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NAMI’s Principles for Health Care Reform

June 3, 2009

1. Require that all health plans made available to uninsured individuals and families through a "Health Insurance Exchange" or other means both offer coverage for mental illness treatment and comply with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.

Health reform proposals moving forward in the House and Senate envision a Health Insurance Exchange that would make coverage more available and affordable to uninsured individuals and families and small businesses, with the goal of moving toward universal coverage.  These proposals are expected to include a requirement for everyone to have coverage – including tax credits and subsidies for low-income families and incentives for small businesses that are unable to offer coverage.  A number of proposals also call for a “public plan option” whereby a federally sponsored plan would be available as a market alternative.    

As part of any Health Insurance Exchange or public plan offering, NAMI is seeking a minimum requirement that all plans both include coverage for mental illness treatment and meet the requirements Paul Wellstone and Pete Domenici Mental Health Parity and Equity Addiction Act for equitable coverage with respect to treatment limits and financial limitations

2. Integrate mental and physical health care and promote wellness.

Mental and physical healthcare should be integrated and easily accessible.  A 2007 NASMHPD report found that adults with serious mental illness have a life expectancy on average 25 years lower than the general population -- largely resulting from medical co-morbidities such as obesity, heart disease and chronic obstructive pulmonary disease (COPD). These in turn result from a multitude of factors such as poor access to primary care, the debilitating side effects of some psychiatric medications, sedentary lifestyle, high smoking rates, poor diet, and infrequent physical exercise. Health reform is a historic opportunity to address this public health crisis and expand access to patient-centered primary care and chronic disease management.  Health plans should cover smoking cessation, exercise, nutrition and wellness education, and related services designed to improve overall healthcare and reduce premature deaths.

3. Do not discriminate in the coverage of inpatient psychiatric treatment.

Currently, federal Medicaid law does not permit payment for inpatient treatment in facilities that primarily serve people with mental illnesses. This discriminatory policy must be eliminated.

4. Address serious workforce shortages and increase the qualified mental health workforce.

Strong incentives are needed to attract and retain qualified mental health professionals, including higher payment rates, loan forgiveness programs, funding for fellowship programs, and the utilization of peers and families as mental health service providers.

5. Make early identification and early intervention priorities in healthcare reform.

Research shows that 50% of serious mental illnesses begin by age 14 and 75% begin by age 24.  On average, it is 8 to 10 years from the onset of symptoms to diagnosis and treatment.  In the life of a child, those represent critical developmental years that simply cannot be recaptured.  Research also shows that delays in services and supports results in more severe and difficult to treat mental illness.  The early identification of mental illnesses in primary care and other child-serving systems through early screening and evaluation must be included in health care reform to allow children and youth with mental illnesses to receive the services and supports they need to ultimately lead independent and productive lives. Early identification and intervention also promises to help control overall health care costs.

6. Enhance information sharing, while protecting privacy.

Improved information technology can significantly improve coordination of care and prevent adverse outcomes.  Health care reform should include improvements in storing and disseminating information among healthcare providers, while notcompromising the privacy of sensitive medical and mental health information.

7. Improve data collection, outcomes measurement, and accountability.

Without good data, it is virtually impossible to design or implement quality mental health services and supports.  Urgent action is needed to improve data collection and outcomes measurement both at the local and state levels.  Federal leadership is needed to develop uniformity in the collection and measurement of this information.   At a time of economic turmoil -- policy makers, consumers, and family members have the right to know whether scarce resources are being spent wisely and producing positive outcomes.

8. Improve cultural and language competence.

Medical and mental health services in the U.S. have not kept pace with the increasing diversity of the American populace.  Health care reform must include incentives to increase the diversity and cultural sensitivity of healthcare systems and the healthcare workforce.  

9. Protect access to psychiatric medications.

Clinical judgment of treating physicians, in partnership with consumers, must be protected.  A "one-size fits all" approach to prescribing psychiatric medications must be avoided.  Also, funding should be provided to support effective psychosocial and therapeutic interventions that, when combined with medication treatment, often lead to improved outcomes.

The Future of Medicaid

As stated above, many state Medicaid programs provide an array of services for youth and adults with serious mental illnesses that far exceed what is available through private insurance policies.  There is a good reason for this.  Whereas private insurance tends to focus on immediate medical treatment needs (hospitalization, prescription drugs, outpatient medical care), Medicaid often covers services that are rehabilitative and recovery-oriented for people with serious mental illnesses.

Currently, it is not clear whether health care reform will incorporate significant changes to important public programs such as Medicaid and Medicare.  A number of states are considering expansion of Medicaid to cover people who are uninsured but do not meet traditional economic eligibility standards for this program.  NAMI strongly believes that current Medicaid mental health benefits must at least be maintained and ideally expanded as more information becomes available about evidence based practices. 

Medicaid is the most important safety net program for youth and adults with serious mental illnesses.  For these individuals, any narrowing of Medicaid benefits would be calamitous.

 

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