Anticipating the 106th

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

Newt Gingrich is out and psychologists Ted Strickland and Brian Baird are in. The Democrats picked up five House seats, while the Republicans lost the same number. So goes the shift from the 105th to the 106th Congress. Overall, little has changed and the stage is set for yet another round of fights over patient-protection legislation.

The last Congress failed to enact meaningful patient protections in the private sector (some protections did pass in Medicaid and Medicare). Yet, there was sufficient progress in this arena to support the prediction that we will gain more comprehensive health-care-system reform legislation in 1999. 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 (R-La.) rise to Speaker. Congressman Livingston was a co-sponsor of the 1998 Patient Protection Act, which included our language to hold managed care accountable for their negligence.

Importantly, health-care consumers are likely to continue pressing Congress for something more than a token 'tweaking' of the broken system. According to an analysis of November election results by the powerful national health-care consumer organization Families USA, nearly all congressional and gubernatorial candidates, regardless of their party, expressed support for some form of patient-protection legislation. In a number of close races, the candidate who advocated for patient protections won. According to Families USA, the election results indicate that virtually no one is willing to defend the insurance and managed-care industries' position that patient protection legislation is unnecessary. Not surprisingly, the managed-care advocacy organization, the American Association of Health Plans, tallied election results differently and concluded that a majority (58 percent) of pro-managed-care-reform candidates lost. Even so, the managed-care industry recently expended considerable money in an effort to oppose anticipated health-care reform legislation.

On this year's docket

The new Congress' focus on health-care will not revolve solely around managed-care patient-protection legislation. Although such bills usually include a provision to protect confidentiality, we anticipate separate confidentiality proposals again in 1999. The increasing use of electronic communication and the rapidly evolving health-care system together stimulated efforts by the 105th Congress to produce a federal law that addresses the changing realities of health-care information and record keeping. Unfortunately, the proposals spanning the past couple of years needed work. Some bills proposed replacing state law, which provides good protection in some states, with only mediocre federal law. Most proposals did not sufficiently distinguish the necessary confidentiality protections for mental health treatment from generic confidentiality. As a result, the Practice Directorate was unable to provide unconditional support for any of the confidentiality proposals, and we opposed a few that would have done more harm than good. We will, however, continue to work closely with future sponsors of such legislation to enact solid protections for individuals receiving mental health treatment.

Further, Congress will receive the report from its Medicare Reform Commission in early spring. No doubt, this will again propel Medicare-related debates and proposals to the legislative forefront. Continued congressional zeal for Medicare cost-cutting will require our enhanced vigilance for proposals that attempt to move the program in the wrong direction, that is, slashing cost at the expense of quality care. In fact, we likely will need to work to protect the many patient protections enacted in 1997 from being repealed or scaled back. On the positive side, however, the renewed focus on Medicare may provide a vehicle for fixing the laundry list of related problems that the directorate has pressed the Health Care Financing Administration for several years to resolve. The challenges that have persisted ever since the Medicare program recognized psychologists as autonomous healthcare providers in 1989 include the lack of graduate medical education funding for psychology training and a spate of reimbursement difficulties.

Time for unification

These are but a few issues the directorate anticipates targeting for federal advocacy efforts in the coming year. No doubt there will be others, such as mental health parity the closer we get to the 2001 sunset date for the 1996 Mental Health Parity Act. Whatever the issue, successful advocacy will demand that health-care professionals, consumers and purchasers unify to press for a better health-care system. Anything less is unlikely to fare well against an opponent the size of the combined insurance and managed-care interests.



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