Senate blocks health insurance deregulation bill that psychology opposes

The HIMMA bill would have allowed employers to provide "bare bones" health insurance coverage, cutting off access to mental health services and other important benefits

by Government Relations and Communications Staff

May 31, 2006 — In a major victory for psychology and consumers of psychological services, the Senate recently blocked a bill that threatened to dismantle state-level health consumer protection laws established over the past 30 years.

The Senate took a “cloture” vote on May 11 that, if successful, would have ended debate on the Health Insurance Marketplace Modernization and Affordability Act (HIMMA) so the Senate could proceed to a final vote. Instead, the cloture vote, which occurred almost strictly along party lines, fell five votes short of the 60 votes needed to end Senate debate on HIMMA. The bill was then sent back to the Health Committee.

Defeating HIMMA has been a major legislative priority for the APA Practice Organization in 2006. If it passed, the bill would change the way health insurance is regulated from a state-based model to a federalized system with weaker standards. As many as 68 million individuals in state-regulated health plans and millions more with individual insurance coverage would face a loss of health insurance benefits if HIMMA were enacted.

Proponents of HIMMA, or S. 1955, claim the bill would give small businesses a viable mechanism for providing health insurance to their employees. Opponents including the APA Practice Organization counter that S. 1955 would enable companies to offer minimal, or “bare bones,” coverage to employees and thereby forestall access to mental health and other important insurance benefits.

According to APA Executive Director for Professional Practice Russ Newman, PhD, JD, years of state efforts to eliminate discriminatory mental health insurance coverage and to ensure adequate mental health benefits would be lost if HIMMA became law. Thirty-nine state mental health parity laws and 32 state minimum mental health mandate or mandated offering laws would be preempted by this legislation. Forty-two state and the District of Columbia “freedom of choice” laws that give consumers a choice of health care provider also would be preempted.

Psychologists throughout the country joined with the APA Practice Organization and state psychological association leaders to resist HIMMA. The opposition involved a combination of advocacy efforts, coalition work and financial contributions from psychologists. Among the major activities:

Leading a coalition to “Stop HIMMA.” APA co-chaired a coalition of organizations that included the American Association of Retired Persons, Families USA, the AFL-CIO, the American Nurses Association and other health-related associations to provide the “strength in numbers” needed to challenge HIMMA’s influential proponents. HIMMA enjoys the strong support of groups including the National Association of Realtors, the National Association of Manufacturers, U.S. Chamber of Commerce and the National Federation of Independent Business.

Among its activities, the coalition to “Stop HIMMA” set up a nationwide toll-free phone number that members could use to express their opposition to members of Congress. Approximately 21,000 individuals took advantage of this service on two national “call-in” days.

E-mails to Senate offices. Psychologists sent more than 18,000 email messages to senators, governors and state attorneys general. Practitioners used the Legislative Action Center available at APApractice.org to convey their opposition via email. To lend even more voice to the opposition, thousands of psychologists made phone calls to Congress in the days before the Senate vote.

In concert with psychology, a total of 41 state attorneys general signed a letter from the National Association of Attorneys General to members of the Senate opposing HIMMA. The attorneys general are the officials who enforce state laws that would be preempted by this legislation. Twenty state insurance commissioners who regulate the state insurance market also generated letters of opposition, many in response to direct outreach by APA members. Further, twelve governors signed a letter of opposition to HIMMA.

Face-to-face meetings with key Senate staff. Psychologists throughout the country also shared their opposition to HIMMA directly with Senate representatives. For example, Federal Advocacy Coordinators (FACs) in Delaware, Kansas, Pennsylvania, New Hampshire, Ohio and Rhode Island were among those who arranged face-to-face meetings with Senate staff. These contacts followed meetings in early March with 86 Senate offices during the 2006 APA Practice Organization State Leadership Conference.

Psychologists who serve as FACs cultivate relationships with their members of Congress.

Messages in the local media. FACs in Arkansas, Florida, Idaho, Minnesota and Virginia succeeded in having op-eds and letters to the editor published in key state newspapers. In Wyoming, home of Sen. Mike Enzi, the principal sponsor of HIMMA, Hollis Hackman, PhD, had op-eds published in three local newspapers. Sen. Enzi’s office submitted rebuttal statements in response to Dr. Hackman’s op-eds.

Contributions to aid psychology’s efforts. Psychologists gave generously in response to a fundraising appeal by the APA Practice Organization to stop HIMMA from gaining congressional approval. More than 1,700 psychologists contributed a total exceeding $81,000 to AAP/PLAN, psychology’s national political action committee. The contributors also signed petitions opposing HIMMA which, along with 10,000 others, were delivered to senators from all 50 states just as the debate about HIMMA began.

While HIMMA has been defeated for now, psychology leaders and staff for the APA Practice Organization will continue to track it closely. HIMMA proponents could try to resurrect the bill or similar legislation in the coming months.