May 7, 1999

Deputy Assistant to the President for Health Policy Chris Jennings was among several officials from the White House and the Department of Health and Human Services who addressed about 100 APA members at a special briefing on health policy during APA's biennial Federal Legislative Institute in Washington, D.C., last month.

Special Assistant to the President Barbara Woolley, Deputy Assistant to the President and Deputy Director of the Office of Presidential Personnel Marsha Scott, and Deputy Assistant Secretary for Program Systems and Office of the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services Delores Parron, also discussed various health care-related issues.

Scott discussed in general terms the White House Conference on Mental Health, now scheduled for June 7 in Washington, D.C. There are plans for nationwide satellite hookups at as yet undetermined locations. The goal is "to have a thousand-plus conferences occurring at the same time," said Scott.

Discussing efforts toward insurance parity, Jennings said the 1996 parity legislation was "a step, a small step, in the direction of acknowledging some of the discriminatory practices" surrounding insurance coverage of mental disorders. But he conceded that it "gave rise to a whole host of new debates about the limitations of that legislation and what else we should or may want to consider."

It is "probably at our peril" that the mental health community focuses on parity to the exclusion of other pressing issues, said Jennings. "That seems to be a great rallying cry for the community as a whole, but I think that we make a huge mistake if that is the only issue that is highlighted and pursued from the community's perspective."

He cautioned that there is a "real divide" within the mental health advocacy community itself, which undermines the capacity to pass reform legislation. If that community "itself doesn't agree, then there is usually no way Congress is going to touch it, and that is another message I'd like to provide you with," he asserted. The split involves those who would hold out for truly comprehensive parity and those willing to settle for more limited versions along the road to comprehensive parity.

Privacy issues are also extremely important, said Jennings, not only from the perspective of "potential negative impact on medical outcomes" but also because there is a "fundamental imperative of ensuring the patient's confidence in how their records are used and hopefully not misused. This is a huge, huge issue."

He asked APA for "guidance on how best to seek the balance" between confidentiality and the need for access by other parties with a legitimate need for access to some of the information contained in medical records. Privacy and confidentiality issues are now the focus of several bills pending in Congress, he noted. He pointed out that the Department of Health and Human Services (HHS) in 1997 suggested "some flexibility" by the states regarding regulation of psychiatric records. The "fundamental issue" at this juncture is the federal preemption of state laws in terms of privacy legislation. If Congress does not act soon, after this August HHS will promulgate regulations on medical record confidentiality, which may fall short of what psychiatrists and other mental health advocates think is required, he reminded the audience.

Medicare reform is another major issue, Jennings noted. He characterized current mental health coverage under Medicare as "wholly inadequate within the current policies," but added that within the Congress, few people are seeking to alter Medicare coverage of mental illness.

Jennings expressed optimism that there may be some movement toward expanding Medicare to cover prescription drugs, something he characterized as a "key issue for psychiatry." He noted that by the year 2000 there will be more than 15 million people under Medicare who will have no prescription drug coverage.

"If we're really going to talk about modern medicine in the 21st century and not cover prescription drugs in the Medicare program, we think that we're going to be keeping it in the dark ages of health care," Jennings added. Although "suggesting that, recognizing that, and raising that issue is important and valid," said Jennings, such coverage is also "a hell of an expensive deal" for which there must be some offsets. Finding those offsets to pay for prescription drug coverage is "quite a challenge," Jennings concluded.

At press time, key Democrats unveiled a bill that would provide prescription drug coverage if passed, according to a report in the April 20 CQ Daily Monitor. The draft bill, which would apply to the outpatient portion of Medicare (part B), would require the program to cover up to $1,700 in drug costs yearly per beneficiary, with an initial $200 deductible and 20 percent copayment on each prescription.