Congress combines Medicare and health care reform

by Government Relations and Communications Staff

April 28, 2009 — Change is implicit in "reform." So it may not be surprising that health care reform is in a state of flux on Capitol Hill. One recent change in course is that Congress now seems intent on combining Medicare and health care reform into one major package of legislation in a one-shot effort to address both issues this year.

On a positive note for professional psychology, a lobbyist for the APA Practice Organization has been invited to participate in key stakeholder discussions about health care reform convened by a key committee of jurisdiction — the Senate Health, Education, Labor and Pensions (HELP) Committee. Doug Walter, JD, legislative counsel for the American Psychological Association Practice Organization (APAPO), is helping to bring the perspective of the mental health and substance use communities to these discussions. Further, he is the only participant associated with a non-physician provider group. Mr. Walter and others at the table are providing substantive input to HELP Committee members for consideration in crafting legislation.

Yet the new tack within Congress of pursuing a combined Medicare-health care reform package is creating challenges for professional psychology and other groups in advocating for their members' interests. As was the case with mental health parity, advocates for the profession expect the substantial policy changes underlying Medicare and health care reform to require a long-term legislative process — especially in light of the current state of the U.S. economy and related federal budget woes.


The intention among key members of Congress to minimize controversial aspects of the Medicare portion of legislation complicates professional psychology's lobbying efforts.

The APAPO's legislative advocacy is focused on gaining Congressional passage of three provisions important to professional psychology:

  • Extending the provision enacted in 2008 that partially restored psychotherapy payment rates that were cut in 2007. This provision is set to expire on December 31, 2009.

  • Amending the Medicare definition of "physician" to include psychologists and thereby removing unnecessary and inappropriate physician supervision of psychologists' services.

  • Requiring the Medicare program to reimburse psychologists for the evaluation and management (E/M) services that they may provide to patients within their licensure.

The first issue may have the most traction since Congress restored payment for Medicare mental health services during its last session. However, the provision, given its fiscal impact, may be more difficult to achieve in the current economic environment. Organized medicine opposes the latter two provisions, and the resulting controversy poses an obstacle to achieving these legislative objectives for psychology in 2009.

Winding path to health care reform

APAPO lobbyists expected earlier this year that the Senate would produce a single bill for floor action that was focused solely on health care reform. Now it appears that the Senate Finance Committee and the HELP Committee are each working on a bill, with the Finance Committee version bundling Medicare and health care reform. With competing bills for consideration, the legislative process in the Senate may become even more complicated. The two committees are looking for ways to link their bills so only one bill ultimately will go to the Senate floor.

The House of Representatives leadership is guiding the three committees of jurisdiction in that chamber to develop a single bill later in the year for negotiation with Senate. Further complicating prospects for rapid legislative progress are signs of controversy. Major media including the Washington Post in an April 14 article have reported fundamental disputes about whether to create a new government-sponsored health insurance program for the uninsured, a cornerstone of reform, with some congressional factions showing little willingness to compromise on the issue.

Notwithstanding signs of a difficult road ahead for health care reform, psychology advocates continue to cultivate and take advantage of opportunities and mechanisms to represent psychology's interests as the health care reform debate continues to unfold.

Practice leader amplifies reform messages

During a March 27 congressional briefing and press conference on Capitol Hill, APA Executive Director for Professional Practice Katherine C. Nordal, PhD, urged policy makers to keep clearly in mind the link between mind and body as the nation looks to heal its ailing health care system.

She and other participants called for a system that integrates the delivery of physical and psychological services and enhances access to necessary services. Dr. Nordal presented remarks on behalf of the American Psychological Association (APA) and the APA Practice Organization, both of which co-sponsored the recent event with the National Academies of Practice.

"Too often when a patient seeks treatment for a chronic disease such as diabetes, obesity or cancer, that treatment fails to take into account the patient's emotional and psychological needs," said Dr. Nordal. "Successful health care models integrate behavioral, psychological, and medical assessments and interventions in primary care and other health care services."

Dr. Nordal thanked Congress for its wisdom in passing the Wellstone-Domenici Mental Health Parity and Addiction Equity Act of 2008 and observed that the law provides a baseline from which the health care reform debate will address behavioral health services. "We want to make sure that psychological services are included in every facet of health reform - in primary care, prevention and benefit packages," Dr. Nordal said.

APA and the APA Practice Organization have identified eight priorities for health care reform that guide its high-priority focus on achieving necessary reform.

Grassroots engagement

As with mental health parity and other past legislative initiatives, the APAPO is stimulating considerable advocacy activity by grassroots psychologists. In April alone, more than 10,000 psychologists sent emails through our Legislative Action Center online at Their messages called on members of Congress to pass comprehensive health care reform that ensures:

  • Mental health and substance use benefits are included and covered at parity with physical health benefits in all plans offered in a national insurance pool;

  • Psychologists' services are fully integrated into initiatives that strengthen the role of primary and integrated health services delivery; and

  • Prevention and wellness initiatives include screening for depression and other key mental health services.