The current concerns about lobbying date back to 1992, a time when the Clinton health care initiative was in the ascent. Concerned about the effects of this proposed legislation, The American's Committee on Government Relations and Insurance (CGRI), then chaired by Norman “Drew” Clemens, developed a set of goals that included equitable health care benefits for mental illness, the best possible outpatient coverage for the treatment of psychiatric disorders, the inclusion of psychoanalysis within psychiatric coverage, a change of attitude about psychoanalysis and intensive psychotherapy, the inclusion of psychoanalysts on provider panels, the establishment of noninvasive utilization review mechanisms, and an awareness among health care firms of the need to preserve psychiatry and psychology as professions. These objectives were endorsed at the December 1992 Meeting of Council.
The Council also voted approval to hire staff to implement these practice initiatives. In June 1993, Claire Coyne was hired on a part-time basis as Communications Coordinator for committees of The American involved in practice issues.
At the May 1993 Council meeting in San Francisco, Robert Cummings of Southern California, citing the experience of California analysts with third-party payment, held that psychoanalysis cannot be practiced under government coverage. Such coverage invariably invades privacy, he argued, and subjects analysis to abrupt and capricious termination. Despite disagreement on this point, the Council reaffirmed the CGRI plan, with only four opposing votes.
Over the summer there was growing concern among analysts that health care reform could result in severe damage to analytic practice. The main fear was that legislation would allow psychoanalysis and psychotherapy to exist only within a regulated national health care system. A group of analysts, led by members of The American, felt that the key issue was the right to contract privately and that this issue was given insufficient emphasis in CGRI's list of goals. In the fall of 1993, feeling a sense of urgency, these analysts formed the Coalition for Patients' Rights (CPR). Robert Pyles was elected president of the new group. Washington attorney James Pyles, whose firm's practice is exclusively in health care law, was hired as the group's lobbyist.
During the December 1993 meetings, the positions of CGRI, CPR, and Southern California were discussed at meetings of both Board and Council. The CGRI position, which called for
coverage for psychoanalytic care and protection of the analytic environment, was now more explicit regarding the freedom to contract privately outside the health care system. The Council approved the CGRI plan and approved the hiring of lobbyist Daniel Leach on CGRI's recommendation. Leach is a Washington and California attorney experienced in health care legislation.
CPR continued working independently of The American, representing a wider constituency, including patient advocacy groups. As an organization it was independent of CGRI, the Executive Council, and the Executive Committee.
Leach lobbied vigorously throughout the spring, as did CPR's Pyles. Members of The American worked actively within both groups, and both requested donations from members to support their lobbying efforts. Their differing viewpoints and apparent inability to cooperate with each other led the Executive Committee to feel that too much effort was being expended on the internal debate when it should be devoted to meeting challenges from without. President Bernard Pacella requested that representatives of CPR, CGRI, and the Southern California position devise a plan agreeable to all. Robert Pyles, Drew Clemens, and Robert Cummings worked to formulate a compromise proposal. The plan gave top legislative priority to the right to contract privately. Further, The American would officially endorse CPR, and members of The American would be encouraged to support financially the lobbying efforts of both organizations. This compromise was presented at the May 1994 Meeting of Council. However, an amendment that Leach must first determine that a legislator favors private contracting before going on to discuss other provisions of the plan was defeated only when Pacella voted from his position as chair of the Council to break a tie vote.
The compromise included agreement on the following points: (1) the right to contract privately for psychoanalysis and psychotherapy outside the health care system; (2) the need to preserve the clinical environment for effective psychoanalysis and psychoanalytic psychotherapy within the health care system; and (3) the right of analysts to work in a third-party system as providers of covered services, while at the same time conducting private psychoanalysis and psychotherapy, without restrictions, outside the health care system. Once these three demands were met, two additional goals could be advocated: (4) expanded insurance coverage for the continuum of mental health treatments; and (5) the protection of psychoanalysis and psychoanalytic psychotherapy by excluding them from any health care system that would restrict private contracting.
The tie vote was a clear indication that division of opinion remained. The following day the compromise was announced at the Meeting of Members; however, during the same day a heated disagreement between supporters of CPR and CGRI confirmed that the compromise had not entirely healed the rift.
At the May 1994 meeting, Judith Schachter became president of The American, and Arthur Farley assumed the chair of CGRI. Tensions between CPR and CGRI continued to preoccupy the Executive Committee. CGRI was expanded to include members critical of the work of Leach and the committee's previous decisions. With the demise of the Clinton Health Care Reform Act in the fall of 1994, concerns over health care legislation shifted to the state level. Leach was put on a retainer in January 1995, but because of concern over The American's budget deficits in 1994 and 1995, a further need to reevaluate the role of a lobbyist developed. A formal complaint about Leach was made by a new member of CGRI. The Executive Committee, reflecting the organization, was divided over the role of Leach and, faced with continuing complaints about the lobbying effort and with growing concerns about the budget, felt that the effort could not be sustained.