Rep. Pete Stark (D-Calif.): Progress in overhauling health care
financing in Congress will likely await additional successful state
Photo courtesy of Office of Rep. Pete Stark
Increasing attempts by states to overhaul their health care financing
systems, a higher profile for the impact of a lack of medical insurance, and
change in the political winds may combine to change substantially how
Americans get their medical care, according to federal mental health
The view that major changes in the way the nation finances health care are
likely to come sooner rather than later was voiced by mental health advocates
who gathered for the annual Washington, D.C., policy meeting of the Bazelon
Center for Mental Health Law in April. It was widely agreed that the states
will continue to lead the effort for the next several years.
"We're going to look to the states, unhappily, to begin the move
toward universal coverage because we won't be able to do it all in
2009," said Rep. Pete Stark (D-Calif.) about his disappointment that
Congress will likely wait to see the outcome of state efforts to overhaul
health care financing. "Politically that is a bigger bite than
[Congress] can chew."
Once several states follow Massachusetts and Vermont and enact
comprehensive health care financing reform, the federal government will be
able to attempt a national program, he said.
Stark and other speakers at the annual event said such incremental change
will be necessary to convince Americans that change for the better is possible
and that all Americans—not just prisoners—should have a
constitutional right to health care. If the public buys into the idea of
health care rights and that everyone should pay what they are able for access
to care, then a universal U.S. health care system could be established within
Stark said there already has been some progress toward such a system, as
evidenced by recent efforts of unions and health insurers to work together to
"I wouldn't have been able to predict that happening a few years
ago," he said.
Diane Rowland, executive vice president of the Henry J. Kaiser Family
Foundation, agreed that state health care financing reform efforts will
continue to outpace reform at the national level, although advocates should
push for both.
The mental health advocates said much emphasis has rightly been placed on
what plans the next president will have for health care financing, but they
acknowledged the importance of being active in shaping the expectations for
those plans. Rowland also encouraged advocates to work actively on health
reform proposals now, so that well thought out alternatives could be
considered regardless of who the next president is.
"What you ideally want is to have the ideas and the framework ready
for Congress to move on when they come back in January after the elections;
you don't want to then negotiate on what provisions should be there,"
Health care access for people with mental illness may improve under the
Democratic candidates' health reform proposals, Rowland said, although mental
health advocates need to be wary of psychiatric care "being squeezed
out" in favor of expanded access to other types of health care. The
health care plan from Republican candidate Sen. John McCain has drawn much
more concern from advocates, who are troubled that his emphasis on Americans
buying insurance on the individual market would backfire because many health
plans would exclude people with a range of preexisting conditions.
Some advocates have raised concerns that the election of a Republican
administration would freeze reform of mental health care financing, according
to Howard Goldman, M.D., Ph.D., a professor of psychiatry at the University of
Maryland and editor of the APA journal PsychiatricServices.
However, he pointed out, many recommendations of President Jimmy Carter's
reform panel—the Carter Commission on Mental Health on which Goldman
worked—were implemented under Republican President Ronald Reagan and a
"Advocates were able to take the blue-print provided by the Carter
commission and turn it into changes in laws and regulations that have had a
profound effect on how mental health services have been delivered,"
Rowland and others also encouraged advocates at the April meeting to
continue to push for current reforms, such as mental health insurance parity,
even while trying for more ambitious financing overhauls. Specific areas of
concern in the financing of mental health care include recently proposed
regulations to cut federal funding for a variety of services long provided
under Medicaid, including many that serve people with mental illness.
"Too often we have lost progress while we have waited for health
reform, and then that health reform hasn't happened," Rowland said.
Jeffrey Crowley, a senior research scholar at the Health Policy Institute
at Georgetown University, called for advocates to support legislation (HR
5613) to place a hold on the Bush administration's proposed administrative
Medicaid cuts (Psychiatric News, May 2). A successful effort to keep
Medicaid strong for the populations it already serves may allow for its future
expansion as a way to provide health care coverage to much larger segments of
the U.S. population.
"This creates opportunities that we will need to seize to expand
coverage" in the future, Crowley said. ▪