This week, Montana becomes the 29th state (plus the District of Columbia) to close the coverage gap, and the first state to get legislative approval to expand Medicaid in over a year. As a result, 70,000 low-income Montanans will soon gain health coverage, many for the first time.

This was not an easy fight. The bipartisan compromise passed through both Republican-controlled chambers this month despite the best efforts of well-funded conservative political organizations like Americans for Prosperity (AFP) and the state’s Tea Party-affiliated House leadership.

How did people prevail over politics? There are a lot of reasons, but top among them is smart, sustained, authentic community organizing.

Under the leadership of Montana Women Vote and the Montana Human Rights Network among others, a coalition of advocates had been conducting public education events and canvassing in key districts on this issue since 2013. Over the years, they built a list of thousands of volunteers who were educated and actively engaged, they trained dozens of Montanans who were trapped in the coverage gap to lift up their voices, and they engaged countless hospitals, businesses, and even city council-members in target areas.

Because of this solid groundwork, the campaign was able to generate a firestorm of support for closing the coverage gap in the weeks leading up to the final votes, including over 11,000 calls to legislators and an average of 8-10 earned media pieces a week.

By contrast, AFP did not invest time building relationships in affected communities on this issue. Instead, they invested hundreds of thousands of dollars, and assumed that would buy them the influence they needed. But they were wrong.

AFP and other conservative political organizations relied on expensive paid ads, push-polls and mailers in the weeks leading up to the vote to generate opposition to closing the coverage gap. But without pre-existing relationships on the ground, these efforts generated only 755 calls to legislators during the week of the key votes; during that same week, supporters generated nearly 6,000. And when AFP organized “town hall” events to target three Republican legislators who were considering supporting the bill, Montana citizens who supported closing the coverage gap turned out in such high numbers that AFP was forced to apologize for its tactics.

The recent success in Montana is a win for low-income Montanans, and it’s a refreshing reminder that sustained, strategic and organized consumer advocacy can triumph over moneyed interests.

Yesterday, we alerted our partners to the great news that the Senate had passed H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). In addition to permanently repealing the Sustainable Growth Rate, the flawed formula used to determine Medicare physician payment rates, we are pleased that MACRA refunds the Children’s Health Insurance Program (CHIP) for two years with all its current provisions intact. It also provides funds for community health centers, the Maternal Infant Early Childhood Home Visiting program, and family-to-family information centers and continues the Transitional Medical Assistance program which supports families as they transition out of Medicaid eligibility.

In reflecting on this huge win for children and families, we want to thank our partners for their tireless advocacy for CHIP. These advocates encouraged their governors to submit comments about the importance of CHIP in their state, educated their Congressional delegations about the harm that would come from losing CHIP funding, and activated their grassroots to ensure policymakers heard the message loud and clear. Their engagement on the issue of CHIP funding has been unflagging, and we are deeply appreciative of their work—we hope they will take a moment out of their busy schedules to take a victory lap!

So what’s next for children’s health? We still have plenty of work to do, ensuring that kids who enroll in Marketplace plans—now or in the future—have access to comprehensive benefits and provider networks via policies that are affordable for their families. We need to continue exploring policies that will support continuity of coverage and reduce churn, so kids can stay connected to the care they need. And we are excited to think about health system transformation with an eye toward children’s health, building on our existing work on children’s health care quality. We are looking forward to engaging with our partners on all these topics and more. 

Imagine you have diabetes and your insurer won’t pay for insulin. Instead, you have to pay out of pocket or face blindness, or even death? Now imagine you learn that people like you with diabetes were twice as likely to be denied treatment compared to people with other medical problems. Sound unfair to you?

For millions of people who need treatment for drug and alcohol problems or mental illness, inequity is a reality.

Behavioral health discrimination in health insurance is once again in the spotlight. Health insurance denials for substance use and mental health care in private insurance plans were nearly twice those for other medical care in the last year, according to a report released last week by the National Alliance on Mental Illness (NAMI). NAMI is one of our partners advocating for more fair treatment for people living with chronic behavioral health problems.

For years, people with behavioral health issues, their loved ones and advocates have pushed for a more equitable system, one in which substance use and mental health treatment is covered equally, or at parity with, other forms of medical treatment under health insurance plans. This work resulted in the 2008 passage of the Mental Health Parity and Addiction Equity Act, a federal law requiring many health insurance plans to follow parity rules, meaning that if they offer mental health and substance use disorders benefits, they must cover them equally to other medical benefits. The Affordable Care Act (ACA) has extended these protections to more health plans. New federal regulations were issued in late 2013 for private plans and proposed regulations came out last week for Medicaid.

NAMI surveyed nearly 3,000 behavioral health consumers (thanks to those of you who participated!) and analyzed 84 insurance plans in 15 states. The takeaway? While more consumers than ever should have access to health plans that require behavioral health parity as a result of the ACA and the federal parity law, consumers are often left without the treatment they so desperately need.

In addition to the high rate of substance use and mental health coverage denials, the survey’s highlight other common problems with parity implementation:

  • Many insurance networks have far too few substance use and mental health providers
  • Discriminatory drug tiering, when insurance companies make medication for certain conditions more costly for the consumer, creates barriers to needed for substance use and mental health disorders
  • Consumers do not have enough information about behavioral health coverage to compare health plans and choose a health plan that meets their needs

What can we do?

If you’re looking for even more ideas, you’re in luck! Keep your eye out for new Community Catalyst resources on behavioral health parity enforcement in the coming months. It’s time to leverage the letter of the law to make behavioral health equity a reality in our health system. Together we can make change – let’s work to keep the spotlight on parity.  

We know we’re starting to sound like a broken record, but we couldn’t help but share that yet another report boasts how closing the gap is good for state budgets. It’s no surprise—similar to the outcomes we highlighted in previous posts, this most recent study from the Robert Wood Johnson Foundation and Manatt Health Solutions finds that closing the gap will deliver more than $1.8 billion in savings and new revenues for eight states by the end of 2015.

These savings and revenues come from three key sources:

  • Savings from enhanced federal matching. States that have closed the gap receive 100 percent federal funding for providing full Medicaid coverage to beneficiaries who previously had limited Medicaid benefits. These folks include “medically needy” individuals, pregnant women and individuals with disabilities. Seven out of the eight states in this study projected savings in this category.
  • Reduced state spending on programs for the uninsured. Now that certain groups of people are no longer in the coverage gap and are able to secure full Medicaid benefits, every expansion state will spend much less on state-funded health care for prisoners, mental and behavioral health programs, public health programs and uncompensated care funding to hospitals.
  • Increased revenue from insurer taxes. Four states in the report were able to capture increased revenue because more people are covered – although all states with these taxes will get in on this action. For example, Arkansas brought in $4.7 million in 2014 and will bring in almost $30 million in 2015 as a result of having closed the coverage gap.

The results are clear – drawing down federal funds to cover more people is good for state budgets. It’s also exciting that both Arkansas and Kentucky were able to calculate that their savings and revenue will more than pay for expansion through 2021. We only hope that policymakers in states with a remaining coverage gap hear this good news loud and clear!

Last week, the Edward M. Kennedy Institute for the United States Senate opened here in Boston. The institute features a to-scale replica of the Senate chamber and will be used as a tool to teach civic engagement, negotiation and debate. The dedication of the institute was a moving tribute to Senator Kennedy and to the legislative body in which he served for 47 years.

It is also a fitting acknowledgement of the  man who worked tirelessly toward health care coverage and access for all Americans that, next week, the Senate will return from recess and resume its consideration of a H.R. 2, a legislative package that would extend the Children’s Health Insurance Program (CHIP). Senator Kennedy and Senator Orrin Hatch (R-UT) worked with colleagues from both sides of the aisle to launch CHIP in 1997, and more than 17 years later, this program is still vital to the health and well-being of millions of children across the country.

The Senate must act quickly next week to extend CHIP and protect the coverage of 8 million children. Advocates and governors across the country have asked Congress to continue CHIP. We are hopeful that the Senate will move swiftly to answer them.