Show your Support for Health Care Reform during the August Recess
Congress has made a lot of progress on developing health care reform legislation. While the Senate Health Education Labor and Pensions (HELP) Committee and the three Committees of jurisdiction in the House have already approved very similar health care reform bills, there are some significant differences. These discrepancies will have to be worked out. In addition, the Senate Finance Committee is still working on a compromise version of the legislation that they hope will garner some Republican support. The Finance Committee is expected to issue its version of this legislation some time in September.
Many members of Congress are hearing from radical groups who oppose health care reform. It will be important for mental health advocates to help counter these negative messages by attending public events and speaking out in support of expanding health care coverage to the uninsured and making improvements to our current health care system. We also encourage you to seek individual or group meetings with members of Congress to discuss these issues.
Priority messages to raise with members of Congress regarding health care reform:
- Expand coverage for the uninsured many of whom have unmet needs for mental health care.
- Ensure that mental health and substance abuse treatment are fully covered and at parity with other health conditions under any new federal coverage program.
- Improve coordination between primary care and mental health and substance abuse treatment providers.
- Increase recruitment of mental health and substance abuse treatment providers.
- Increase access to services aimed at preventing mental health and substance abuse.
- Improve quality of care by including consumers and patients in research development and dissemination.
Background
Below is a summary of some of the major topics addressed in the Committee-passed bills indicating the prevailing approach on many issues in the House and Senate. Nonetheless, if the Finance Committee is able to develop a compromise version that has the support of several Republicans, that bill will likely prevail on many of these fronts.
Health Care Coverage for the Uninsured
The Senate HELP Committee bill and the House Tri-Committee bill focus on expanding coverage to the uninsured by creating a mandate that all individuals have to have insurance (with tax penalties for those who do not comply and exceptions for financial hardship).
The Tri-Committee bill would require employers to offer coverage to employees and the HELP bill would impose fees on employers who do not provide coverage. Both include exemptions for small employers, but the bills differ in how they define small employers. Both also would establish tax credits to help encourage small businesses to offer coverage.
Both the HELP and Tri-Committee bills also include provisions to make coverage affordable through various means:
- By establishing “Gateways” or “Exchanges” (similar to the “Connector” established in Massachusetts) through which individuals and small businesses could purchase coverage;
- By providing subsidies for families with incomes up to 400% of poverty;
- By expanding Medicaid (to be fully federal financed for some initial period and with state maintenance of effort requirements); and
- By including a government-run public plan option within the “Gateways” or “Exchanges” to create competition for the private plans (but, the Finance Committee is likely to include an alternative plan not run by the federal government).
Both the HELP Committee and Tri-Committee bills would require all plans in the “Gateways” or “Exchanges” to offer at least an essential benefits package that would be required to include mental health and substance abuse services – as well as preventive services (with minimal or no cost-sharing), and rehabilitative and habilitative services (in addition to the usual outpatient, emergency, hospitalization, prescription drugs, lab services, maternity, and pediatric services). Further details regarding required coverage would be established by an independent board or council.
There are mental health parity provisions in both bills, but the House provision would apply to all plans in the Exchange including those purchased by small businesses. The Senate HELP bill would extend parity to plans purchased by individuals but would seem to exclude small businesses.
Both the HELP Committee and Tri-Committee bills include broader insurance market reforms. Health plans would be required to offer and renew coverage for all who apply (guaranteed issue). Pre-existing condition exclusions would be prohibited. Premiums could only be based on family structure, geography and age (as well as tobacco use in Senate). Annual and lifetime limits on coverage would also be prohibited.
The Tri-Committee bill would move CHIP enrollees into Exchange plans in 2013 but an amendment was adopted requiring assurances that coverage will be comparable.
Health Care Quality Improvements
The HELP Committee and Tri-Committee bills include provisions to encourage development of medical homes or community health teams to improve care coordination. (The Senate bill includes funding to support co-location of primary care in community-based mental and behavioral health settings.)
In addition, both bills would establish a new center within the Agency for Healthcare Research and Quality to fund and oversee comparative effectiveness research.
Both the HELP and Tri-Committee bills would provide direction and funding for additional quality measure development and best practices research and implementation.
Prevention
A number of provisions are included in the Senate HELP and Tri-Committee bills to improve access to prevention and wellness services although both take somewhat different approaches to addressing prevention. The HELP bill would establish a national prevention and public health council to coordinate the work of a number of federal agencies and a prevention and public health investment fund. It would also improve coordination of the two federal preventive services task forces, establish community transformation grants as well as a grant program for school-based health clinics. A temporary program to cover preventive services for the uninsured would be provided until full coverage could be offered through the new Gateways. The bill would also support additional research on public health and prevention delivery and employer wellness programs.
The Tri-Committee bill would require coverage of preventive services under Medicare and Medicaid. This bill also establishes a prevention trust fund and calls for development of a national prevention and wellness strategy. It also would fund community prevention research and services grants.
The Tri-Committee bill would create a state option for nurse home visitation services under Medicaid and a grant program for home visitation programs. Like the HELP Committee bill, the Tri-Committee bill would support school-based health clinics.
Workforce
In addition, a number of helpful workforce development programs specific to mental health are proposed. The HELP Committee bill includes loan repayment programs for child and adolescent behavioral health providers and behavioral health education and training grants, as well as programs to educate primary care providers about evidence-based prevention, mental health, and chronic disease management. The Tri-Committee bill includes a grant program increasing the public health workforce that identifies mental health as a severe shortage discipline. This bill would also expand the National Health Service Corps which includes behavioral health professionals.
Medicare Improvements
The Tri-Committee bill also includes a number of provisions affecting Medicare including a provision to phase-out the gap in coverage called the “doughnut hole” in the Part D benefit. In addition, this bill would authorize reimbursement of marriage and family therapists and mental health counselors under Medicare.
