Capitol Hill Update

Parity success requires sustained advocacy; SCHIP, Medicare need grassroots support

Congress is entering the home stretch of this year’s legislative session, and your help is needed to achieve the mental health movement’s priorities. The advocacy of Mental Health America affiliates and thousands of individuals throughout the country have helped fuel the success of many recent mental health-related issues in Congress. Your action is especially needed now because, as the session winds down, early gains could be overtaken by competing priorities. Be sure to join Mental Health America’s online Advocacy Network at http://takeaction.mentalhealthamerica.net to learn how you can get involved, contact Congress on key issues and sign our Vision for Change petition.

Parity Wins Unanimous Senate Vote

Advocates across the nation are celebrating the unanimous Sept. 18 Senate passage of the “Mental Health Parity Act of 2007,” S. 558, which would close the legal loopholes that deny most Americans equal coverage for mental and physical disorders. Simply getting that bill to the floor was a long haul! Late this summer, advocacy organizations, business groups and others came to an agreement on the provisions of the bill, introduced by Sens. Pete Domenici, R-N.M., Edward Kennedy, D-Mass., and Mike Enzi, R-Wyo.

Although the bill won Senate committee approval in mid-February, it became the subject of prolonged discussion, analysis, and multiple rewrites to address concerns around the interplay between the bill’s provisions and state laws. Policymakers resolved those issues by eliminating language that would have allowed federal law to override state law in certain circumstances. The bill’s supporters in Congress then launched an effort just before the August congressional recess to bring the bill to the floor for a vote. But that attempt, which required unanimous consent, sparked an objection from a single senator, Sen. Jim DeMint, R-S.C. That one objection delayed further action on the bill until a few weeks ago, when the MHA of South Carolina spearheaded a successful effort to have its junior senator lift his hold.

We’re closer than we’ve ever been to winning this fight, but we cannot take passage of a parity bill for granted. The crowded end-of-year congressional calendar is just one more hurdle that parity legislation must clear and requires our sustained advocacy. The House parity bill, H.R. 1424, hasn’t advanced as far as the Senate bill but is in play. The bill was passed by the Education and Labor Committee in July, and the Ways and Means Committee adopted the legislation Sept. 26. That means the bill has now cleared two of the three committees that must act before the bill can get to the House floor for a vote, leaving just the Committee on Energy and Commerce. Although Mental Health America has supported House passage of H.R. 1424 (as we have Senate passage of S. 558), Senate leaders have warned that the more farreaching provisions of the House bill cannot clear the closely divided Senate chamber. Please visit http://takeaction.mentalhealthamerica.net for more information.

Advocates Work to End Discrimination in Federal Programs

Discrimination against people who have mental illnesses extends beyond the private marketplace, where individuals face unequal mental health and physical health benefits. Public health insurance programs, including the State Children’s Health Insurance Program (SCHIP) and Medicare, also have discriminatory limits on covered mental health services.

Current SCHIP law singles out mental health care as services for which states can impose discriminatory benefit limits. Under SCHIP, states most frequently limit outpatient visits to 20 per year and inpatient care to 30 days or less per year, although some set their limitations on coverage even lower. This effectively limits access to extensive services that many children who have mental illnesses need to develop socially and emotionally, and to complete their education.

Access to these services is vital for kids enrolled in SCHIP, who are more at-risk for these disorders than their peers from more affluent families. Yet two-thirds of children with mental health treatment needs never receive care.

Medicare law also erects discriminatory barriers to mental health care, by imposing a 50 percent copayment on Medicare mental health services, which is in stark contrast to the 20 percent copayment required for other medical services under the program. That disparate cost-sharing burden is not only unfair but also tragic given the data on the prevalence of mental illnesses among older Americans. About 20 percent of older Americans have anxiety disorders, depression or another mental illness, according to the National Institute of Mental Health. Older adults also have the highest rates of suicide, according to the American Association of Suicidology.

Mental Health America helped win adoption this year—as part of larger bills expanding the SCHIP program—of provisions requiring parity under both SCHIP and Medicare, as well as a number of measures to improve access to needed mental health care. SCHIP reauthorization legislation passed by the House of Representatives included a Medicare parity provision not included in the Senate-passed bill.

The House and Senate, working to reconcile their differences, have developed a compromise SCHIP bill that defers action on Medicarerelated issues. A compromise SCHIP bill does assure mental health parity under that program, but, at press time, the President’s threat to veto SCHIP legislation has put the promise of expanded kids’ coverage and parity at risk.

Since it deferred action on several Medicare issues in order to develop a more streamlined SCHIP package, it is likely that Congress will revisit health care later this year. With that in view, it is not too early for advocates to press Congress to end Medicare’s inequitable 50 percent copayment requirement on mental health services.

Provision Won in SCHIP Package

As with many bills that Congress considers each year, the SCHIP legislation includes provisions that affect some other programs as well, notably Medicaid.

In partnership with the Consortium for Citizens with Disabilities, we won support to include an important provision in the SCHIP package that would temporarily block any action by the federal government to restrict Medicaid coverage or Medicaid reimbursement for rehabilitative or schoobased services. This is important because the administration has proposed regulations that would restrict this important coverage, which helps pay for many community-based services for vulnerable people, including individuals with HIV/AIDS, older adults with disabilities and, most often, people who have serious mental illnesses.

With the threatened veto of the SCHIP bill at press time, however, and uncertainty regarding an override vote, we are not out of the woods on these proposed Medicaid cuts. Be on the lookout for draft comments on the rehab regulation soon.

Join Mental Health America in registering profound concerns with the effort to slash more than $2 billion in Medicaid funding for critical services that can help people recover and live to their full potential.

Visit http://takeaction.mentalhealthamerica.net to sign up for action alerts and learn what you can do to improve access to needed mental health services today.