Psychiatrists Lobby Congress on Health Reform, Privacy Issues

APA members lobbied members of Congress during APA's 2009 Advocacy Day events last month to ensure strong and timely regulations in the coming months that will implement the landmark federal insurance parity law enacted late last year.

The timing of the advocacy events, which took place from February 8 to 11, coincided with congressional consideration and passage of the massive American Recovery and Reinvestment Act of 2009 (ARRA, PL 111-5). The legislation, which was signed by President Obama on February 17, included federal electronic medical record (EMR) privacy protections.

This year's Advocacy Day brought 105 APA members from 43 states, the District of Columbia, and Puerto Rico to Washington, D.C., to learn about the major federal health policy challenges facing psychiatry and to urge their representatives in Congress to support APA-backed solutions. Attendees participated in several days of training and heard multiple issue updates before making 262 visits to the offices of members of Congress.

“I am pushing for strong privacy standards in electronic medical records,” Leslie Secrest, M.D., of Dallas told Psychiatric News before his scheduled visits with his congressional representatives during Advocacy Day. “The thing that makes [EMRs] different is knowing how quickly [the information] can be transmitted.”

The patient-privacy message that Secrest and other psychiatrists took to Capitol Hill may have made some impact because, despite long-held opposition in the Senate, the law contains a series of privacy protections long called for by APA and other mental health advocates. The law includes an expansion of the scope and penalties of violations of the federal privacy and security rules under the Health Insurance Portability and Accountability Act and a reduction in the amount of the information physicians must reveal to insurers (see Incentive Payment Will Go to M.D.s Who Adopt Electronic Records).

The other main issue that psychiatrists visited their congressional representatives to discuss was the need for careful oversight of the regulations that federal health officials promulgate to implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (PL 110-343). This milestone law requires health insurance plans that offer mental health benefits to provide coverage for treatment of mental illness on the same terms as for other medical and surgical care.

Some employers have indicated that substantial time will be needed to implement the parity requirements in their insurance plans. Thus, APA has been urging the departments of Health and Human Services and the Treasury—the two departments charged with implementing the law—to quickly release to the public the regulations under consideration. For most insurance plans, the law requires parity benefits to be effective by January 2010.

Kenison Roy III, M.D., of Metairie, La., told Psychiatric News that he planned to urge members of Congress and staff members whom he visited to consider broadening the parity mandate to encompass all of the public sector, including military health care systems, and “nurture it through any health care reform.” The Federal Employees Health Benefits Program already has parity coverage for mental illness.

The enactment of mental health parity and the reduction of the Medicare copay for outpatient mental health services to 20 percent were major accomplishments this past year, and APA leaders are urging Congress and the Obama administration to ensure that psychiatric care is covered on an equal basis with other types of care under any proposals to reform health care.

The APA members who met with members of Congress disseminated APA's Principles for Health Care Reform for Psychiatry, which were approved by APA's Assembly and Board of Trustees late last year. One principle, for example, states that Americans with psychiatric symptoms have the right to comprehensive evaluation and an accurate diagnosis leading to an appropriate, individualized plan of treatment.

The need for psychiatric health care to be included as a part of basic health care was repeated often by APA members during Advocacy Day.

“We know that health care reform is a primary focus of the Obama administration, so we need to make sure parity is protected within that,” APA President Nada Stotland, M.D., M.P.H., said in opening remarks to the psychiatrists participating in the Advocacy Day events.“ By being here this week, you are the front line of psychiatry's advocacy effort.”

The psychiatrists also were encouraged by a former Senate champion, Gordon Smith. Smith, who was defeated in a reelection bid last November as a senator from Oregon, was a staunch APA ally and sponsor of the 2004 suicide-prevention law named after his son who had taken his own life.

“Your job is to make sure that mental health is not put on the back burner” as some money-saving measure in health care reform proposals, Smith said.

Smith urged psychiatrists to seek support from their long-time advocates, as well as from some members of Congress who may be more supportive than they suspect, including Sens. Olympia Snow (R-Maine), Susan Collins (R-Maine), and Tom Coburn (R-Okla.).

“Remember that mental health doesn't register 'R' and 'D,'” Smith said. “Your issue doesn't have to be partisan.”

John Wernert III, M.D., chair of the Board of Directors of APAPAC, also emphasized the need to support the monetary advocacy that provides the access and relationships APA needs to build with congressional leaders.

“How important is the PAC? I think it is pretty evident,” he said about the 2008 passage of parity and the Medicare copay change that APA had urged for decades.

The text of the American Recovery and Reinvestment Act can be accessed at<http://thomas.loc.gov> by searching on the law number, PL 111-5. APA's Principles for Health Care Reform for Psychiatry are posted at<www.psych.org/MainMenu/AdvocacyGovernmentRelations/GovernmentRelations/PrinciplesforHealthcareReformforPsychiatric.aspx>.▪