2004 Legislative Preview: What’s Coming Down the Pike

Election Day is the lens through which all bills in Congress are seen. That’s always the case, but in the second session of the 108th Congress, all the more so.

Clearly all eyes are on the presidential race.

One respected columnist recently wrote: “All sorts of current numbers suggest that President Bush should win this year’s election in a landslide, but he and his re-election campaign are acting as though America is still a ‘50-50 nation.’ ”

In other words, President Bush is not taking a second term for granted. Meanwhile, Democrats are in a spirited debate over who will lead their challenge in November.

Just as important as the presidential race to APA is the makeup of the next Congress: a third of U.S. Senate seats are up, as are all 435 House seats—though fewer than 40 of those seats are in play.

Commentators predict that Republicans will increase their hold on the Senate, which is losing five Democratic senators—from Georgia, Florida, Louisiana, North Carolina, and South Carolina—to retirement. The retirements, it is believed, will force the party into an uphill and expensive struggle to hold on to its southern seats.

In the midst of all of this, APA continues to advocate for psychiatry and the care of our patients before Congress and the administration. Here’s a 2004 legislative preview:

• The hot topic last year was passage of a sweeping bill to authorize a prescription drug benefit under Medicare and to otherwise “reform” the program. Now Sen. Edward Kennedy (D-Mass.) and Senate Minority Leader Tom Daschle (D-S.D.) are seeking to amend the new law, but Republicans say they see “no need for even technical corrections.” Undoubtedly the Medicare prescription drug law will be a campaign issue.

• An insurance nondiscrimination (or mental health parity) bill will be a top item for the Senate, where its passage is likely. House prospects, despite 243 cosponsors, are less certain. House leaders have not made moving the bill to the floor a priority, but APA is working aggressively to change that.

• APA continues to advocate for an end to Medicare’s discriminatory 50 percent coinsurance for outpatient psychiatric services. The Snowe-Kerry and Strickland-Murphy bills reflect a new approach: phasing down the coinsurance to 20 percent over six years. While we prefer immediate equalization, we support this method, which helps keep budget costs under control, even as it comes with a 10-year price tag of nearly $6 billion.

• SAMHSA reauthorization presents an opportunity to build on the work of the President’s New Freedom Commission on Mental Health, which documented a crumbling public mental health system. The commission was not authorized to look at increased funding as a solution, but we believe such investments are necessary. We are part of a coalition working to secure additional funding for, and better organization of, our country’s public mental health infrastructure.

• Independently and in coalitions, APA will continue vigorous support of NIMH, NIDA, and NIAAA research funding. Timely passage of Fiscal 2004 appropriations has been a problem, but it is likely that modest increases will go to NIH (3 percent). For Fiscal 2005, we anticipate that the president will recommend a 2 percent increase for NIH.

• APA is pushing hard for bipartisan action on the Keeping Families Together Act, which would halt the “forced custody relinquishment” of children by their parents to gain access to necessary mental health treatment through the Medicaid system. The bill has an excellent chance of passage in the 108th Congress.

There are many other bills—pertaining to privacy, genetic discrimination, patient safety, and more—that affect psychiatry and patients. I encourage your involvement. Start by exploring APA’s online advocacy center at www.psych.org and joining our political action committee, APAPAC.

With general elections less than nine months away, your APA Division of Government Relations and APAPAC stand ready to work in a bipartisan fashion to advance our agenda—that which is good for patients, for science, and for your profession.

Stay tuned! ▪

Eugene Cassel is acting director of APA’s Division of Government Relations.