APNA President Susie AdamsA Message from the President

July 2015

This message reflects my own personal thoughts about the recent Supreme Court ruling and access to healthcare in the U.S. It does not represent an official APNA position.

Nearly 62 million Americans have received increased access to mental health and substance use services as a result of the Affordable Care Act (ACA) and the federal parity law (the Mental Health Parity and Addiction Equity Act). The U.S. Supreme Courted ruled 6-3 on June 25, 2015 that Internal Revenue Service (IRS) subsidies for health care coverage under the Affordable Care Act (ACA, Obamacare) are legal. Had the plaintiffs won (King vs Burwell), it would herald an end to subsidies for people with incomes between 100% to 400% below the poverty level and left 6-7% of our nations’ poorest without access to affordable health insurance. The ruling upholds that all states can issue subsidies whether they have set up their own exchange or whether the federal government sets up that exchange for them.

As I reflected on this landmark decision that upholds access to health care for low-income Americans, I wondered what impact this will have on the 4 million people who fall into the “coverage gap” in the 22 states who had previously opted-out of Medicaid expansion under the ACA. Living in one of those 22 states (Tennessee), I’m aware of the demographics and unmet health and mental health/substance use treatment needs. Individuals who have income above Medicaid eligibility greater than 44% of federal poverty level (FPL)* ($8,840 for parents in a family of three) but below the lower limit for ACA Marketplace premiums (subsidies) 100% FPL* ($11,770 for an individual) are not eligible for the ACA subsidies. Medicaid expansion was designed to reach low-income adults left out of the employer-based system. Nationally uninsured adults who fall into the “coverage gap” reside predominantly in the southern U.S. and are comprised of 43% White non-Hispanics, 27% Black, and 24% Hispanics. Over half are middle-aged (age 35-54) or near elderly (age 55-64) and may often leave health needs untreated while waiting until age 65 when they become eligible for Medicare coverage. This only defers health care costs that become more serious and more costly when left untreated for years or decades. While variations of state administered health care coverage are negotiated in the months following the King vs Burwell ruling, the overarching goal needs to be providing affordable, accessible health care to Americans in a fair and equitable manner. As psychiatric nurses we need to stay abreast of pending legislation and rulings that impact health care delivery for the individuals, families and communities we serve. Make time to stay informed and use your voice to advocate for those we serve.

One particularly helpful tool to help you stay informed is the new monthly APNA State Legislative Activity Report, now included in this newsletter. APNA’s new legislative tracking system allows the organization to provide you with easy access to information regarding any proposed legislation in your state that may impact your professional interests as a psychiatric-mental health nurse and an advocate for mental health. You can view this month’s report here.




Susie Adams, PhD, RN, PMHNP, FAANP



*Kaiser Family Foundation. (April 2015). Issue Brief: The Coverage Gap: Uninsured Poor Adults in State that Do No Expand Medicaid – An Update. Retrieved from http://files.kff.org/attachment/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid-issue-brief

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