APA Discusses Health Reform With Obama Administration

Even before Barack Obama took his oath as president of the United States, he was off to a running start on the issue of health care reform. A week before his inauguration, members of his transition team invited APA and other mental health advocates to discuss both major and incremental changes to the U.S. health care system that could expand access to care for people with psychiatric illness.

APA Medical Director James H. Scully Jr., M.D., said last month's meeting was apparently unprecedented for an incoming administration and is seen as a sign that the new president places a high priority on enacting major health care reform, with mental health care as an integral part of that reform.

“It's clear that [members of the Obama administration] are reaching out to every stakeholder in health care as they get ready for some type of health reform,” said Scully, who attended the meeting.

In addition to Scully, the meeting at the administration's transition headquarters in Washington, D.C., included representatives of the National Alliance on Mental Illness, Mental Health America, the Campaign for Mental Health Reform, the Bazelon Center for Mental Health Law, and the American Psychological Association.

The mental health advocates urged that any proposals to overhaul the health care system build on the gains made in two milestone laws enacted in 2008: the federal parity law and the law to phase out higher copays for outpatient psychiatric care under Medicare. The parity law, called the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, requires private insurers to provide parity insurance coverage for mental health care in plans that offer mental health coverage.

“We believe that any health care reform program—whether incremental or comprehensive—should be fully consistent with the basic principles embodied in last year's legislation: insurance-driven distinctions between mind and body have no place in 21st-century medicine,” wrote APA leaders in a briefing document Scully submitted at the meeting.

Obama's transition team did not make any commitments but “seemed receptive to our message,” Scully told Psychiatric News.

In response to a request by the Obama team for items on which the administration could take action within the first 100 days to benefit people with psychiatric conditions, Scully urged accelerating the issuance of regulatory guidance regarding implementation of provisions of the new federal parity law. He also pressed for maintaining coverage for all six protected drug classes under the Medicare Part D program (including antidepressants, antipsychotics, and anticonvulsants) and ensuring that beneficiaries maintain access to substantially all of the six classes by requiring the Centers for Medicare and Medicaid Services to codify this current policy through regulation.

Moreover, Scully urged the Obama administration to include strong patient privacy protections in any accelerated health information technology effort.

Another suggestion was to eliminate the two-year waiting period for Medicare eligibility after being granted a disability determination.

A “substantial number” of the estimated 1.5 million disabled applicants now on the disability waiting list for Medicare have a primary or secondary diagnosis of severe and persistent mental illness, according to the briefing document.

APA pointed out in the briefing document that more federal research funding is needed especially to develop medications for treatment-resistant depression and for addiction and to improve the care of service personnel and veterans with PTSD and traumatic brain injury. At a minimum, funding should be increased each year at the same rate as biomedical inflation; keeping funding amounts level results in a loss of real dollars.

In addition to the briefing document, Scully provided the transition team with APA's “Principles for Health Care Reform for Psychiatry” as developed by the Board Ad Hoc Work Group on a Mental Health Care System and approved by the APA Assembly and Board of Trustees in late 2008. The transition team also was given a copy of principles developed by the Campaign for Mental Health Reform (CMHR), of which APA is a member.