[NYAPRS Enews] MHW: MH Field Weighs In On Senate Health Care Reform Proposal

[Matt Canuteson]

Field Weighs In On Senate Committee Health Care Reform Proposal

Mental Health Weekly June 22, 2009

 

Senate lawmakers last week began marking up their national health care
reform proposal, which puts the emphasis squarely on disease prevention
and public health, along with access, management of chronic illness, and
quality care improvements, much to the approval of many in the field,
who conceded that these are all areas important to mental health.

 

Called "The Affordable Health Choices Act," the 600-plus page document
was met mostly with enthusiasm by mental health and addiction groups,
many of whom sent letters of support, recommendations and priorities to
members of the Senate Health, Education, Labor and Pensions (HELP)
Committee. Key on their wish list is that any minimum or basic benefit
package includes equitable and full coverage for substance use disorders
and mental illnesses at parity with coverage of other chronic health
conditions.

 

According to lawmakers, the legislation aims to reduce health care
costs, protect individuals' choices of doctors, hospitals and insurance
plans and guarantee quality and affordable health care. The HELP
committee plans to work on marking up the bill through June 26 when they
leave for the July 4 recess. The Senate Finance Committee, expected to
release their proposal last week, have reconsidered and are opting to
unveil their own bill after the recess. At press time, the House
Committees on Ways and Means, Energy and Commerce, and Education and
Labor, were expected to come up with another health care reform
proposal.

 

Provisions in the Senate HELP committee's Affordable Health Choices Act
include the Community Living Assistance Services and Supports (CLASS)
Act of 2007 that would create an insurance program for adults who become
functionally disabled. CLASS will also help ensure that they are able to
function independently within their homes and communities.

 

In the area of prevention the bill promotes early screening for
depression, cancer and heart disease. It will also provide consumers
with more information on healthy nutrition and the dangers of smoking.
The health reform measure's basic preventive services include
reimbursement for nutrition counseling and tobacco cessation.

 

The Affordable Health Choices Act addresses long-term care and services,
which will make it possible for the elderly and disabled to live at home
and function independently. It will help them be able to afford to put
ramps in their homes, pay someone to check in on them regularly, or any
of an array of supports that will enable them to stay in their
communities instead of in nursing homes.

 

Wellness Concerns

Many in the field concede that while they support health and wellness
efforts in the health care reform proposal, they don't want to see
consumers with mental illness penalized if they cannot adhere to
recommended treatment.

 

"Our concern is they might be forced to pay higher premiums because of
their illness," Andrew

Sperling, director of legislative affairs for the National Alliance of
Mental Illness (NAMI), told MHW. He noted that preventive care
incentives for Safeway supermarket and Dell

Computer employees to address smoking and obesity and reign in health
care costs, are highlighted in the health care reform debate.

 

According to the Wall Street Journal, Safeway officials use a provision
in the 1996 Health Insurance Portability and Accountability Act that
permits employers to differentiate premiums based on behaviors. The
company is currently focused on tobacco usage, healthy weight, blood
pressure and cholesterol levels. "We do believe the proposed attempts
for prevention, wellness, and health promotion are generally good ideas,
however we are very concerned that individuals not be penalized
financially or by exclusion from coverage or services if they are sick
or if they have certain health conditions," Marcie Granahan, chief
executive of the US Psychiatric Rehabilitation Association (USPRA), told
MHW. "Research has shown that weight gain/obesity is a side effect from
the medications used to treat mental health conditions."

 

Some lawmakers would like to see prevention and wellness along with
healthy behavior at the heart of the health care reform and have
suggested that much of the overspending on health care is a result of
bad behavior that could be prevented or reversed solely by changes in
lifestyle, Granahan said. "This is not always the case and if a proposal
such as this is in our new health reform package this could put the cost
of health coverage beyond the reach of the individuals who will need it
the most," she said.

 

Advocates Encouraged

Advocates say they are encouraged by the legislation. "We salute the
[HELP] committee's support of access to affordable and quality health
care," Laurel Stine, director of federal relations for the Judge David
L. Bazelon Center for Mental health Law, told MHW. The bill emphasizes
the coordination of primary care in other health care settings, she
noted. "The World Health Organization (WHO) calls the integration of
mental health services in primary care a viable way of closing the
treatment gap for untreated mental illness." Stine added, "It's vital
that comprehensive health care reform legislation provide mental health
coverage that is equivalent to the coverage provided for general health
care and the Affordable Health Choices Act must establish this equity
for all of its plans."

 

"Much of the bill is very positive," said Sperling. He noted that while
NAMI has signed on to health reform principles released by SAMHSA this
month (see MHW, June 15), the organization has also issued its own set
of principles. NAMI's principles include the need for the legislation to
address serious workforce shortages and to increase the qualified mental
health workforce. The organization also wants the legislation to avoid
discrimination in the coverage of inpatient psychiatric treatment.

 

Following the release of the HELP proposal, NAMI sent a letter of
support to Sens. Edward M. Kennedy (D-Mass.) and Mike Enzi (R-Wyo.).
NAMI also indicated its support for insurance market reforms included in
the draft bill, which calls for a prohibition of pre-existing health
condition exclusions as well as restrictions to prohibit use of health
status in determining premium rates, Sperling said.

 

NASMHPD Weighs In

The executive director of the National Association of State Mental
Health Program Directors (NASMHPD) told MHW that the HELP proposal
represents a positive direction in health reform. The bill's emphasis on
prevention also bodes well for behavioral health, he said. "Many aspects
of the legislation recognize the importance of addressing mental health
and substance use disorders in health reform," said Robert W. Glover,
Ph.D. Glover added, "The emphasis placed on prevention and early
intervention has the potential to significantly improve the health
status of the general population with implications for the public mental
health system.

 

"Early identification and intervention of at-risk individuals and
families are essential to improving health and controlling long-term
growth in healthcare spending," said Glover.

 

He added, "We must reduce the time between the onset of behavioral
health problems and providing the effective treatments that are now
available."

 

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