Bush, Kerry Take Stand On Key Mental Health Issues

“Privacy is a fundamental right, and every American should have absolute control over their personal information, particularly their highly sensitive medical, genetic, and financial information,” the Bush campaign told Psychiatric News in 2000.

Yet in 2002 his administration removed an important patient-consent requirement in the final federal privacy regulations. APA has long advocated that patient consent is the cornerstone of any meaningful patient privacy rule and expressed strong disappointment at its removal.

Under the revised privacy rule, health care plans, professionals, insurers, clearinghouses, and hospitals do not have to obtain patient consent before they release private health information for routine transactions including treatment and payment (Psychiatric News, September 6, 2002). Health care entities must make only “a good-faith effort” to notify patients of their privacy practices and obtain their written statement that they have been so informed.

Bush also pledged in the 2000 campaign to support patients' rights to sue their HMO or managed care organizations. In office, however, Bush insisted that he would only sign patients' rights legislation that had“ responsible tort reform,” which he defined as discouraging“ frivolous” and unnecessary lawsuits that could drive up health care costs (Psychiatric News, June 15, 2001).

He opposed a bipartisan bill (S 1052) sponsored by Sens. John Edwards (D-N.C.) John McCain (R-Ariz.), and Edward Kennedy (D-Mass.) that would have allowed patients to collect unlimited pain and suffering damages in federal court and capped punitive damages at $5 million. The Senate passed the measure.

Bush opposed a similar bipartisan bill (HR 2563) introduced in the House of Representatives until a compromise was reached with Rep. Charles Norwood (R-Ga.). The Norwood amendment capped noneconomic damages in federal court at $1.5 million and punitive damages in state court at $1.5 million and imposed several other restrictions. The House narrowly passed the bill, but Senate and House conferees could not reconcile their differences.

Kerry supports full parity and voted for the 2001 MHETA, which the Senate passed, but has been opposed by House Republicans, who argue that it will drive up health care costs. He has vowed to fight the “social stigma” that accompanies mental illness and “to end discrimination against those with mental illness.”

Kerry also supports an end to discrimination against Medicare beneficiaries with mental illness, co-sponsoring the 2001 Medicare Mental Illness Nondiscrimination Act with Sen. Olympia Snow (R-Maine). APA supported the bill (S 841), which would reduce from 50 percent to 20 percent the copayment for outpatient psychiatric services. Kerry and Snowe introduced nearly identical legislation last year, but Congress failed to pass it.

Kerry also has pledged to protect the Medicaid program. “That means stopping the Bush so-called `reform,' which would essentially block-grant the Medicaid program and threaten benefits and coverage,” Kerry stated in a press release.

To provide states relief in the next two years, Kerry proposed authorizing $25 billion annually to help protect Medicaid programs from cuts in covered services or reductions in Medicaid enrollment.

Kerry would also reform Medicaid. He was a co-sponsor of a bill that would give states the option of expanding Medicaid coverage for children with disabilities up to age 18 in families whose incomes are no more than 250 percent of the federal poverty level.

Moved by accounts of parents' taking drastic steps to keep from losing Medicaid coverage for mentally disabled children, Kerry said, “No parent should have to turn down a job or give up the custody of a child to ensure that [the child] gets health care.”

The bill, the Family Opportunity Act (S 622/HR 1811), was approved by the Senate in May, but failed to pass in the House of Representatives (Psychiatric News, June 4).

Kerry also promises to work to remove restrictions imposed by Bush on human stem-cell research. He voted for a bill (S 723) in 2001 allowing federal funds to be used for human embryonic stem cell generation and research (Psychiatric News, October 5, 2001).

Kerry promised to “lift the ideologically driven restrictions on stem-cell research that are impeding progress toward cures” for several devastating diseases.

He also cosponsored the Genetic Information Nondiscrimination Act of 2003, which passed in the Senate late last year with the support of the Bush Administration, according to APA's Department of Government Relations (DGR). Similar but stronger legislation was introduced last year in the House (HR 1910) and had 242 cosponsors as of August. “APA supports a strong genetic nondiscrimination bill to protect Americans from potential abuses,” said DGR.

On the issue of patients' right to sue an HMO for negligent care decisions, the Kerry-Edwards team has promised to “push Congress to pass a real patient's bill of rights that allows Americans to hold HMOs accountable for decisions that harm patients by denying medically necessary care,” according to the Web site<www.johnkerry.com/issues/health_care/fairness.html>. One way they plan to accomplish this is via a stronger appeals process for patients. They would also guarantee HMO enrollees the right to see a medical specialist.

Kerry's statement on mental health policy is posted at<http://www.johnkerry.com/pdf/mental_heath_statement.pdf>. The statement “Key Components of the President's Health Care Reform Agenda” is posted at<www.whitehouse.gov/news/releases/2002/03/20020301-1.html>. Congressional bills can be accessed at<http://thomas.loc.gov> by searching on the bill number or name. ▪