Medicare: What To Expect From the 117th Congress - S1E10

Dr. S. Kent Dr. Butler: Welcome to The Voice of Counseling from the American Counseling Association. I'm Dr. S Kent Butler, and joining us today, Brian Banks. Brian is the Chief Government Affairs and Public Policy Officer for the American Counseling Association. Today, we're exploring Medicare. You're ready? How are you doing, Brian? 

Brian Banks: I'm doing well, Dr. Butler. Thank you for having me today 

Dr. Butler: Good to see you. Good to see you. We're going to explore Medicare, it seems, and you're going to tell us a little bit about what you do, how you bring it all together, and how counselors are supported by you and the staff at American Counseling Association. First, before we even get started, you've been here now at the American Counseling Association for how long now? 

Brian: Just about three years, I've been here. Prior to here, I was with the United States Air Force supporting the secretary. The same type of work. 

Dr. Butler: Okay, for us who are new to the game, and who have not had the opportunity to meet Brian Banks, what do you do for the American Counseling Association? How do we get to know who you are and what you bring to the table? 

Brian: That's a great question, Dr. Butler. When someone asks me what I do, I always tell them that's it's my job and the people that I work with's job to protect the organization. It's our job to ensure that we understand the policies, we understand the laws, we understand the proposals that affect this profession or that may affect this profession. In a sense, we're your detectives. We're looking around at every policy possible through all 50 states, through the US territories, and we rely on our grassroots, which are members and stakeholders and people that just care about counseling issues. They help guide us as we go through the several different issues that we work on. 

Today, we're talking about Medicare, but that's not all we do. We focus on issues with school counselors, counselor educators, rehab counselors, we work within the federal government, with the VA, and even the Government Accountability Office, which a lot of counselors aren't familiar with. They actually do hire, the GAO, they hire counselors to actually help their employees on staff with issues and concerns that they may have. 

In short, I'm looking at the policies and the issues that are going to make a difference or potentially attack this profession, and ensure we put our best foot forward with research, analysis, and historical perspective, as well as stories that matter to members of Congress, state legislators, that can help them fight for us in their respective offices. 

Dr. Butler: Good. I love that part of what you're doing for the organization. How do counselors get involved and how do they then take part in what you're doing so that they can move the needle forward as well? 

Brian: Absolutely. Well, there's several ways counselors can get involved. I'm going to tell you a few that are very, very critical to our organization. One, if a counselor was to go to the Government Affairs website on www.counselling.org, those are the Government Affairs website, and you click on the Take Action tab, once you get there, if you were to scroll to the very bottom of that page, anyone, counselor or not, my mom is signed up on this, can put in their name and their address, and they're going to get action alerts from the association, which is going to come directly to their emails. 

Those are issues that we care about as an association for our members, and the member can take two minutes, literally, two minutes, to respond. I'm going to give an example. Say a member wants to respond on Medicare. When that one person responds, they are actually sending three messages. One to their senator, and two to their members of the House of Representatives. 

Dr. Butler: It's just that easy. 

Brian: It's just that easy. Another way to get involved is just reach out to us. Pick up the phone and call us or email us. Our email is advocacy@counseling.org. Email us. If you have a question, a concern, you have intel, you just want to know what we're doing, send us an email and we'll respond within 48 hours. Those emails are extremely helpful. Just about any success that we've had has come because we've had members that have been involved in the issue, whether they know the issue or not, whether they're comfortable or not, we help get them there. They definitely can rely on us to support them. 

Dr. Butler: That's really good. That's how we have evolved as a profession, I guess, using technology and everything else because before, you had to sit down and write a letter and do this and do that. It took a lot of time. Now we have put forth through our organization, a very escape-proof, a very easy way to get counselors to be involved and still continue on with their day. 

Brian: Continue on with their day. Listen, we do the work for you. We'll write everything up that you need. We do ask if counselors have a very personal story to share that can pull on the heartstrings or provide intel to members of Congress. Share those stories. They do make a huge difference. 

Another thing counselors have to be aware of, and I'm going to use this example in- wow, I guess it was 2018 when we were in New Orleans at a conference. A counselor came to me and goes, "Hey, I'm not a mental health counselor, but I want to help with Medicare. Should I respond to these action alerts?" The answer is yes. If you are a mental health counselor and there's a school counselor issue, you should respond to those action alerts as well. They're strengthened in numbers. It gives us the clout and the credibility that we need as a profession and it also shows the members on the Hill or the state legislator that there is a profession out there, people that are constituents that need help and assistance, they are already in the process of helping the constituents in that state. They'll listen to us because we are the experts. 

Dr. Butler: I heard you slip in mom there a while ago. Tell me, what does your mom do? Is she a counselor, not a counselor? How's she involved? Is she there just because of her son, or what's going on? How's she getting these alerts? 

Brian: Well, I'll tell you what, not just my mom, but my dad and my brother, my sister-in-law is a counselor, but you asked me about my mom. My mom is not a counselor. My mom is retired. She's well into her seventies. In my family, we've always been service-oriented people. My mom was a nurse, but she's now- her and my dad both are retired, and of course, they want to help their boys when they can. 

Dr. Butler: Nice. Right. That's a good answer because anybody can get involved in this game because really what it means is getting into the voices of- or getting our voices into the spheres of our Congresspeople so that they can do the work that's necessary to move it forward. 

Brian: Absolutely. You're 100% right. 

Dr. Butler: Thanks, mom. I know you're watching. We appreciate what you're doing for Brian and for our organization. Brian, 1989 was the last update of the CMS made for Medicare or to Medicare. First of all, describe CMS so the people understand what that is, so that everybody's on the right page with that. Again, from 1989, what is new in the program in 2021 that supports the counseling profession? 

Brian: Okay, perfect. Thank you for that question. CMS, the Center for Medicare & Medicaid Services, they're a government agency. The short of it, they're the agency that when we actually get this bill passed, that are going to approve the bills. They're going to get counselors paid. They also look at the codes that counselors use to actually get reimbursed from Medicare. Of course, they work on Medicaid issues that some counselors will take advantage of right now, or I shouldn't say take advantage of, utilize with their clients. 

Now, as it pertains to this bill, the Mental Health Access Improvement Act has been around for quite some time. This year, the Senate bill is S.828, which stands for Senate, and the bill is 828. It's the 828th bill that was introduced in the Senate. The Congress bill is House Resolution 432. Over the years, there have been progress with this bill, which is actually a great thing. 

The bill has passed in the House a couple of times, it has passed in the Senate a couple of times, but never at the same time. However, Congress sees the value of this profession. I'm going to give you two examples, Dr. Butler. We have federal-certified opioid treatment programs across the nation. Unfortunately, those centers are jam-packed and the staffs there are overworked. Congress, CNS, saw the need to bring in more professions to do the work. 

The first profession that they looked to were licensed professional counselors, mental health counselors. Going on now a little over two years, we have mental health counselors that are in these facilities, working with clients. When the work is concluded, the facility is being reimbursed through Medicare. As you see, CMS, the federal government has already said that counselors matter, their work is efficient and they're experts, and they can tap into the Medicare system. The difference is the Medicare funds that come to the facility do not go to the counselor for the services rendered. It goes to the facility. Go ahead, please. 

Dr. Butler: How do we get Congress and others to recognize that this is a dilemma maybe, especially with regards to counselors? Because we do see or feel as though we're invisible to society with regards to not only the services that we offer, but how they view us with regards to what we do for mental health, I guess, the field, and for our clients. 

Brian: Exactly. The reality of it now, the good, the bad, the ugly in our country right now has led Congress to say, "Well, we have a mental health crisis. We need to find a way to solve this problem." Here's the good of it. Many of the members, that's not all of the members on Capitol Hill that the American Counseling Association has talked to and we've spoken to hundreds, agree with us when we talk about Medicare. They agree that there's a need to increase access to clients. They understand that counselors are well-trained and they pretty much do the same work as a social worker. 

Quite frankly, they know that counselors, when it comes to clinical training, have more training for the most part throughout the country in the States. They look at it as a profession that needs to be within the program. Here's a problem that Congress faces, and it's a two-prong problem here. When you look at the conservatives on Capitol Hill, they need to have more business arguments about why this bill should pass. They're concerned about the cost of the bill, quite frankly. The score on this bill, and when I say the score, it means the cost for anyone that's listening, which is done by the Congressional Budget Office. They get a bill, they read through it. 

What they won't tell you, a lot of people don't know, mental health bills usually start at 1 billion. That's where they usually start. This bill will cost 1.5 to 1.6 over a 10-year time period. When a Republican looks at that, and then they look at the state of Medicare today, it concerns them because they see it as money that the federal government may not have in the future to fund this program. That's okay because they [unintelligible 00:12:04]. 

Dr. Butler: You specifically said "Republicans". Is there a reason why you specifically said "Republican"? 

Brian: In this case, yes, there is. I'll tell you this. Two of our strongest sponsors, especially our Senate sponsor Senator Barrasso and we also have Representative Katko, Republican Party, they support this bill and they're very, very well-respected. When you look at the conservative side of the aisle, they want to save money, and they want to make sure they're making money for this country. Being that the Medicare program is in flux and people don't know what's going to happen, they believe their program's running out of money, it does concern them. They're looking for innovative ways to save money and to move this program forward. 

That's what ACA did. Dr Butler, we have a brand new document online. It's a Medicare brief, and we also have a summary of that brief online, on the ACA website, which explains how the federal government can actually save money through the Medicare program when they let counselors in the program. We're doing our job, and we're continuing to sell that story to make a difference for the profession. 

Dr. Butler: I just find it funny, maybe you can walk me through this being in the policy the way that you are, I've always heard that this costs too much money, and you're punting it down the road a little bit, and it's going to cost money for- it's going to hurt our children and those individuals. I'm of the mindset that every year since the government has been in existence, they've been punting it down the road to the future generation. 

How does that stick? How does that mantra of "We're going to be putting this pressure on future generations to pay this bill down" really stick when, in all actuality, we're all doing it? Every generation is paying back or doing something to pay off something that future or past iterations of Congress have put forward. Help me understand that. 

Brian: That's a great question. I'll tell you this. I have worked in healthcare, education, gaming, all types of different issues, working with Congress. When you look at Congress, they do their best work when they compromise and when they work together on issues. We're in a new place right now where there's a lot of concern, and quite frankly, there's a lack of people compromising. 

When you talk about over the years, a bill like this, when you have a mental health bill or a healthcare bill, it's going to cost- to pay for it, it's going to cost, or you have to find money from somewhere to pay for it. The concern is where do we find this money? Well, here's the reality. I told you earlier I worked for the Air Force. When I worked for the Air Force, there is the National Defense Authorization Act. People don't know that in that bill, there's money for the counseling or the mental health profession and counselors do take advantage of it. That bill is-- Oh my gosh. I can't remember the exact amount, but it's not even close to what we were- this 1.5, 1.6, it's well beyond that. It's a priority of Congress and what they really want to fund. 

Also, over the years, this bill, and I'm going to be really blunt here when I say this, this is a bill that's a little different because if you looked at a bill, and I don't have a bill number in it right now for the psychologists or the social workers, they may want to add something to Medicare. Maybe they believe they have an increased payment. I'm not arguing for or against what they want to do. They're very good professions and we have to work together. Then you look at the Medicare bill, it's a bill that actually combines professions. 

Counselors are included in this bill as well as the marriage and family therapists in this bill. Essentially when you look at the cost, which many conservatives are concerned about, having two professions in that bill is going to increase the score. That's a challenge as well. Currently, what we have to do is work together with those groups to ensure that we're telling the appropriate story and we're empowering these members with the information they need. 

We talked about the Republic against the conservative side, but there's some conservative Democrats as well. A lot of times with the Democrats, and I used to work on Capitol Hill for a little while, I don't want to offend anyone, but you have to pull on the heartstrings of the Democrat and tell the story that relates to the constituent for them to understand and get them to see the need for it. Quite frankly, there's some Democrats on the Hill as well that are concerned about the cost and they're actually doing the right thing. They have to show that concern because they're supporting their state, right? 

Dr. Butler: Right. 

Brian: As well as the country. It's our job to ensure that we're empowering them with the best research and the best analysis to show them how this bill, especially in the House, how it's going to help their constituents, in the Senate, how it's going to help their constituents as well, and also how it's going to help the nation. 

We are part of the Medicare Coalition. In that group, we have national groups like- I'm trying to think, NBC is a part of the group. I'm trying to think of groups that counselors would know. We have aging groups in Oregon. They're a small group in Oregon that has an association on aging. They're part of the group, and there's several other people as well. We come together to make sure we can tell the story in an effective way. 

Last thing, the most effect that we've had at ACA is really going back to the grassroots which are our members and the people engaging, whether it's sending those letter, those action alerts are actually coming to meetings with ACA which I should have mentioned earlier, so I apologize to the listeners. We need your help. We send requests out to members to come with us to these meetings. They're all virtual now. It's much easier to meet with your legislators and to meet with the staffers and tell your stories. That makes a huge difference, and it does help push the needle forward. 

Dr. Butler: I get it, but I don't buy it when it comes to the whole thing about all this money that's going to be put on future generations. The reason why is because, like I said earlier, we're always going to be paying down the debt. Nobody has proved to me that there was ever a time that we weren't paying down the debt. Is there another approach to getting to these individuals? Because I think that sometimes they're just playing a political game. 

They get what they want, they'll go for it. If they don't get what they want, then they won't go for it, but mental health and how people are surviving in this world is so extremely important. To play political games with it is, I believe, malpractice on the parts of these senators and representatives who are doing this work on behalf of all of us here in the US. I think that when I see those types of things happening, playing with people's lives in the manner in which that I see them doing that, there's got to be some type of accountability, something where. Where are the adults in the room that stops this bad behavior of people not really caring for the citizens who really truly need their support and their help? 

Brian: You bring up a lot of good points, and I think we could do another hour of this to talk about the adults in a room, but I'll tell you this. You bring up some really good points, and I'm trying to go through several of them fairly quickly. Just stop me if you need clarification. With our members, it's one thing for me to say, "Let's do our action alerts, come to meetings," but another thing that we have to do is as a community, the counseling community, we need to be more involved, and I'm not saying every person needs to hop on a plane when it's safe to come to DC and go to Capitol Hill. 

Just about every weekend, the members fly home. When they fly home, they're doing town hall meetings. They're given updates on their agenda to their community in public forums. We need to be able to attend those meetings. How do you learn about those meetings? You simply go to the website of that member. You can Google their name. If you don't know who they are, you just Google your address. If they're a member of Congress, member of the state legislator, it will pop up. Go to their website and you can sign up for the updates, and you'll receive all of those updates. Our voices need to be heard on Capitol Hill as well as at home. 

That makes a huge difference. Also, I'm not a huge campaign guy when it comes to working campaigns, and, "Vote for this person." I've done that before, not my cup of tea. However, it's very important. It is critical for our members to know that campaigns can take place by an individual at home. You don't have to worry about voting for a person. Go to the person that's already won, speak to them about this issue, and let them know who you are as a person, so they'll know they have an expert that will fight for them and help them be a voice. We have to help them make the right decisions. 

The last thing I'll say is, if they're not being accountable, holding themselves accountable, and being responsible, as a nation, we need to hold them responsible. Vote them out of office. Get some other people in there. I have to do this, Dr. Butler, one last thing. Counselors, there is an opportunity to run for office. There's an opportunity to be a part of the school board. There's an opportunity to sit on your license board, be a part of the conversation. 

Dr. Butler: Say it loud for people in the back. 

Brian: You're right, Dr. Butler. 

Dr. Butler: I think that that's really important because I think one of the misnomers that I think counselors sometimes think of is the only thing they really do is they sit in a counseling room and counsel. The social justice advocacy part is so important in terms of getting out there, getting in the faces of our legislators, and doing the hard work that's necessary to help move the needle because it could be that compelling voice that the person who finally hears that is able to push the needle a little bit further in terms of them then taking a stance. That's for the right thing to do. 

That's really what we're hoping and looking for them to be able to do, is to do the right thing for the citizens. Not because of some type of lobbying or something that's going on that's stopping the process. Another question I have for you in regards to Medicare goes with reimbursement. Medicare reimbursement is important to counselors. How should the profession go about informing Congress of the need for this bill to become a law? 

Brian: That's a great question. When you look at this bill-- Well, you know what? Let me just say this. Members of Congress need to know how this affects them at home. ACA, we have a list of every single state in the nation. We have how many mental health counselors are there, how many marriage and family therapists, so on and so forth. We have to be able to share these numbers with them. A lot of the states that have an urgent need for problems are people that are in rural areas. 

The majority of professions in rural areas, mental health professionals, I should say, are mental health counselors. There are people that live in- wherever, in Wyoming, that if they don't get a service from a counselor, they're not going to get it from anywhere else unless they drive two or three hours. You have to remember these people that are going through this issue, they're disabled. They may have caretakers in the house, but Dr. Butler, sometimes there are people just like you and I, we're working every day, working hard every day, but they may not have the money in some cases for transportation to get two or three hours. We need to make sure members know what's happening in their- [crosstalk] 

Dr. Butler: Will there be support for tele-mental health as well within this regard or is that something that's too far on the horizon? 

Brian: That's a really good question. Moving through the Counseling Compact, once we get there, there'll definitely be support across the board, which is great news. We're moving in the right direction there. This bill doesn't necessarily focus on telehealth, it just focuses on the Medicare piece. Down the road, say, the Counseling Compact didn't work, [unintelligible 00:24:28] didn't work. Everyone that's listening in, we're moving in the right direction. If it didn't work, we can work with Congress to ensure that that's happening. 

There are countless bills. In the last check, there were 300, 400 bills focused on telehealth right now. Members of Congress are getting it. The challenge that they're facing right now is that besides the debt ceiling, there are about 500 or 600 bills that they need to get passed between October 15th and the end of the month. They have already said to us and to others that we are going to put together a mental health package the end of the year around the holidays and going into the next year. It's our job right now to ensure that we're included in that package. 

Dr. Butler: That's a good question to ask you right now then because you just brought up something that made me think, "Package." Why does everything have to be inserted in a package? Why can't they stand alone? 

Brian: Okay, that's a good question. That's a good question. I'm going to give you a really- what's going to seem like an odd example. My wife sent me to the grocery store this weekend, and some items that she forgot to pick up. I'm like, "Oh, babe, I'll get the items." I didn't take a list with me. I just put it in my head. I didn't put in my phone. When I brought them back home, she looked through and I missed two or three things. She was like, "You need to have them all in there. Without these items, I can't make this entire dish. We were cooking something together, a Filipino dish. 

Anyway, with Congress, you can have a bill that's by itself that has a lot of support, or a little bit of support, in some cases, and the bill would just sit there and hang out. If there are a lot of bills, say, there's a telehealth bill and a Medicare bill and the bill focused on access for veterans beyond the VA to use the counseling profession, mental health profession, you combine all those bills, it becomes more attractive to a lot of congressional members to say, "You know what? I want to lobby for this bill internally." 

Dr. Butler: It also increases the amount of money that will go towards the debt ceiling, right? 

Brian: In some cases. In some cases, that's true, but not in all cases. For example, if we connected a telehealth bill, telehealth is going to cost one way or the other, or we have something to do Medicaid, it's going to cost one way or the other, but those funds are there and they're going to be there on an annual basis. Congress is going to pass those funds annually. They have to do so. You combine those bills, and it gives an opportunity to say, "This is what needs to happen, so bills can pass." Through that process, there is a lot of negotiation happening. There are some things that will be pulled out, bits and pieces of bills that will be pulled out to actually lower the cost of the bill, the total. 

Dr. Butler: Okay, all right. They, I guess, are doing their fiduciary responsibility to the government. There are some things that seem to get passed without a moment's notice, and then there are things that like, again, going back, I'm harping on this, but I'm talking about health care, I'm talking about people who need to be able to be okay, to be able to see individuals, to be able to have services that are necessary. Yet, those are the things that we keep getting pushed away from. How come, and we could probably talk about this after the break, but how come when it comes to the welfare of American citizens, we have to fight so hard? 

Brian: You want me to answer now or we're going to wait to break? 

Dr. Butler: You can start the answer now. 

Brian: I'll start it. Okay. Well, you know what? That's a really good question. It's also a difficult one to answer. We know the role of Congress is to pass a balanced budget on an annual basis. That's their only role. Everything else is secondary. In that process, Congressmen, Senators, they have to make a decision of what they're going to support and what they value the most. 

We talked about Medicare today. The Senate, our Senate leader is Barrasso, as well as Stabenow, has already made our bill their number one priority. Barrasso has made it his number one priority. Stabenow, who has several mental health bills, has put it on her priority list. That's a good sign for us in the Senate. We need our bills to continue to become a priority. 

Health care in the nation, quite frankly, and maybe this is more personal to me, on the personal side of me, it's been a disaster in so many ways. There are people that don't have health care. There's nations that people will say aren't as great as America, but everyone has health care, and the health care is paid for, and the health care includes mental health care. There are some issues as a nation that we need to work on. There's no doubt about it. There are some members on the Hill that get that. There's others that need that education, and they need to hear from their constituents. 

Dr. Butler: We'll get back to this in a few minutes, but I want you to think about this as well. Has the pandemic helped in any way to let Congress know that people's mental wellness is in check or in need of some check? 

Brian: It's a good question. I'm looking forward to answering that one after the break. 

Dr. Butler: Let's do this after the break. Thank you. This has been a great first half of our conversation with Brian Banks on how we can work on Medicare and other things with Congress. We'll be back. This is The Voice of Counseling. We'll be back in a moment. 

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Dr. Butler: Welcome back, I'm S. Kent Butler and we're continuing with the conversation with Brian Banks from ACA. We left off talking about the pandemic and how it has affected the mental wellness of our counseling clients. Brian, how has it affected Congress and their look at maybe passing some of this legislation? 

Brian: It has affected Congress. Congress, they look at more health care and mental health as within their scope as something that they have to take serious because you know what? They're hearing more from their constituents, and they're also are hearing horror stories, and quite frankly, they're looking at statistics and seeing that there's some issues that are happening in their states and around this country that needs to be avoided. 

When you look at telehealth, for example, people will look at telehealth as, "Oh, we don't think that's important," in some states and other states, "Oh, yes, we need to actually make this happen." Now, they're looking at many members on the Hill as well as in a state legislature saying, "We have to move this forward." Not too long ago, a month or maybe two months ago, someone was telling me a story about a client that they were seeing and this client was at home sick with COVID. This person lives alone, needed to speak to their counselor, and couldn't leave the house because he had COVID. 

Without telehealth, this person who was having some pretty major issues would have quite frankly had suffered. Who knows what this person would have had to turn to? They can look at our nation, just recently numbers came out that suicide is actually increasing in the armed services. I also spoke to a member who works for the army as a counselor for the army, and we had a meeting scheduled, he goes, "Brian, I can't speak to you today. Two of our members just committed suicide." Now, I can't tell you what was going on- 

Dr. Butler: Died by suicide- 

Brian: Yes, died by suicide. I can't say what was going on with the two people. The reality is, you're seeing a lot of people just unsure, and people are literally asking for help and assistance, and this may sound bad, Dr. Burtler, COVID has helped us tell our arguments. We all want COVID to go away, but quick people will notice that we need to do- 

Dr. Butler: It's really exposed a lot of disparities in many communities, not just in black and brown communities, but in communities around, it showcases just what has really been happening in our healthcare system, and just how we have been bamboozled in a way by people who will keep us at bay so that they don't have to worry about the rising cost of health care. 

Brian: Exactly, and health care is expensive, it's extremely expensive. The reality is, I'm an advocate for- look at Medicare or just health care in general-- I'll give an example, I just had a physical exam. I'm sure you've heard this from your physician, why not have a mental health exam on an annual basis for everyone across the nation? I'm an advocate for that. I know there's some people on Capitol Hill that would definitely support that, but this country is one when we look at the insurance companies and so much dollars and cents involved, and there's debate and there's people donating certain amounts to members, the water gets a little- I don't want to say dirty, but it gets a little dirty at times. 

Dr. Butler: I'd like to use the word messy. I think people- 

Brian: You can say messy. I like that. We need to clean up our mess, right? 

Dr. Butler: Yes, we need to clean up our mess. 

Brian: We have great minds in this country. We have great minds in this profession. We have a policy that has moved forward that has made a difference. We need to make sure that we are helping Congress understand this policy. Did you have another question? 

Dr. Butler: I don't have a question, but I'm sitting here thinking, one of the things is- that's why it's so important to get out and vote. That's why it's so important to find people who are like-minded and putting them into office. That's why it's important for counselors to go out there and that they have the mindset to be Congress individuals to go out and do that because what's really happening is the need for these types of voices to be heard. 

As long as we keep suppressing that voice, that's what's happening with the voter suppression, that's what's happened with the gerrymandering that's going on. There are people who are in positions of power who want to stay there but don't see the best interests of all of us as Americans. They only are staying there so that their services or their way of living can stay at the top of the pecking order. We need to find a way to relieve them of their posts. It comes from these types of legislative actions, being aware of who's really standing in your corner, and who really doesn't think much about you or your life, or how you exist, or how you live. 

Brian: Exactly, exactly. Unfortunately, some people have to get uncomfortable before they can get comfortable. They have to be affected directly before they want to take action. The reality is, as you said, we have the power of the vote, we can vote people out, but I truly believe counselors need to take-- There are counselors out there that are in office, by the way, or that have been in office, but we need to take the opportunity to continue that process of running for office, getting appointed to offices by governors in the state. 

Not too long ago, ACA did-- It's on our YouTube channel on how to actually get elected to office. We have a resource out there for our counselors if they would like to use it. Just visit the ACA YouTube channel, and it's there. If you have more questions, call us. We'll direct you to it or guide you to where you need to go within your state to get involved. 

Dr. Butler: A lot of times, people are private, and they don't want their personal life on display. I get that. I understand that. Sometimes we have to pick the heavy hit, right? We have to take one for the team and say, "You know what? I'm living a just life. I'm living a good life. I need to put myself out there and be able to stand up and stand for those people who have been marginalized, who have been oppressed, who have not been able to have their voices heard." 

We can go and stomp the yard all we want, but the fact of the matter is unless we have people who are committed to the welfare of the human nature of individuals and human beings who are living here in our society, we're not going to necessarily move the needle. Again, like I said, that's where it goes back to me saying, "Where are the adults in the room?" There's so much bad behavior going on. At least, it's obvious to me that is bad behavior, yet they continue to still stay in positions of power. You just wonder, what is stopping that from moving forward? 

We know, right? Again, it goes with the gerrymandering, goes with voter suppression, it goes with bullying and scaring people from going out and vote. It goes with all of that so that people can stay in power, but we have to be more powerful than that narrative. We have to find ways that we can circumvent that system so that people who are doing wrong in Congress and anywhere else get unseated. 

Brian: Right. You're absolutely right. Another part of that, that I think is extremely important, is people need to advocate in their communities. This is usually a very easy job to do. People don't realize how easy it can be. I'm going to give you an example. I am in a pretty big neighborhood. I live on a street called Fox Hill Lane. Just about every weekend people- [crosstalk]. 

Dr. Butler: You don't want to give that information to everybody, brother, do you? 

Brian: That's okay. There's Fox Hill Lane all across the nation. If they want to come by, come on by. I'll teach you a thing or two. [laughs] We stand on the corner, every weekend, my neighbors and I-- It's a diverse group of people, age, ethnic background. We sit and we talk about all the issues that are going on and what we need to do to help improve this or whatever it needs to be. Then we actually get together and we take action because we're involved in our community. We know our local officials by the first name. We know our state officials by the first name. I know my Congressman by the first name. You don't have to know them by the first name, but you just need to know where to go to take action and to get together with your neighbors, so you can educate them. 

Dr. Butler: Does that take a special person to know? I'm listening to you. We can have these conversations. A lot of times people have the one-offs, right? Have this great conversation with you and then I go on about my business and I don't think about it anymore. How do we get people to stay connected? How do we get people to continue on with that energy that's necessary? I guess it's locking arms with people who are like-minded, but you don't want people to fall by the wayside. How do you get people to stay involved? It is difficult. A lot of times what people do when it gets difficult is they tune out or they move away from it. 

Brian: They tune out. A lot of times they're aware they just tune out. Here's what you have to do, in my opinion. You have to meet people where they are. I had the great fortune to sit on a committee years back at a university in DC. It was an alignment between Africa and the United States. They were doctors from the United States, students were going to Africa and vice versa. It was at the very beginning stages of the program. I say at the very beginning, it was two years in. 

One of the gentlemen from Africa, I'll never forget this, he stood up and says, "I want to tell you all a story. When I come home from work, my daughter runs to the door, she gives me a hug and says, 'Hey, daddy, I'm so glad you're home,'" and he said there's this wife, and she kisses her, and she always runs to the refrigerator and she opens it up and says, "Daddy, what's for dinner?" And all he sees is that bright light. 

That bright light is just people talking. After people have a long day, every day, they need to see more than that bright light, that empty refrigerator. They need to see some substance, and they need to know that there are people around them that they can rely on. You don't always have to be the out-front person in the voice, but everyone has some story to tell, so they can help us know what that story is, or we can tell it for them. 

I love going out and talking to people and learning about people and researching and analyzing issues, and then bringing it all together to go to wherever I need to go across this country to make a difference. One of the best things I saw as a staff person at the association is when Michigan went on attack against counselors not being able to bill insurance. Rich, our CEO, sent me up there to do my thing, to talk to counselors, and to talk to the board. When I got there, it was amazing that the people there knew whether they were with ACA, as a member or not. They knew I was coming. They talked to me, they told stories. 

I had people always like, "This is not my thing. I don't like getting up and talking, but this really matters, I have to make a difference." Admit something to them. It's our job to show them, at times, that it's not that difficult to tell your story. Nobody knows your story better than you. If you always do what you've always done, you always get what you always got. One of my football coaches in college would tell me that, and he was always right. We perform at a high level, get with the right people that we need to talk to, or just send the right email or drop a call. Whatever you can do to make a difference, do it. 

There are people out here that will carry the water for you, but we need your help and your support. Quite frankly, I'm going to be honest here. When we look at state government, things move fast. You look at the federal government, in some cases, things move fast, but those are the things that have to pass every single year, or there's a tragedy, so we have to do something immediately so people are happy. The reality is, federal government moves slow and people get tired of it, they get bored with it, they get angry with it, they get frustrated with it. I'm going to be honest with you, so do I. Working in this profession for 22, 23, 24 years now, actually, I get tired of it, I get frustrated. 

Dr. Butler: You forgot one thing though. They play games with it too. 

Brian: They will play games with it, and Dr. Butler, a lot of the games is to talk to the media, but then behind the scenes, something different is happening. I went to a senator's office a while back, I was working on environmental issues. This senator, very well-respected, once said to me, "Brian, I'm with you, but my people aren't, so you need to get my people in here to talk to me." That was the message I needed to hear. 

We marched on up to Maine, we marched on up to Connecticut and we talked to a lot of different people. We got members to talk to her, and we made some change happen on a bill that quite frankly, they were pushing 20 years to try to get something passed. She was able to step up for the Republican Party and bring along some Democrats across the aisle to make sure our bill got passed. 

Really, for the policy, a lot of policy is local. I will say, start at the local level, know what's going on, read a newspaper, talk to your neighbors, but really read, analyze. Don't allow people to tell you what's happening without having effects, go find them for yourself. Our organization is going to help you find those facts, and we're going to give it to you straight whether the answer is good or not good because we need your support to make a change. 

Dr. Butler: I think you're right, and you have to open up your pathway to be able to find these facts in multiple fashions, not just coming from ACA, but also coming from other factions of life so that you can discern what's best for yourself and what's best for moving forward. That's not meaning that you shouldn't listen to ACA because I think that's what we want. 

We're doing this on behalf of counselors. We're hoping that we're putting our best foot forward for counselors, but the truth of the matter is that you have to also have a passion for what you want out of this as well. That also keeps you involved. Yes, you can walk lockstep with ACA, right into your legislator's office, and have all the right things to say, but if your heart's not there, then you're probably not going to stick with it and stay with it. It's like that pin you have on your lapel there. It talks about power. I think one thing that I believe in is just power in numbers. You have to find some way to lock arms with people who are like-minded, who can give you the energy to continue to fight and to get this thing done, get it taken care of so that we can really change the way the world views mental wellness and mental health. 

Brian: We have to live to fight another day, and we can do it working together. I was in a conversation with a group of people that do the same type of work. They don't work for ACA. We were discussing an issue that we believe is going to come up next year and a big part of the group, half the group, I'll say close to 50% of the group, didn't want to discuss the issue. 

What I said to them, I said, "Look, we know the chances are probably 90% or above it's going to come up. It's better for us now to be prepared for that issue because it's going to give us the strength, the power, the credibility, to get the information to the people that need it, the Congressional staffers, certain members on the Hill, so they can review it, ask all their questions now, we will answer those questions and then they can advocate for them." 

Same thing in your community. I have a couple of neighbors next door. We're friends. They'll come over and they'll talk about a lot of issues. They're not into the whole politics extending, they're voters and all that, but they can [unintelligible 00:45:54], but they'll come over and talk about those issues and I'll say, "Look, here's my opinion, and here's what I think is going to happen.” What you should also do, this is something that we didn't hit on during this conversation, I'm going to throw it in there, if there's something that you disagree with, you don't like, you feel needs to be done, those matter too, you need to speak up on those issues because the right people may not be aware of them and you may be the key to changing that issue just by speaking up. 

Some people don't have the-- It's who they are. It's built into them to not be upfront and to not speak up on the issues. My grandmother was a very quiet woman, but when she spoke, you better believe people listened because she knew everything. She had a lot of good information and knowledge, and because of that, especially from DC, she helped change some policy in the city, a very quiet woman who wanted to be behind the scenes. It just has to take someone- [crosstalk] 

Dr. Butler: You're helping them to cultivate their role, no matter what that role is, you shouldn't push somebody in the forefront if they are behind the scenes, grassroots workers. I get that. I hear what you're saying. 

I got something I want to ask you. How would you make this statement stronger? Because maybe it's the way that we advocate for our profession. Don't just get mad or be mad, but be strategic. How could we tweak that so that it makes much more sense? 

Brian: Oh, that’s a good one. You're putting me on the spot with that one. I'll tell you what. I know that strategy makes a difference. I would say with that quote you just gave me is to be smart, be strategic and take action because you can be smart and strategic but if you don't take action, nothing is going to happen. No one is going to tell you what's working and what's not working. If you take the action, people would literally come to you like, “Oh, you shouldn't do it this way, you should do it this way because--” They're going to give you the intel that they have. 

Just taking an opportunity to be intelligent in that conversation will allow people to want to come to you and help and support you whether they agree or not. My job, it's very important to say this, I'm on the PPLC, the Public Policy Legislative Committee, we have people that are Democrats, Republicans, independent, whatever. The reality is we have to work with everyone and it starts with being smart, intelligent, using a strategy, and taking action. 

We're not going to all-- Well, I'm going to speak for myself. I'm not always want to take the right action, but I going to take the most strategic. I'm going to learn from it and do the right thing for this organization. 

Dr. Butler: What I sense you saying is, take mad out of the equation. It's not enough to be mad because people would look at you all day and say, “Hey, you're mad, but guess what? I have power and I'm going to move forward.” You're saying, be smart, be strategic. 

Brian: Take action. Listen, you can be mad. If you want to be mad, you can be mad at it. Listen, I get frustrated and angry about a lot of things that have happened in this world. The reality is when you go speak to a member, they may have those same feelings. Now they need help because the people that we vote for, very smart and very intelligent people, their staffers are extremely smart and extremely intelligent. They don't know these issues like we know them. We have to provide them that information. 

I have a friend who's a state legislator, a powerful state legislator, and I was going to speak to him. The session was in the State of Maryland. I was just going to go say, “Hey, what's up?” He came, he goes, "Brian, are you coming to advocate today, or you're coming to educate and empower me today?" I said, “I'm just coming to say hello, but you know I'm going to educate and empower you before I leave.” He goes, "I'm tired of hearing from the advocates," and what he meant by that, he was actually being sincere, what he meant by that is people banging on this door, requesting meetings, they were coming and telling him what to do and how to do it, and why are you taking so long? What he really needed to hear was like, “Hey, what is your issue? How does this issue affect my constituents, and what can I do to help you? Tell me what actions I need to take." He didn't know. He needed to hear from experts. 

[crosstalk] 

Dr. Butler: You come in here and meet me where I am as opposed to trying to tell me what I should be doing. I love that. 

Brian: Exactly, and understand this, and this is very important for counselors to know, and I hope they get this, a counselor has more power than the legislator. The legislator needs you more than you need them, and you got to show them that you are an expert in your field and that you can support them along the way. It takes time to build those relationships, but once you build them, those legislators will start calling you and asking you for the support that they need. 

Dr. Butler: Well, Brian, we have to leave it there, and I will take those words that you have shared, I think it's words of wisdom for sure. Smart, strategic, big action, a hashtag in there somewhere, [unintelligible 00:50:58] forward, but thank you so much for your time. I think you've shared so much that we can do as a counseling community to move the needle when it comes to how we are going to change the narrative of those who are in need of Medicare in our services. Thank you so much. 

This has been The Voice of Counseling. I'm Dr. S. Kent Butler, I've been here today with Brian D. Banks, and we had a good time talking about Medicare. We'll see you next time. This is The Voice of Counseling coming to you straight from the American Counseling Association. Have a phenomenal day. 

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Female Presenter: ACA provides these podcasts solely for informational and educational purposes. Opinions expressed in these podcasts do not necessarily reflect the view of ACA. ACA is not responsible for the consequences of any decisions or actions taken and reliance upon or as a result of the information and resources provided in this program. This program is copyright 2021 by the American Counseling Association. All rights reserved.