January 15, 1999

By Marcia Kraft Goin, M.D., Ph.D.

A generation ago state and federal legislative initiatives in health matters spurred little interest among many practicing psychiatrists. But not today! Problems with ERISA, Medicare considerations, and confidentiality matters were wake-up calls to those of us accustomed to letting APA's Division of Government Relations carry the ball. At every legislative session decisions about quality patient care, payment for treatment, access, and confidentiality are being made. This means that you, as the future caretakers of this profession and as responsible citizens, must find your way "to the forum" and help determine the course of legislative actions. Five thousand strong, the voice of APA's members-in-training (MITs) makes a difference.

That is why APA, through its Division of Government Relations (DGR), is working with you to organize member-in-training grass-roots activities. Legislators often do not know that psychiatric illness is diagnosable and treatable and that treatment is cost-effective. You can educate them. They will listen; they want your expertise; they want your vote. When legislative decisions are pending, the voice of each and every constituent makes a difference. The numbers of faxes, letters, and e-mails legislators receive influence the outcome of bills being considered. Administrative aides count the pro and con communications, providing guidance to vacillating legislators.

What is ahead of us in this legislative year? When the new Congress convenes this month, its members will be eager to refute the charges that it is a "do-nothing" body. Members of Congress know that the public is outraged by the present system of health care, and many office aspirants campaigned with a promise to reform inequities and affirm fairness, access, and justice.

• A Patient Protection Bill will once again be introduced in Congress unless the sequelae of the impeachment process paralyze action. Passage of a patient protection bill will clearly affect your future and that of your patients. The bill that APA supports will permit our patients the freedom to seek care outside of their provider networks; allow utilization review by appropriately trained personnel; assure the right of independent appeals for denial of services; forbid requiring physicians to sign gag clauses; and bar terminating physicians from managed care plans without giving a reason in writing.



• We are still fighting for parity. Manipulation of statistics is nowhere better displayed than on this topic. The insurance industry has consistently opposed parity for mental health and substance abuse-manipulating the data to exaggerate anticipated expenses. Your experiences, especially the personal stories of your patients who came to harm because of inadequate access or funding, can be a tremendous asset in this debate.



• A confidentiality bill must be passed by August 1999; otherwise, the Secretary of Health and Human Services, Donna Shalala, will have to write the needed regulations mandated by the Kassebaum-Kennedy health care reform law. Secretary Shalala calls for punishment of those who violate confidentiality rules, but her suggested regulations seriously omit safeguards to protect confidentiality and restrict access to medical records. Included in her regulations would be the right of law enforcement officers, the FBI, and national security agents to demand instant access to patients' medical records, invading your files without the patient's permission or the current protections provided by court-ordered subpoenas and search warrants.

How to Respond

APA's Division of Government Relations is ever present on Capitol Hill and rapidly disseminates its "Action Alerts." What is the best way to add your voice to this process? Once the organization and administrative details are set in place, the rest is easy.

When Action Alerts arrive, you can act instantly. Go to "Public Policy Advocacy." A sample of the appropriate letter as well as the names and addresses of the appropriate people to contact appear immediately. When you enter your ZIP code, the names of your representative and senators are displayed.

If you do not have access to the Internet, DGR will fax you sample letters and the names and addresses of your legislators.

To receive Action Alerts automatically either through fax or regular mail, as well as be put on the mailing list for DGR's two newsletters (one for state legislative news, the other for federal legislative news), you can subscribe online at "Joining APA's Grassroots Network." If you do not have Internet access, you can subscribe by calling DGR at (202) 682-6060.

Another route to making sure you are informed about late-breaking legislative developments is to join DGR's list serve, DGRNet. To join, send an e-mail to Jim Walsh of the DGR staff at jwalsh@psych.org. In the subject line, enter "DGRNet," and include in the message your name, address, phone number, and e-mail address.

Form a Committee

To expedite this work, you can be instrumental in forming a Grassroots Member-in-Training/Faculty Legislative Committee at your site. How can you best organize yourselves?

Identify the residents in your program with an interest in legislative issues. Join together as the nidus of a group that informs others when action is needed. Your resident group can then gain administrative support by collaborating with a faculty member who is equally concerned about these matters. Forging a link with a faculty member provides immediate organizational support and also ensures the continuation of the process after you graduate. A national consortium of grassroots MIT and faculty legislative committee members will be organized through DGR to disseminate information and to share ideas about strategic planning and reports of successes and failures.

How to Proceed

You, the psychiatric residents in each training program, should bring together a group of those residents interested in working on legislative issues.

• Identify a faculty member who has an interest in these matters and a willingness to provide a ready conduit to the departmental administration to gain access to the communication tools necessary to get the job done.



• Send a list of the names of those on your committee (including the faculty member) to me at mgoin@hsc.usc.edu or your MIT representative, Dr. Diana Dell, at ddell@torhosp.toronto.on.ca. We will forward this information to DGR.



• When DGR dispatches a legislative alert with a request for letters and telephone calls, sound the alarm, call the group together, send out for pizza, and in no time your responses will be flying across the country.



• This year you have a special opportunity to meet with your members of Congress in their Capitol Hill offices while you're in Washington, D.C., attending APA's 1999 annual meeting. The meeting is being held May 15 to 20. Once you know what dates you'll be in town, you can schedule meetings with your representative and senators. To get their phone numbers, call DGR at (202) 682-6060 or refer to APA's Web site at and click on "Public Policy Advocacy." Also, each morning DGR will offer briefings, instructions on how to lobby, printed materials to bring to your meetings, a light snack, and buses to the legislative office buildings. It will be a great, almost painless way to learn to lobby, and it should do a lot of good for us and our patients.

Dr. Goin is a member of the APA Board of Trustees and one of its liaisons to the Joint Commission on Government Relations. She is director of residency education in the psychiatry outpatient clinic at the University of Southern California medical school in Los Angeles.