As we anticipate the 1983 legislative session, the prospects for relief from the recent discriminatory cuts in FEHBP psychiatric treatment coverage appear fair, providing national pressure is exerted by our national organizations.
The Oakar bill in the House and the Stafford bill in the Senate will be reintroduced in the next session. Letters, calls, telegrams and personal visits to senators and congressmen requesting their support of these bills, is essential. These bills, or at least the mental health portion of these bills, will pass only if the representatives and senators believe there is significant constituent support for them.
The 1982 FEHBP contracts reduced coverage only in the National Association of Letter Carriers policy, which went from an outpatient coverage of 50 percent with a $10,000 annual limit to 50 percent with a $2,500 annual limit. That Blue Cross and Blue Shield did not reduce their outpatient coverage below the present 50 visits per year is considered by many to be a reaction to the Congressional protest of the previous cutbacks. The American Psychoanalytic Association and many of its members contributed significantly to that protest.
The American Psychiatric Association has in the past 18 months taken an increasingly active and effective leadership role in this struggle. Many members of the American Psychoanalytic Association have worked effectively through the American Psychiatric Association. This work is helping to convince the APA leadership that its membership believes in officially, publicly, and actively supporting insurance coverage for all medically necessary modalities of treatment, including intensive psychotherapy and psychoanalysis.
An “action paper,” initiated by the Washington Psychiatric Society and passed by the APA Assembly, put the APA on record as supporting medical necessity, determined, if necessary, by peer review, as the only acceptable requirement for insurance coverage. Thus the APA went on record as opposed to artificial limitations on insurance coverage, such as an arbitrarily determined number of visits or days in a hospital. Similarly, this action officially answered those in the APA who have periodically cautioned against insurance coverage of psychoanalysis and intensive psychotherapy.
Washington Psychiatric Society leaders have been told by key House staffers that only national groups such as the APA can effectively make the needed case to Congress that these issues are national in scope. Since the leadership of the APA still has some concern about the extent of support among its members for insurance coverage of intensive psychotherapies, members of the American Psychoanalytic Association are urged to communicate their views to the APA administration.
Legislative advisors tell us that passage of the mental health provisions of the Oakar and/or Stafford bills will have to be accomplished before Congress adjourns in July 1983, since subsequent Congressional attention promises to be focussed on preelection issues. In the next Newsletter, when the political scene is more crystallized, I will discuss more specific ways that our members can help achieve this goal.
Lawrence Sack, M.D.
Washington