With its more than 115,000 members and dedicated advocacy staff, APA is the largest and most visible national group advocating for psychology. The association speaks out on a wide range of issues, but only pursues issues for which psychology has recognized expertise and that are consistent with APA’s mission to advance psychology as a science and profession, and as a means of promoting health, education and human welfare. In addition, APA prioritizes issues that are supported by its governance groups, as well as issues in which psychology’s role is an important factor in advancing a legislative goal.
Health-care reform, and the critical role that psychologists play in health care, has been an APA advocacy priority for decades. The association’s most recent efforts have centered on safeguarding the Affordable Care Act of 2010 (ACA), which increased access to health insurance for 32 million Americans.
Increasing access. The law expanded Medicaid and established health insurance exchanges, which offer consumers comprehensive coverage and financial assistance with their premiums and cost-sharing obligations, such as copays and deductibles. The ACA also requires insurance plans to cover mental health and substance use disorder services, including behavioral health treatment, and extends mental health parity to small group and individual market plans.
Due in part to strong advocacy by APA and the APA Practice Organization (APAPO), the ACA also opened up new opportunities for psychologists in the private health-care system and in public health programs, and prohibited insurers from denying coverage or increasing premium rates due to pre-existing conditions.
Protecting patients. During 2017, psychologists voiced strong opposition to every new proposal by Congress and the Trump administration to repeal or dilute the ACA’s protections, destabilize its insurance markets, and eliminate or detrimentally alter Medicaid for millions of Americans. APA and APAPO joined together to issue more than 25 Action Alerts and Information Updates about the ACA. Our members rose to the occasion each time, sending almost 60,000 messages to Congress, urging them to preserve the law.
Government relations staff for both APA and APAPO led the charge on multiple responses. This advocacy included opposing President Trump’s executive order on association health plans and short-term insurance plans as well as on the president’s decision to halt cost-sharing reduction payments. In addition, APA spoke out on a variety of legislative efforts, such as the American Health Care Act, the Better Care Reconciliation Act, the Graham-Cassidy-Heller-Johnson proposal, and the “skinny” repeal.
Moving forward. APA strongly supports bipartisan efforts to stabilize the nation’s health insurance marketplaces, lower costs to consumers and expand access to mental health care. APA and APAPO will continue to monitor and engage members to support psychologists’ interests on these and other key health-reform issues.
For more information, go to www.apa.org/advocacy/health/affordable-care.aspx.
President Trump has vowed to build a wall along the Mexico-U.S. border, issued a travel ban affecting six predominantly Muslim countries, as well as North Korea and Venezuela, ended the Deferred Action for Childhood Arrivals (DACA) program and initiated many other anti-immigrant policies. APA has a long history of advocating for immigration policies that keep families together and discourage deportation. The Trump administration’s actions have intensified these efforts.
Mental health risks. Research has found that threats to immigrants and their families have significant psychological impacts and are linked to increased risks of overall health problems. Sustained or sudden separation of parents and children due to deportation is particularly damaging. The trauma that results from this experience often leads children to experience ongoing difficulty trusting adults and institutions, and places them at risk for housing and food insecurity as well as post-traumatic stress disorder, among other adverse effects.
APA action. The association hosted a congressional briefing on the Dream Act of 2017 and sent a letter to Congress in support of the legislation, which would provide a path to citizenship for undocumented youth and young adults who were brought to the United States illegally as children. Both the letter and the briefing informed Congress about the latest research on the mental health risks of separating families. In addition, APA has issued statements calling on President Trump to protect DACA and sent letters to then-Secretary of Homeland Security John F. Kelly opposing the separation of families at the border. APA also spearheads an immigration working group in which psychologists collaborate with policy experts to strategize on sound immigration policy.
APA works to inform and mobilize the public and members about the importance of DACA as well. In December, then-APA President Antonio E. Puente, PhD, published an op-ed in USA Today in support of the Dream Act. And, in January, APA sent an Action Alert to its members, urging them to write to members of Congress to advocate for the Dream Act. At press time, more than 250 letters had been sent. APA will continue to advocate for DACA until it becomes law.
For more information, see the “APA Resolution on Immigrant Children, Youth, and Families” at www.apa.org/about/policy/immigrants.aspx. To get involved, go to www.apa.org/advocacy/immigration/index.aspx.
In 2017, President Trump declared the opioid epidemic a public health emergency. Some 91 Americans die each day from opioid overdose, according to the national Centers for Disease Control and Prevention (CDC), and the number of youths entering the child welfare system is increasing due to opioid use among parents. This public health crisis has been driven largely by the overuse and overprescribing of opioids for pain management: The number of prescription opioids sold to pharmacies, hospitals and physicians’ offices nearly quadrupled from 1999 to 2010. The number of deaths due to opioid overdose has also quadrupled since 1999, according to the CDC.
A starting place. In November, the President’s Commission on Combating Drug Addiction and the Opioid Crisis issued a comprehensive list of recommendations for preventing and treating opioid addiction. While APA applauded this much-needed effort, it is only a first step. Congress has yet to provide dedicated funding to implement these recommendations.
Urgent needs. APA is urging Congress and the administration to take the following actions to address the opioid crisis:
- Launch a public service campaign about the dangers of opioids.
- Fund research into and promote nonpharmacological alternatives for pain management by mental health professionals.
- Decriminalize opioid use and establish federal drug courts that focus on treatment and rehabilitation over incarceration for nonviolent offenders.
- Allow governments to negotiate lower prices for naloxone, the life-saving drug that can counteract the effects of overdose.
- Increase funding for research on effective treatments by the National Institutes of Health (NIH) and for substance use prevention and treatment services at the Substance Abuse and Mental Health Services Administration.
- Improve training on evidence-based addiction treatment.
- Ramp up enforcement of the Mental Health Parity and Addiction Equity Act of 2008, which requires insurance providers to cover substance use disorders at the same level as physical conditions.
- Provide additional funding for mental health counseling in schools and other social service systems that are seeing an increased need for services due to this epidemic.
Funding for research
Federal funding is the lifeblood of psychological science. Agencies including the NIH, National Science Foundation (NSF) and Institute of Education Sciences (IES) support research by a broad variety of scientific disciplines, including psychology, in service of their missions to improve health, expand basic scientific knowledge, and improve education, respectively. Research funding in the aggregate is higher than it was after substantial cuts in 2013 (NIH lost $1 billion that year). However, the spending caps adopted as part of the Budget Control Act of 2011 will reduce overall spending each year through 2021.
APA’s priority. APA advocacy is focused on increasing the overall budgets for research funding, with a specific focus on boosting funding for the behavioral and social sciences. To amplify its message, APA participates in broad funding coalitions, including the Coalition for National Science Funding (to increase the NSF budget), the Ad Hoc Group for Medical Research (focused on NIH), the Coalition for Health Funding (focused on all Public Health Service agencies), and the Friends of IES (focused on education research). In addition, APA signs joint letters to members of Congress, meets with congressional staff and members, engages association members via Action Alerts and participates in joint social media events designed to help move Congress toward APA’s funding goals.
What’s ahead. Among other priorities, APA is calling for Congress to:
- Support significant, sustained increases in FY 2018 appropriations for the research budgets of the NIH, CDC, NSF, Department of Veterans Affairs, Department of Justice and Department of Education.
- Oppose cuts to NSF’s Directorate for Social, Behavioral and Economic Sciences.
- End sequestration and take a balanced approach to deficit reduction that does not rely solely on discretionary spending cuts.
- Empower agencies to choose which scientific advisers are most appropriate and refrain from imposing partisan or ideological tests on research results.
Outlook for 2018. As the Monitor went to press in late January, the funding picture for psychological science was still unknown because the federal government was still operating on temporary funding authority (a continuing resolution). The leadership of the U.S. House and Senate must negotiate overall funding levels before they can vote on any appropriations bills.
For more information and to get involved, go to www.apa.org/advocacy/federal-funding/index.aspx.
As health care in the United States continues to embrace integrated primary care, the next generation of psychologists must be prepared to work in these settings. There is also a dire need for more psychologists to treat high-need, underserved communities.
To help meet these demands, APA has worked to establish and support federal programs that expand access to care and provide critical training for psychologists and graduate students—particularly the Graduate Psychology Education (GPE) Program and the Behavioral Health Workforce Education and Training (BHWET) Program.
Critical funding. While the association has made significant progress in increasing funding for these programs, more work is needed. GPE currently supports 31 grants that provide training for psychology practicum students, interns and postdocs who work to address the behavioral health needs of vulnerable populations, including older adults, children, ethnic-minority populations and veterans. The program, established in 2002 after years of advocacy by APA, is funded by the Department of Health and Human Services’ Health Resources and Services Administration. Because of APA’s efforts, the program has grown from $2.7 million in FY 2013 to $8.9 million in FY 2017. For next year, APA has requested an increase to $10 million.
APA also fought to secure funding for the BHWET Program, which was formally authorized as part of the 21st Century Cures Act of 2016. The program—which supports 12 disciplines, including psychology—seeks to develop the behavioral health workforce by supporting interdisciplinary training for students, graduate students, faculty and field supervisors. APA’s successful advocacy efforts resulted in two important expansions of the program: eligibility for doctoral programs in health service psychology and targeting patients across the life span instead of including only youths. These changes led to an increase in grant funding from $875,000 in 2014 to more than $5 million across 21 programs supporting doctoral psychology training in 2017.
Ongoing threats. Despite a shortage of psychologists in many at-risk communities, these programs may be targeted for elimination by the Trump administration. To find out how you can help keep this funding intact, go to http://cqrcengage.com/apapolicy/edgro.
Public service loan forgiveness
Today’s psychology graduate students and early career psychologists have an average of $110,000 in student loan debt—financial pressure that can keep many graduates from pursuing lower-paying public service careers.
To help address this problem, the Public Service Loan Forgiveness (PSLF) Program offers debt relief for psychology students and others who commit to working in government or the nonprofit sector for 10 years. These careers may include working in public health, serving veterans or providing behavioral health services to communities in need. Preserving the PSLF Program is one of APA’s top priorities.
Program at risk. Legislation passed in December by the Committee on Education and the Workforce in the U.S. House of Representatives—called the PROSPER Act—would eliminate the PSLF Program for new borrowers if Congress passes the legislation.
The PSLF Program is also facing challenges from the U.S. Department of Education, which announced last year that it may stop providing debt relief for some students—even for those who have already started training and were counting on loan forgiveness. Eliminating or changing the PSLF Program would prevent many of these students from pursuing graduate education in psychology and would jeopardize behavioral health care in communities with the most need.
Fighting for forgiveness. To protect PSLF, APA signed on to a letter—along with 35 other concerned associations—to Education Secretary Betsy DeVos, calling for her to uphold the program’s initial promise.
In addition, APA Action Alerts directed 1,700 messages to Congress opposing the elimination of this program, and the association worked independently as well as with a coalition of 50 other organizations to educate members of Congress about the value of the program. As part of that effort, APA helped secure Republican support for an amendment that would have reinstated the program. While the amendment failed, APA is building on this bipartisan demonstration to seek to reauthorize the program.
Finally, the association continues to work to maintain the accessibility and affordability of graduate study, including preserving tuition waivers and the student loan interest deduction. Learn more and sign up for action alerts at: www.apa.org/advocacy/higher-education/student-debt/loan-forgiveness.aspx.
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