PROFESSIONAL POINT

Few surprises so far

By Russ Newman, PhD, JD
APA Executive Director for Practice

In my January column, "Anticipating the 106th," I discussed what might be expected this year from the then-new Congress on a number of health-care issues. While the 106th Congress has only completed one of its two sessions, I thought it might be of interest to review as of late October the accuracy of my anticipation.

First and foremost, Congress was expected to work on patient protection legislation. According to my column last January:

"We expect the bipartisan support for health-care reform that grew to powerful levels in the last House--only to fall prey to partisan campaign politics and 'Monicagate'--to resurface, though the threat of partisan politics remains. And while the congressional rank-and-file was thwarted last year by the Republican leadership, chances of a repeat are less likely given Bob Livingston's (-La.) rise to Speaker."

The House rank-and-file did prevail in passing a patient-protection bill with some teeth. Of course, it was not under the watchful eye of Speaker Livingston, who left Congress under a bit of a cloud even before assuming that role. Instead, Dennis Hastert (-Ill.) ascended to the House Speaker position. Despite his lack of support for the right-to-sue provision in the Norwood-Dingell proposal, Speaker Hastert did the fair-minded thing and allowed a vote on the bill--something his predecessor, Newt Gingrich, had vehemently refused.

Also as anticipated, continued pressure by health-care consumers (in addition to advocacy by the health-care professions in general and some extremely effective advocacy by psychologists around the country) was a critical factor in gaining the House patient protection bill. As noted in my earlier column: Health-care consumers are likely to continue pressing Congress for something more than a token "tweaking" of the broken system.

In this context, it is no coincidence that the House was able to pass real reform while the Senate enacted a limited patient protection bill that lacked health plan legal accountability. More so than the Senate, the House tends to be in closer touch with its constituents and more sensitively tuned to the will of the people. Patient protection, including legal accountability, continued to be a grassroots issue in this congressional session with survey after survey demonstrating the public's increasing desire for managed-care reform. In fact, many House Republican members pointed to the growing public outcry about managed care as justification for defying the GOP leadership position. The jury is still out, however, as to whether this grassroots wave can successfully envelop the House and Senate conferees when (and if) they are appointed to resolve differences in the patient protection bills.

Further, we anticipated more proposals concerning confidentiality of health records and patient privacy protection following failed attempts by the 105th Congress to enact such legislation. Indeed, Senator Bennett (R-Utah) and Senator Jeffords (-Vt.) put forward separate bills proposing confidentiality fixes. Unfortunately, neither was much better than proposals from the last Congress, particularly regarding mental health records. One bill was simply too vague to adequately address complex confidentiality issues, and the other bill would have pre-empted even strong state laws governing records confidentiality. As a result, the Directorate's advocacy posture was to once again work to ensure that bad federal confidentiality legislation did not become law. So far so good on this limited score, though we likely will see more confidentiality proposals in 2000.

We also anticipated that Congress would receive the Medicare Reform Commission's report, in turn propelling legislative debate and proposals for comprehensive Medicare system reform. As it turns out, the Commission never reached sufficient consensus to generate a report. Rather, congressional action has been narrowly focused on problems resulting from Medicare cuts made as part of the 1997 Balanced Budget Act. Since psychological services were specifically excluded from the 1997 cuts, the current give-back proposals are not relevant to psychology. However, we have continued dealing with a number of other Medicare issues, including reimbursement and Graduate Medical Education funding, through a combination of regulatory and legislative strategies.

Lastly, we expected that mental health parity would become a congressional issue the closer we get to the 2001 sunset date for the 1996 Mental Health Parity Act. While there was considerable discussion last spring about revising the existing federal parity law, any push for a legislative proposal ultimately gave way to the larger patient protection and managed-care reform proposals.

In addition to anticipated activities, we have been working this year on some unexpected congressional developments. But all and all, there were few major surprises during the first half of the 106th Congress.



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