Psychiatrists Lobby Congress To Make Parity a Reality

Lea DeFrancisci, M.D., a psychiatry resident, has had extensive training in child psychiatry, but that didn't prepare her for meeting with her representative, Rep. John Hall (D-N.Y.) on Capitol Hill. She was nervous before her visits to five congressional offices during APA's Advocacy Day in March, but she need not have worried about Hall.

“He was actually the most receptive to me and listened to what we had to say,” DeFrancisci said about the reception she received, which was less enthusiastic in other offices she visited.

DeFrancisci was well prepared for the range of responses she received on Capitol Hill by two days of training from APA staff on lobbying techniques and issue briefings on legislation affecting psychiatry and mental health care in general.

The visit by DeFrancisci, chair of the Committee of Residents and Fellows, to Hall's office made it one of the 271 Capitol Hill offices visited by APA members during Advocacy Day. It also represented a success in APA's goal of increased lobbying participation by members in training. Twenty residents attended the 2007 event, up from 10 last year.

“We're really making a major effort to bring the members-in-training to Washington,” said Nicholas Meyers, director of APA's Department of Government Relations. “They add a real energy to our efforts, which members who have been coming for years have noticed, and it energizes all of us.”

That enthusiasm was readily apparent to Rep. Danny Davis (D-Ill.), who stopped by an APA Capitol Hill reception after the 20 residents and 100 other APA attendees had spent the day trooping through the vast buildings near the Capitol that contain House and Senate offices.

“This is the most energized room I've been in today,” Davis said at the reception.

Davis commended the psychiatrists for “the critical work you do,” which he saw firsthand many years ago while working with a Chicago psychiatrist on alcoholism-treatment programs. He credited the clinician with sharpening his awareness of substance abuse, including the realization that 75 percent of suspects arrested in Chicago tested positive for drug use.

“Our country has to find a way to do something about that,” Davis emphasized.

The challenge on which many Advocacy Day attendees focused was encouraging members of Congress to support federal parity legislation that has been introduced in each chamber.

Mitchel Stein, M.D., a La Mesa, Calif., psychiatrist, said parity was the main issue he discussed in the five congressional offices he visited. After three years of participating in Advocacy Day, he has come to understand over time how his representatives and their staffs stand on mental health issues, and most were receptive to his message.

“It's very doable this year,” he said about parity.

That positive assessment of the chances for long-awaited federal parity legislation was echoed by a bipartisan group of congressional staffers, who updated attendees on the politics of the parity bills.

Andrew Patzman, deputy health policy director for Republicans on the Senate Health, Education, Labor, and Pensions Committee, described the two-year effort by Sen. Michael Enzi (R-Wyo.) and others to bring mental health advocates, insurers, and the business community together to craft a compromise they could all support. That effort culminated in a bill (S 558) that has begun to move through the Senate (Psychiatric News, March 16).

“We can see a realistic chance of enactment, if favor smiles,” he said.

A House bill (HR 1367) that takes a somewhat different approach in key areas is based on the parity approach followed by the Federal Employee Health Benefits Program (FEHBP), which requires equal coverage when both mental and general physical care are insured. Research on FEHBP plans providing parity have found that costs have not increased faster than costs in plans without parity coverage since 2001, when the program was introduced.

Michael Zamore, a policy advisor to Rep. Patrick Kennedy (D-R.I.), said psychiatrists can help advance the legislation by contacting their members of Congress and urging them to support quick passage of the bill without amendments that would complicate passage. Psychiatrists should promote parity as an issue of fairness and cost-effectiveness, which would result in more worker productivity and less disability, he suggested.

“There are a surprising number of people on Capitol Hill who don't realize how evolved [is] medicine's view” of mental illness, Zamore said.

When members of Congress addressed Advocacy Day attendees, one topic was the need for better psychiatric care in rural areas. Rep. Michael Michaud (D-Maine) said he planned to reintroduce legislation from the previous Congress that would expand veterans' access to mental health care in rural areas, for example.

“We have to make sure they get the treatment, and that it is intensive treatment,” Michaud said.

In response to questions about insufficient staffing from two psychiatrists who have worked at the VA, Michaud said he has begun to collect information on delays in filling mental health positions through his new role as chair of the Veterans Affairs Health Subcommittee. Michaud said he will hold hearings on PTSD and gender-related health care issues, including sexual trauma, among veterans.

The Congress members also acknowledged the continuing stigma military personnel often suffer when they seek mental health care. Changes in the reporting system must allow members of the military to come forward privately and to receive ongoing evaluations, instead of one-time, postdeployment mental health checks.

Rep. John Shimkus (R-Ill.) told Advocacy Day attendees that he doubted Congress would undertake a full-fledged overhaul of the physician-payment formula in Medicare this year because of the strict fiscal rules mandating budget neutrality that Democratic leaders have adopted. Also, he voiced support for increased use of digital health records and telemedicine as ways to promote the expansion of access to psychiatric services in rural areas.

Other members of Congress who participated in Advocacy Day events were Rep. John Sullivan (R-Okla.), Rep. Steve Buyer (R-Ind.), Rep. Jim Gerlach (R-Pa.), Rep. Phil English (R-Pa.), Rep. John Tanner (D-Tenn.), Rep. Bob Etheridge (D-N.C.), Rep. Jim McDermott (D-Wash.), Rep. Eliot Engel (D-N.Y.), Rep. Joe Wilson (R-S.C.), and Rep. Tim Murphy (R-Pa.). ▪