In the Health Care Battle, the Focus Shifts to the Hill

The Committee on Government Relations and Insurance (CGRI) has for several months been grappling with the complex issue of national health care reform. Its initial task was to educate key decision makers in Washington about analytic patients, their needs, and the effectiveness of intensive psychotherapy and psychoanalysis in meeting them.

CGRI has made some friends along the way. Tipper Gore and Dr. Bernard Arons of the White House Task Force's Mental Health Working Group have both become strong advocates of comprehensive coverage for mental illness under the new health care plan. Senator Paul Wellstone (D-Minnesota) has drafted a Senate resolution (SR107) calling for full coverage for mental illness in any national health plan and has joined Senator Richard Shelby (D-Alabama) and Representatives McDermott, Kopetski, and Norton in resolutions strongly advocating nondiscriminatory coverage for the mentally ill. In addition, the Senate's Mental Health Task Force has sent a letter to Hillary Clinton urging comprehensive coverage for the treatment of mental illness in the new health plan. The letter was signed by Senators Wellstone, DeConcini, Shelby, Riegle, Leahy, Harkin, Bingaman, Simon, Kennedy, Braun, Akaka, Boxer, Metzenbaum, Pell, and Inouye.

A great deal more, however, remains to be done. The general sense among mental health activists in Washington is that psychoanalysts have kept a very low profile, by Washington standards, in the health care reform debate. Analysts need to make themselves more visible on Capitol Hill and to state their positions more clearly. Now that the White House has made its detailed recommendations, the battle turns to Congress, and the profession must make itself heard.

To that end, CGRI is developing a Legislative Contact Network of members who have personal or professional contact with legislators. The network will keep a list of these legislators' names on file for the use of members who wish to write or visit Capitol Hill to advocate equitable treatment for mental illness. Arthur J. Farley, co-chair of CGRI, has created a Legislative Contact Sheet to be filled out and sent to the Central Office by members who have developed contacts with legislators. Copies can be obtained from the Central Office (212 752-0450).

As part of its effort to make the profession more visible and comprehensible to decision makers in Washington, CGRI has also developed a Fact Sheet on psychoanalysis that highlights key facts about patients, analysts, and treatment for a general audience. The information is taken largely from the presentations made by members of the Psychoanalytic Consortium to the the White House Working Group last April. The Fact Sheet is available from the Central Office.

CGRI is currently at work compiling a presentation for Congress that will contain a letter stating The American's views on health care reform, followed by data presented to the White House last April by Alan Zients and Edwin Hustead, actuary for Hay/Huggins Inc. The presentation will contain a summary of Susan Lazar's informative report, “The Long-Term Psychotherapy Needs of Psychiatric Patients.”

CGRI is also working with the Mental Health Liaison Group, a Washington-based coalition of national mental health organizations, for the nondiscriminatory inclusion of intensive psychotherapy in their overall plan for mental illness coverage under the health care reform. The goal is for psychoanalysis to be perceived by decision makers as a necessary aspect of mental health care, available for patients with disorders for which other kinds of treatment are unlikely to succeed, and that it not be made inaccessible, for economic reasons, to those who need it. That legislators need to be educated about this is hardly surprising, but even colleagues in the medical and mental health professions need to be reminded that psychoanalysis can fit into a national health plan as a tertiary care service vitally necessary for a specific patient population.

Many members of CGRI are providing active liaison with the American Academy of Psychoanalysis (AAP), the American Psychiatric Association, and Division 39 of the American Psychological Association. In addition, the Psychoanalytic Consortium provides liaison with AAP, Division 39, and the Committee on Psychoanalysis of the National Federation of Societies for Clinical Social Workers.

At this point members of The American must continue to make themselves heard in Washington. The response to the committee's Action Alerts has been good, and members are urged to continue working with any Washington contacts they may have. When writing to Congress, members should state their position in the first paragraph and then list their reasons for it, preferably highlighted with bullets. This makes the letter more readable and its argument more easily classified as “pro” or “con.” Members are asked to send copies of all such letters to the Central Office (fax number: 212 593-0571).

Meanwhile, analysts should check the daily newspapers for information on the twists and turns that are bound to occur as health care reform is set in motion. The newsletters of the American Psychiatric Association, the American Psychological Association, and the American Medical Association are excellent sources for interpretations of ongoing changes. CGRI will periodically assess the latest data from Washington and distribute regular bulletins to its network, which includes the presidents of affiliate societies, designated members of those societies concerned with government relations, and their representatives to the Executive Council.

Issues besides coverage that are being addressed include protection of confidentiality, security of the therapeutic relationship, and freedom to contract with self-paying patients outside the health care system.