BHC Features All in Favor of Health Reform, Please Signify…
All in Favor of Health Reform, Please Signify…
(Scroll to the end of the article to download PDFs of the Whole Health Campaign's policy briefs on healthcare reform.)
By Ron Manderscheid, PhD
Global Health and Civil Services Sector
SRA International, Inc.
Although we are in a period of severe economic distress, perhaps unparalleled since the Great Depression of the 1930s, a majority of people still seem to be optimistic that the future holds good promise. In part, this continued optimism stems from the aggressive package of legislative reforms being put forward by President Obama. These reforms range from significant new controls on financial exchanges, to new environmental protections, to national health reform. Of the three, only national health reform has stirred significant controversy. I am optimistic that this controversy will fade like the summer heat, that national health reform will move forward, and that mental health and substance use care and prevention will be part of the reform.
Here, I would like to give an update on where national health reform stands today, describe the major features being proposed, and provide a brief analysis from the perspective of the mental health and substance use fields.
Currently, three Congressional Bills are focused on national health reform, two in the Senate and one in the House. These are the Baucus-Grassley Senate Finance Committee Bill; the Kennedy-Enzi Senate Health, Education, Labor and Pension Committee Bill (called HELP), and the House Tri-Committee Bill, crafted jointly by the Health Subcommittee of the House Ways and Means Committee, the House Energy and Commerce Committee, and the House Education and Labor Committee. Generally, these three Bills share much in common. Hence, I will present an overview of major common features, as well as a short discussion about some of the issues surrounding each of these features.
Universal Coverage. A foundational feature in each of the Bills is a plan to achieve universal health insurance coverage. Currently, about 46-47 million Americans are without health insurance, including about 8 million children. Several strategies have been proposed to overcome this problem: Extend Medicaid to 150% of poverty across all States and create a public option or private collaborative to offer a cafeteria of health insurance plans. Strenuous debate is currently underway about the public option and whether insurance coverage should be mandatory. In the mental health and substance use fields, we need to look beyond the debate and support universal coverage. Fully one-third of persons with mental or substance use conditions currently do no have health insurance.
Medical Home. A Medical Home is being proposed as a vehicle to decrease care fragmentation and increase the availability of coordinated, integrated care. Although some elements are already present, the Medical Home will require further definition to assure that it includes mental and substance use care, as well as disease prevention and health promotion interventions for these populations. Also, the Medical Home needs to be conceptualized to permit both primary care and specialty care to serve as the “home”. Under either model, close coordination will be necessary with the complementary service. Details about the Medical Home are sketchy in the three Bills.
The Medical Home currently is under discussion as part of a Carter Center mental health-primary care integration initiative. Much agreement already exists regarding the future framework and functions of the Medical Home. In our fields, we need to support full national implementation of the Medical Home. Mental health and substance use care consumers currently are dying prematurely for lack of good primary care/prevention/promotion that a Medical Home can offer. We also need to advocate for a consumer centered and directed Medical Home.
Quality Improvement. The three Bills propose a range of approaches to foster care quality improvement. Generally, they center on identifying and implementing documented Evidence Based Practices and mainstreaming their use. One example is Screening, Brief Intervention and Referral for Treatment (SBIRT). Specific details about measuring effectiveness of care are likely to be developed after passage of reform legislation. We need to support inclusion of quality improvement requirements in the legislation. Our consumers need to be assured that they are receiving effective care at a reasonable cost.
I am very passionate about national health reform. To me, the current effort is a once in a generation opportunity for achieving much needed system reform. I hope that you share this same passion and that you will support fully the Congressional proposals. To do anything less would not be true to our original passion for entering the mental health and substance use fields in the first place.
To download the Whole Health Campaign's policy briefs on health reform, click on the file names below (PDF):
Access: A Crucial Aspect of Health Reform for People with Mental and Substance Use Conditions
Financing Health Care Reform
Integrated Health Care
Promoting Wellness through Public Health
Ensuring Universal Coverage