numbers of Americans accessed health care insurance through the ACA and Medicaid during the pandemic.
Cohen spoke about the difficulties lawmakers will face in rolling back the provisions that led to higher insurance coverage and lower costs, as up to 14 million Americans could lose insurance coverage during the phase-out of provisions.
“It’s going to take up to a year for states to sort of predetermine what’s going on,” Cohen said. “This is going to be a long process and something that maybe you’ll want to pay attention to over the next year.”
To ease the transition, the Centers for Medicare and Medicaid Services, a subsidiary of the Department of Health and Human Services, extended the deadline to sign up through plans offered through the ACA.
Similar to Saunders, Cohen discussed the importance of telemedicine since the onset of the pandemic and workforce shortages. She explained that there is bipartisan support in the United States Congress for legislation on telehealth.
“Republicans have their views about how to save money and over health care efficiency, where oftentimes the Democrats are much more interested in getting the most health care to the most people,” Cohen said. “Telehealth kind of hits the sweet spot in that it does both, that can save money and can get more health care to more people.”
Cohen discussed changes in funding for COVID-19 testing, vaccines and treatment. During the PHE, the government covered the cost of many of these services, allowing Americans to obtain these services at little to no cost. With the end of the PHE, COVID-19 related services will not be covered for all Americans, leaving vulnerable populations at financial risk.
“Vaccines will continue to be free of charge for the vast majority of people under private and public insurance,” Cohen said. “However, there’s going to be a big barrier for the uninsured and underinsured adults largely.”
Cohen cited a recent hearing held by the Senate Committee on Health, Education, Labor and Pensions in which Moderna CEO Stéphane Bancel testified about the company’s decision to increase the price of its COVID-19 vaccine.
One of Cohen’s special areas of interest is biomedical research and development. She discussed the role of the Advanced Research Projects Agency for Health, which supports the development of high-impact research to drive biomedical and health breakthroughs.
“This agency is just in its nascent phase, and it would partner with the private sector and with universities,” Cohen said. “There’s sort of this balance here of how do you make things affordable, but still make it worthwhile and lucrative to partner with the federal government.”
Towards the end of the talk, Mellor asked Cohen if she thinks the U.S. is prepared for the next pandemic.
“I really don’t,” Cohen said. “The pandemic became so political so fast, and beating the pandemic and being over it was sort of like this thing that people were racing towards faster than it was happening.”
Cohen brought up her recent interview with Director of the Centers for Disease Control and Prevention Rochelle Walensky. During the interview, Walensky cited the CDC’s struggle to collect adequate data necessary to prepare for future outbreaks.
Cohen explained that in recent years, the majority of health care legislation passes in larger legislative vehicles. This year, the Pandemic and All Hazards Preparedness Act, which aims to improve the nation’s public health and medical preparedness and response capabilities, expires Sept. 30. According to Cohen, lawmakers will use PAHPA as a legislative vehicle to pass other health care provisions.
Cohen ended by discussing her role as a reporter in Washington, D.C.
“I’ve been covering policy in Washington for a while, and I think it’s a really interesting, dynamic place to be,” she said. “One thing that’s really cool about being a journalist is we’re sort of like the connective tissue between the policy analysts and scientists and lawmakers, because we’re constantly talking to all of them.”
“ONE THING THAT’S REALLY COOL ABOUT BEING A JOURNALIST IS WE’RE SORT OF LIKE THE CONNECTIVE TISSUE BETWEEN THE POLICY ANALYSTS AND SCIENTISTS AND LAWMAKERS, BECAUSE WE’RE CONSTANTLY TALKING TO ALL OF THEM.”
Kelsi Putnam ’23, a founder of the Health Policy Club, attended both Schroeder Center events. She discussed the importance of engaging the community in these talks.
“I think it’s a great way to get our community more involved in issues that are potentially going to affect them,” Putnam said.
She commended the Schroeder Center for holding these events.
“Both the talks show how broad a field health policy is, and the Schroeder Center does a great job finding speakers who cover a range of topics to not only inform students of health policy, but get them excited about it,” Putnam said.
