Mental Health Policy – An Outlook for 2009 Presentation by Andrew Sperling Director of Legislative Advocacy NAMI Nationa

1. Mental Health Policy – An Outlook for 2009 Presentation by Andrew Sperling Director of Legislative Advocacy NAMI National andrew@nami.org December 16, 2008

2. First – A Look Back at 2008 – Major Victories at the Federal Level • Insurance Parity • Moratoria on Medicaid regulations • Parity in Medicare outpatient cost sharing • Improvement to Medicare Part D • Affordable Housing Trust Fund and Section 811 legislation

3. Parity in Group Health Plans • P.L. 110-343, signed on October 3 – the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 • Attached to the financial market rescue and tax extenders legislation • Becomes effective in new group health plan years starting after October 3, 2009 • Requires equity in coverage with respect to: • Durational treatment limits (caps on inpatient days and outpatient visits) • Financial limitations (higher cost sharing, deductibles, out-of-pocket limits) • Includes both mental health and substance abuse “as defined by the plan” “in accordance with applicable federal and state law”

4. Parity in Group Health Plans • No preemption of state mandates or parity laws above the new federal standard • Small employers exemption for firms with 50 or fewer workers • Applies only to the group health plan market • Parity for out of network benefits • Cost increase exemption available, unlikely to be used • Full parity will now reach 82.2 million covered lives in ERISA self-insured plans sponsored by firms >50 employees • New Hampshire – 360,000 covered lives in ERISA self-insured plans >50 employees v. 125,000 in fully-insured state regulated plans >50 employees

5. What does parity mean? • Mental health and substance use disorder benefits must be “no more restrictive than the predominant financial requirements applied to substantially all medical and surgical benefits covered by the plan…” • “No separate cost sharing requirements than are applicable only with respect to mental health or substance use disorders benefits.”

6. Political Landscape in 2009 • New President • Expanded Democratic majorities in Congress • Senate – 58-41 (MN still undecided) • House – 256-175 (4-5 races still unresolved) • Economy expected to dominate in 2009

7. Economic Stimulus Early in 2009 • Heavy emphasis on infrastructure spending • Many competing priorities, large and growing -- >$700 billion? • Quick action in Congress • Medicaid FMAP relief for states • $40 billion over 2 years – 8% FMAP increase • Maintenance of effort with respect to eligibility and services? • Regulatory moratoria on 6 Medicaid regulations expires on March 30 • Health IT as economic stimulus • SCHIP renewal by March 30 • Expansions vetoed by Bush? • FY 2009 spending bill must be completed by March 6

8. Key Health Leaders in the Obama Administration • HHS Secretary Tom Daschle – enhanced role as Secretary • Clinton veterans expected in senior positions – Chris Jennings, Jean Lambrew • New faces – Dora Hughes, Neera Tanden • http://change.gov/page/s/hcdiscussion

9. The Obama Health Plan • Universal coverage • National Health Insurance Exchange, • Federal assumption of some catastrophic costs, with premium relief for workers • Individual coverage mandate for children, • “Pay or Play” mandate for large businesses, • Tax credits for small businesses, • Subsidies for low-income, and • Medicaid & SCHIP expansions. • Market reforms including guaranteed issue • Cost containment and improved efficiency • Increased focus on primary care and prevention • Health IT • Comparative effectiveness

10. This is NOT 1993 - 1994 • No secret White House Task Force • No comprehensive legislative proposal coming from the White House • No “line in the sand” or veto threat • Flexible approach to achieving universal coverage over time

11. Competing Roles of Key Leaders in Congress • Senate Finance Committee Chairman Max Baucus – White Paper released in November http://finance.senate.gov/healthreform2009/home.html • Senate HELP Committee Chairman Edward Kennedy – Key leader expected to jump start the process – major legacy issue • Complicated House situation: • Energy & Commerce – Chairman Waxman in new role, ascendant leader • Education & Labor – Chairman Miller as critical ally of Speaker Pelosi • Ways & Means – Chairman Rangel’s future uncertain, Rep. Stark expected to be assertive • Top priority for Speaker Pelosi?

12. Competing Proposals in Congress • Wyden-Bennett (S 334) – 17 bipartisan cosponsors (including Senator Gregg) • Single Payer “Medicare for All” (HR 676) – 93 House cosponsors • Republican alternative?

13. Role of Mental Health in Comprehensive Reform? • Health reform in a post-parity world? • Emphasis on access to primary care, chronic co-morbidity, Patient-Centered Medical Home (20 years of diminished life expectancy) • Role of privacy in the Health IT debate?

14. For more information … • Partnership to Fight Chronic Disease: • http://www.fightchronicdisease.org/ • Partnership to Improve Patient Care • Campaign for Mental Health Reform, health care principles: • http://www.mhreform.org/ • Patient Centered Primary Care Collaborative: • http://www.pcpcc.net/ • National Alliance on Mental Illness • www.nami.org