In anticipation of the 115th Congress and new presidential administration, APA and the APA Practice Organization (APA Practice) offered joint recommendations for health-care reform in mid-December letters to Speaker of the House Paul Ryan (R-Wis.) and Sen. Majority Leader Mitch McConnell (R-Ky.), as well as to then-President-elect Donald J. Trump. The letters expressed interest in working with the new Congress and with the Trump administration on "health care and other issues of national importance."
Request to Congress
In a Dec. 16 letteropens in new window, both organizations urged Congress not to repeal the Affordable Care Act (ACA) without simultaneously replacing it with legislation to ensure that all Americans have insurance coverage with access to comprehensive mental and behavioral health and substance use services and that those services are offered at parity with physical health services. The letter acknowledges that while the law could be improved, it has extended coverage to more than 22 million Americans.
The organizations also highlighted other significant ACA provisions, including its:
- Requirement that mental health and substance use services be part of the essential health benefits package in marketplace plans.
- Extension of federal parity protections to private health insurance plans in the individual and small group markets and in Medicaid alternative benefit plans.
- Provisions that reduce health disparities, strengthen prevention programs, expand Medicaid, and prohibit insurance exclusions based on pre-existing conditions and discrimination.
- Investments in research and training to integrate mental and behavioral health into primary care, and to fund clinical effectiveness research.
Recommendations for the new administration
In a Dec. 19 letteropens in new window to the incoming Trump administration, APA and APA Practice spelled out their recommendations for ensuring health-care reform policies meet the treatment needs of Americans with mental and substance use disorders. Before the Mental Health Parity and Addiction Equity Act of 2008, health plans routinely discriminated against people with mental disorders by structuring and applying policies in ways that made it more difficult to access coverage for mental health care than for general medical care. Even today, private sector health plans deny claims for mental health services twice as often as claims for general medical care. As a result, people with mental disorders rely heavily on public health programs. APA and APA Practice emphasized six core objectives for health-care reform, which call for the need to:
Establish universal access to essential health-care services that include mental health and substance use disorder services at parity with physical health services. All Americans should be covered for necessary health services, and adequate coverage of mental health and substance use services must be equal to the coverage of physical disorders.
Establish and enforce health insurance protections for consumers and providers. Health plans should be required to operate under a standard set of basic rules. Among them, Americans should be guaranteed availability and renewability of coverage, and insurers should be prohibited from rescinding coverage, particularly for pre-existing conditions. Prohibitions should also extend to excessive waiting periods, lifetime or annual dollar limits on coverage and discrimination against participants or providers. In addition, insurers should cover dependents up to age 26 and cover "essential health benefits," including mental health and substance use services, behavioral health treatment, emergency care, hospital stays, and maternity and newborn care.
Integrate mental and behavioral health services into primary-care and other health-care services. Integrated care holds the promise of improving patient outcomes, reducing overall treatment costs and improving population health. The federal government should continue to invest in innovative delivery systems that integrate medical services with mental and behavioral health services.
Ensure access to preventive services, including mental and behavioral health promotion. After first onset of a mental disorder, the median delay before first treatment is nearly a decade. According to the National Academy of Medicine, each dollar invested in early treatment and prevention programs focused on mental health and substance use disorders saves between $2 and $10 in lost productivity and health costs, criminal and juvenile justice costs, and education costs.
Expand the mental health workforce. There are more than 97 million Americans living in mental health professional shortage areas, particularly in rural communities. In addition, more than 30 percent of counties have no licensed psychologists, in part due to low reimbursement rates and increasing graduate student loan debt. The country needs to make greater investments in workforce development, including loan repayment programs, to train psychologists and other mental health professionals to provide evidence-based, culturally and linguistically competent care in underserved communities.
Increase federal funding for basic and translational psychological and behavioral research and training. Research within the behavioral and social sciences increases our understanding of how the behavior of individuals, families and groups interacts with biological, social, environmental and cultural factors to influence physical health, mental health and emotional well-being. Federal support of this research is critical.
To join APA in its advocacy efforts this year, subscribe to advocacy alerts at https://www.apaservices.org/advocacy/get-involvedopens in new window.
