Health care reform moves to the front burner

The APA Practice Organization is working to place professional psychology at the forefront of the health care reform debate likely to gain momentum in early 2009

by Government Relations Staff

December 17, 2008 — With Congress returning from winter recess on January 6 and President-elect Barack Obama's inauguration two weeks later, health care reform returns to the national spotlight.

The new administration and Congress have identified health care reform as a critical step toward improving the economy and have indicated that issue could gain momentum early in 2009. President-elect Obama signaled his desire to move the issue forward by appointing Tom Daschle as Health and Human Services Secretary. In his new role, Daschle will spearhead the reform effort; as former Senate Majority Leader member, he is well positioned to advance the issue among his congressional colleagues.

Meanwhile, psychology leaders are eager to place professional psychology at the forefront of the debate. "The renewed focus on health care reform creates a tremendous opportunity for our profession," says American Psychological Association (APA) Executive Director for Professional Practice Katherine C. Nordal, PhD. "We are working to engage psychology in helping to design a system that appropriately values the skills and expertise of doctoral-level psychologists."

The President-elect and Senate and House leaders have begun to outline several proposals for comprehensive health care reform. So far, the proposals are limited in detail, but the APA Practice Organization (APAPO) is closely examining each and laying the necessary groundwork to play a significant role in the health care reform debate.

The APAPO's advocacy efforts are guided by the principles for reform approved by the APA Council of Representatives in August 2007:

  • Everyone should have coverage that provides affordable health care for all basic services. 

  • Basic health care services eliminate the artificial distinction between "mental" and "physical" health, recognize the inseparable relationship between mental and physical well being and offer access to treatment for "mental health conditions" equivalent in all respects to access for "physical health conditions." 

  • Basic health care services include the psychological treatment of physical conditions in order to maximize rehabilitation and quality of life. 

  • Basic health care services include appropriate prevention services that address the role that behavior plays in seven of the ten leading causes of mortality and morbidity.

The APAPO intends to build on recent legislative wins in pursuing a central role in emerging health care reform efforts. According to Dr. Nordal, gaining the full mental health parity law in October 2008 set a floor for equitable and appropriate treatment of behavioral health services in any future health care system reforms.

Dr. Nordal emphasizes that psychologists, by virtue of their education, training and professional experience, are uniquely qualified to play significant roles in primary care settings. "This country's principal health-related problems are chronic in nature, and their management depends on the ability to motivate patients to be responsible partners in their own health care. Psychologists are the experts in working with patients to change their unhealthy behaviors."

In addition to its own activities on behalf of professional psychology related to health care reform, the APAPO is participating in several coalitions, including:

  • Health Care First, a collaboration of consumer and provider associations led by Families USA and committed to high-quality, affordable health care for all Americans 

  • Divided We Fail, a coalition spearheaded by AARP and working to educate the public about the importance of good health coverage as a key component of long-term financial security, and 

  • Campaign for Mental Health Reform, a working group of mental health organizations advocating to include mental health care in every aspect of reform.

Coalition advocacy efforts are focused on a variety of issues, including the integration of behavioral health professionals into primary care, the inclusion of behavioral health in preventive services and the inclusion of mental health services in proposed federal benefit packages.

Health information technology promises to be another key issue in 2009 and a crucial component of health care system reform. Through leadership within the Mental Health Liaison Group, the APAPO has been working to ensure that patient records privacy and security are the foundation of any legislation Congress passes.

The APAPO is lobbying to specifically safeguard psychotherapy notes-protected under the Health Insurance and Portability Act (HIPAA) in the current system, but not assured in the electronic model-and psychological testing materials. In addition, the APAPO is working to pursue provisions that recognize a patient's fundamental right to privacy and to preserve stronger state laws.

"Health information technology holds the promise of improved outcomes for patients, but protecting the privacy of patients' mental health records must be the cornerstone of any new law," says Assistant Executive Director for Government Relations Marilyn Richmond, JD.