Bush, Kerry Take Stand On Key Mental Health Issues

Presidential candidates John Kerry and George Bush have declared their positions on several mental health care issues. While differences are clear, both are advocates of mental health care parity.

During the 2000 presidential race, the Bush campaign told Psychiatric News that if Bush was elected, he would create a national commission on mental health services, reauthorize the 1996 parity law, and double the NIH budget. A review of his four years in office shows a record that has garnered praise from mental health care advocates in some areas and drawn criticism in others.

Bush established the New Freedom Commission on Mental Health in 2002, which issued its final report in July 2003. The commission declared the public mental health system is a “patchwork relic” and recommended“ fundamental transformation” (Psychiatric News, August 15, 2003).

The Center for Mental Health Services within the Substance Abuse and Mental Health Services Administration has been developing the federal agenda to meet the six goals cited in the commission's report (Psychiatric News, April 2).

Bush reauthorized the 1996 Mental Health Parity Act, which was initially set to expire in 2001, and he and Congress have kept the law on the books by enacting an extension each time the law was scheduled to sunset.

That limited law bars companies from imposing dollar limits on annual and lifetime treatment of mental illness unless the same limits are imposed on treatment of physical illnesses.

In 2002 Bush endorsed full parity and promised to work with Congress to get legislation passed that year. Congress, however, has yet to pass the Paul Wellstone Mental Health Equitable Treatment Act (MHETA) (S 486/HR 953).

The comprehensive parity measure builds on the 1996 parity law by requiring companies that offer mental health benefits to ensure that they are equivalent to those for physical illnesses on factors such as copayments, deductibles, and co-insurance.

Bush also pledged in 2000 to double the budget of the National Institutes of Health (NIH) to foster advances in medical research and clinical care. APA applauded the president's commitment to double the budget by Fiscal 2003, which was achieved. Since then, Bush has proposed significantly lower annual increases for NIH. Critics complained that the decreased funding jeopardizes current and future research grants (Psychiatric News, May 2, 2003).

Compromises on Some Issues

“Privacy is a fundamental right, and every American should have absolute control over their personal information, particularly their highly sensitive medical, genetic, and financial information,” the Bush campaign told Psychiatric News in 2000.

Yet in 2002 his administration removed an important patient-consent requirement in the final federal privacy regulations. APA has long advocated that patient consent is the cornerstone of any meaningful patient privacy rule and expressed strong disappointment at its removal.

Under the revised privacy rule, health care plans, professionals, insurers, clearinghouses, and hospitals do not have to obtain patient consent before they release private health information for routine transactions including treatment and payment (Psychiatric News, September 6, 2002). Health care entities must make only “a good-faith effort” to notify patients of their privacy practices and obtain their written statement that they have been so informed.

Bush also pledged in the 2000 campaign to support patients' rights to sue their HMO or managed care organizations. In office, however, Bush insisted that he would only sign patients' rights legislation that had“ responsible tort reform,” which he defined as discouraging“ frivolous” and unnecessary lawsuits that could drive up health care costs (Psychiatric News, June 15, 2001).

He opposed a bipartisan bill (S 1052) sponsored by Sens. John Edwards (D-N.C.) John McCain (R-Ariz.), and Edward Kennedy (D-Mass.) that would have allowed patients to collect unlimited pain and suffering damages in federal court and capped punitive damages at $5 million. The Senate passed the measure.

Bush opposed a similar bipartisan bill (HR 2563) introduced in the House of Representatives until a compromise was reached with Rep. Charles Norwood (R-Ga.). The Norwood amendment capped noneconomic damages in federal court at $1.5 million and punitive damages in state court at $1.5 million and imposed several other restrictions. The House narrowly passed the bill, but Senate and House conferees could not reconcile their differences.

Kerry a Strong Parity Advocate

Kerry supports full parity and voted for the 2001 MHETA, which the Senate passed, but has been opposed by House Republicans, who argue that it will drive up health care costs. He has vowed to fight the “social stigma” that accompanies mental illness and “to end discrimination against those with mental illness.”

Kerry also supports an end to discrimination against Medicare beneficiaries with mental illness, co-sponsoring the 2001 Medicare Mental Illness Nondiscrimination Act with Sen. Olympia Snow (R-Maine). APA supported the bill (S 841), which would reduce from 50 percent to 20 percent the copayment for outpatient psychiatric services. Kerry and Snowe introduced nearly identical legislation last year, but Congress failed to pass it.

Kerry also has pledged to protect the Medicaid program. “That means stopping the Bush so-called `reform,' which would essentially block-grant the Medicaid program and threaten benefits and coverage,” Kerry stated in a press release.

To provide states relief in the next two years, Kerry proposed authorizing $25 billion annually to help protect Medicaid programs from cuts in covered services or reductions in Medicaid enrollment.

Kerry would also reform Medicaid. He was a co-sponsor of a bill that would give states the option of expanding Medicaid coverage for children with disabilities up to age 18 in families whose incomes are no more than 250 percent of the federal poverty level.

Moved by accounts of parents' taking drastic steps to keep from losing Medicaid coverage for mentally disabled children, Kerry said, “No parent should have to turn down a job or give up the custody of a child to ensure that [the child] gets health care.”

The bill, the Family Opportunity Act (S 622/HR 1811), was approved by the Senate in May, but failed to pass in the House of Representatives (Psychiatric News, June 4).

Other Health Issues Addressed

Kerry also promises to work to remove restrictions imposed by Bush on human stem-cell research. He voted for a bill (S 723) in 2001 allowing federal funds to be used for human embryonic stem cell generation and research (Psychiatric News, October 5, 2001).

Kerry promised to “lift the ideologically driven restrictions on stem-cell research that are impeding progress toward cures” for several devastating diseases.

He also cosponsored the Genetic Information Nondiscrimination Act of 2003, which passed in the Senate late last year with the support of the Bush Administration, according to APA's Department of Government Relations (DGR). Similar but stronger legislation was introduced last year in the House (HR 1910) and had 242 cosponsors as of August. “APA supports a strong genetic nondiscrimination bill to protect Americans from potential abuses,” said DGR.

On the issue of patients' right to sue an HMO for negligent care decisions, the Kerry-Edwards team has promised to “push Congress to pass a real patient's bill of rights that allows Americans to hold HMOs accountable for decisions that harm patients by denying medically necessary care,” according to the Web site<www.johnkerry.com/issues/health_care/fairness.html>. One way they plan to accomplish this is via a stronger appeals process for patients. They would also guarantee HMO enrollees the right to see a medical specialist.

Kerry's statement on mental health policy is posted at<http://www.johnkerry.com/pdf/mental_heath_statement.pdf>. The statement “Key Components of the President's Health Care Reform Agenda” is posted at<www.whitehouse.gov/news/releases/2002/03/20020301-1.html>. Congressional bills can be accessed at<http://thomas.loc.gov> by searching on the bill number or name. ▪