Health Reform in Pieces: Mental health and health care reform

February 1, 2010

There is much speculation — and advice — about what to do about health reform given the change in Congress since the Massachusetts’ Senate race. Some policy makers and pundits are advising that it would be better to take small bites out of health reform — rather than trying to continue down a path focused on change to the entire system. There are significant problems with such an approach when it comes to insurance reform (see for example, this New York Times Economix blog post).There are, however, some considerable gains in health care that could be made in this way and that should not be overlooked.

Mental health care is a good case in point. On January 29, 2010, the Department of Health and Human Services (HHS) promulgated the rules for the Mental Health Parity and Addiction Equity Act of 2008. This Act, which was appended to the 2008 TARP and signed into law by President Bush, has the potential to help many millions of Americans. HHS estimates that 11 percent of the population suffers from serious psychological disorders and nine percent suffer from addiction disorders. Some researchers put these numbers closer to one fourth of the population, not counting family members who also suffer as a result of these diseases.

Advocates have been working towards mental health parity for many years. Many thought equity was achieved when the Pete Domenici Act went into effect in 1996 only to be disappointed to discover how many loopholes were left by that Act. Efforts to close those loopholes started in earnest right after that Act was passed. Though it took more than 10 years to achieve full parity, that goal was achieved — with bi-partisan support — with the passage of the Pete Domenici and Paul Wellstone Act in 2008.

The 2008 Act reformed insurance coverage (for those with health insurance). The comprehensive health reform bills passed in late 2009 by the Senate and the House would have helped further mental health research and care. A little known component of both the Senate and the House health reform bills, the ENHANCED Act (S. 1857 and H.R. 4024), would have provided substantial funding for a national network of depression centers. The funding would have gone to academic institutions or non-profit research entities to expand services and research into treatments for depression, bipolar disorder and the like. Funding for an element of the health reform bill like this — discrete and building on the current system — is something that could be passed as piece unto itself. Given the history of mental health legislation (and the fact that mental disorders are equally likely to strike Democrats and Republicans), such legislation is more likely to garner bi-partisan support than other more sweeping elements of the health reform bills.

Is reform like this good enough? Well, it doesn’t provide a fundamental change to the system. As such, it won’t provide significant help to the millions who have no coverage at all. And, it won’t address the underlying cost issues that drove the discussion and the desire for system-wide health reform. But, it could help many millions in this country, and, in fact, the world. While I still believe we need — and hope we get — comprehensive health insurance reforms, maybe we could at least move forward on something as important as this while we wait.