From Laura W. Groshong, LICSW, Director, Government Relations, Clinical Social Work Association:
I have just returned from three days of lobbying in Washington DC for the Clinical Social Work Association and have some new ideas of what the President and Congress (the five committees and one informal "Group of Six") are doing to develop a health care reform plan.
I think the President is trying to pull together at least four major political groups in Congress (Democratic progressives, 'Blue Dog' conservative Democrats, Republican conservatives, Republican moderates), which are being influenced primarily by PHarma, the AMA/other clinical groups, insurers, hospitals, and AARP/other consumer groups. Any of the political groups could theoretically sink health care reform. Mental health groups/associations (57) are working well together in the Mental Health Liaison Group, but don't have the kind of influence that the AMA does. We are working with the AMA on several issues where we have common cause, e.g., stop the proposed 21% Medicare cut to providers scheduled to go into effect in 2010, keep the "evidence based practice" provisions from taking clinical decisions out of our hands (even though this concept started in medicine, and has increasingly become the de facto way that insurers operate), expansion of care to include the uninsured, etc.
As a clinician and lobbyist, I think there is rarely a time when you can accomplish everything you want, in working with patients or in legislation, no matter how strongly you feel. I think President Obama, Speaker Pelosi, and Majority Leader Reid are trying to deal with the reality that the conflicting interests here will not allow wholesale reform of the health care delivery system or expansion of the kind that would be most humane.
Most successful legislation in my 12 years of experience is incremental and works pretty well because most issues do not arouse the conflicting passions that health care is right now. I think it has become the lightening rod for other sources of anger and anxiety, not the least of which is job loss and income reduction in general. This is unfortunate because it could stop our getting some improvements in health care delivery and coverage altogether.
Much as some legislators and interest groups have framed this as an all or nothing situation, it does not have to be. The HELP draft bill, HR 3200 in the House and the Baucus/Group of Six bill draft all contain several pilot projects which would give us a chance to see what works best in containing costs, the driving force behind any health care reform.
The legislator working the hardest to make sure that any bill has a strong mental health and substance abuse benefit is Rep. Patrick Kennedy (D-RI), with some help from Rep. Barney Frank (D-MA). Neither House wants to determine what the basic benefits package should look like at this time. A new Federal oversight body may be created to do this, the Department of Health and Human Services could be charged with developing the package, or Congress could eventually decide to do it themselves.
Here's the time frame as I see it. Things are on hold until the Baucus bill comes out on Tuesday or Wednesday. After amendments are considered by the Finance Committee (the 'mark up'), the bill will be passed by the Finance Committee. Then the full Senate will consider the HELP bill and the Finance Committee bill and reconcile them. This will influence the bill, HR 3200, which has been passed out of three committees in the House, but has not passed the whole House of Representatives. The Majority Leader intends to pass a bill by mid-October; the President has asked for a bill to sign before Thanksgiving, so the two bills which emerge would have to go to conference committee as soon as possible to be integrated. Again, the Baucus bill is seen as the most likely framework for a bill that could be passed by both Houses.
A word about the "public option", or a government health plan to cover the uninsured who cannot find insurance that they can afford. Though this is a popular concept for liberal representatives in particular, and some clinical groups, keep in mind that the way it is being developed is to tie payment to Medicare rates, possibly plus 5-10%. That could be a reimbursement decrease for some mental health clinicians. It appears that the public option will not be part of the final bill but I wanted you to be aware of the financial piece which is not widely known.
I hope this is helpful in understanding the incredibly complex process taking place in Congress which will affect all mental health and medical clinicians, in some way. Please let me know if you have any questions.
Laura W. Groshong, LICSW, Director, Government Relations
Clinical Social Work Association