The Ottinger Bill (HR5995), requiring nondiscriminatory mental health benefits for Federal employees and catastrophic coverage for mental illness, continues to gain ground in the House of Representatives, with 87 cosponsors at last count.
Meanwhile, in the Senate, Senator Robert Stafford (R) of Vermont has introduced S. 2816 with the co-sponsorship of Senator Lowell Weiker (R) of Conn. The Stafford Bill provides that, whenever a treatment of a patient encounters an artificially imposed limit on number of treatments per year or number of allowable hospitalized days per year, peer review may be obtained to determine the medical necessity of the treatment, which then must be covered by Federal Employees Health Benefit Plan third party payers.
The Stafford bill prohibits discriminatory coverage based on diagnosis, as contrasted to current Blue Cross and Blue Shield coverage. The bill also requires that all plans have coverage for treatment of mental disorders, alcoholism, and substance abuse.
The cost to the Government of the Stafford Bill is estimated to be less than $13 million for the outpatient coverage and $50 million for the inpatient coverage. This bill is more likely to be enacted than H.R. 5995, because it mandates a system of utilization review, which will satisfy many critics of H.R. 5995 by providing a means for cost containment. This system, however, would be based on clinical indications for treatment, not on marketing whims or groundless fiscal fears.
Reliable sources report that not only have Blue Cross and Blue Shield requested an additional 26 percent increase in premiums, but also, in the current secret negotiations between OPM and the carriers, further selective cuts in psychiatric coverage are being considered, particularly in outpatient services. (Donald J. Devine, Director of OPM, had explicitly targeted psychiatric treatment, along with dental care and abortions, for cutbacks in 1982.) The current 50 percent unlimited coverage for outpatient psychiatric care, offered by the National Association of Letter Carriers, is expected to be dropped or severely curtailed. In addition, Senator Durenberger (R), Minnesota, has introduced legislation that would result in further substantial cuts in FEHBP psychiatric coverage.
The American has joined the coalition of groups working to educate government decision-makers about the need for adequate insurance coverage for mental disorders and to reverse the FEHBP cutbacks. It is now seeking to obtain cosponsors in the Senate for the Stafford Bill.
At this time, it is very difficult to predict if and when this legislation will pass. Ultimate passage of a definitive restructuring of the FEHBP may not occur until next year, but the Stafford Bill presents an opportunity for those in favor of nondiscriminatory coverage for psychiatric treatment, including psychoanalysis, to make this support known to their Senators.
Even should passage this year not occur, a substantial expression of constituent support for such coverage will lead to the acquisition of a large number of Senate cosponsors for S. 2816, and this in turn will discourage Blue Cross and Blue Shield from making further cuts in coverage. If a large number of Senate cosponsors can be obtained now, these Senators will be “on record” as committed to support this legislation next year, when the political climate is expected to be more favorable for its passage.
So far, 95 members of the American have responded with contributions to the Washington Psychiatric Society to help them defray the expenses undertaken by that group in their Psychiatric Education Program.
Drs. F.K. Millican and A.E. Marans, spokesmen for that Program, have issued the following statement: “By the cutbacks, the government has, in effect, stated that psychoanalysis and intensive psychotherapy (more than one visit per week) are no longer medically indicated modalities of treatment and that we are no longer a creditable medical specialty. Outpatients have, in turn, been essentially disenfranchised from entitlement to coverage for any treatment more intensive than once-a-week therapy. The implications of this for the future of psychoanalysis are enormous”.
Members of the American can help by writing, calling, or visiting their Senators to urge his or her cosponsorship and/or support of the bill. Those who are unable to do so may authorize telegrams sent to their Senators on their behalf (at a cost of $4.50 per message) by calling (202) 659-4589. In addition, members are urged to lend their financial help to the Washington Psychiatric Society for its Psychiatric Education Program.
Lawrence Sack, M.D.
Washington, D.C.