Even as I write this column, the U.S. House of Representatives has just finalized the vote on their combined bill, H.R. 3962, “Affordable Health Care for America.” The vote was very close, 220-215, with only one Republican voting for the bill.
Chances for the passage of the bill did not look promising until House Majority Leader Nancy Pelosi made last minute deals all but eliminating insurance coverage of abortion and ensuring that illegal aliens would not receive coverage.
The next step is for the Senate to finalize their bill, which is likely to look much like the Baucus bill, passed several weeks ago. Final versions of the House and Senate bill are voted on by each body, and then go to a joint Conference Committee. The combined bill is then voted on by both House and Senate. It then goes to the president's desk for signing into law.
“Congress is in town, and no one is safe!”
To illustrate the complexity of this legislation, H.R. 3962 is 1990 pages long, makes a stack two feet high, and is estimated to cost a minimum of $1.2 trillion over a 10-year period.
Questions have come up from a number of members as to how we approach lobbying on such complex pieces of legislation that might contain some provisions which might be helpful to our patients and some not so positive. Questions have been raised, such as does our Association support a particular bill, or oppose it.
Excellent questions, certainly. We have been actively working to protect our patients and our profession since 1993, and I think we have honed our skills as we have learned. Because of our relatively small budget and limited resources, we have had to learn to work “smart and lean.”
Our strategy has been to target very specific goals that are crucial to the practice of psychoanalysis and psychoanalytic psychotherapy. Those have been primarily the right to private practice and the right of privacy for health records. Our Association is virtually the only organization working on those issues, and we are generally considered the lead group in those areas. We support other issues of importance, such as parity and universal access to care, but other, much larger groups, take the lead on those issues, so we lend our support to those efforts.
We magnify our effect by working with a variety of groups, mostly through the Mental Health Liaison Group, a collection of over 40 mental health associations.
To get back to how to approach such a monster bill as H.R. 3962, full of potential “poison pills” and “white knights,” we never simply support or oppose a bill. We comment on the portions of it that are of particular interest to our Association and try to improve it.
Here is an example of language that we suggested should be included in the various bills to protect private practice: “Nothing in this title shall be construed to limit or prohibit the right of an individual to pay for health care services out of pocket rather than file a claim with an insurance company, and nothing in this title shall be construed to require a health care practitioner to participate in an insurance plan.” We were able to get similar language included in the Health Information Technology for Economic and Clinical Health (HITECH) bill, which was the precursor to H.R.3962. At this writing, we have not yet seen the final version of H.R. 3962, which was in flux until two hours ago.
It would be natural to assume that both the right to health record privacy and the right to private contracting could never possibly be in danger Alas, such is far from the case. Almost invariably, efforts at massive health care reform tend to revolve around attempts to get both health care professionals and patients into the tent, where costs can be controlled. Private practice is often considered a threat to such a system, where the operating premise is that whatever care that is needed can be provided by the system. We have come to consider our basic practice requirements to be rights. Unfortunately, these are not rights but freedoms that have to be constantly protected.
One example of what our Association has accomplished in this area of protecting practice was the achievement of establishing the right of Medicare patients to contract privately. Our Association worked diligently with Senator John Kyl of Arizona to get this enacted.
We have been able to get strong privacy protection language into the House HITECH bill, so we will see what was included in H.R. 3962. We were also able to get similar language, protecting both privacy and privilege, into the two pending Senate bills.
There is some good news. H.R. 3962 contains very strong coverage for mental health, much better than most private insurance companies now provide, and even more complete than that contained in recent parity legislation.
We can pause for a moment, take a deep breath, and be pleased with what we have accomplished so far. But the Washington roller coaster will soon resume, and we must do our best to guide it. As the old saying goes, “Congress is in town, and no one is safe!”
Bob Pyles, M.D., is chair of the Committee on Government Relations and Insurance.