There is much public discussion in the presidential debates (and in the press and on candidate's web pages) surrounding the best way to address American healthcare and insurance accessibility. While I believe it is a fair statement that all Americans agree that health insurance coverage should be assessable to everyone, how each presidential candidate would like to resolve this matter is where the differences reside in ideology vs. economics vs. reform. Fully understanding the choices in front of us is important.
But aren't such overriding discussions on health insurance access putting the cart before the horse? There is still much to be done that can be done for health insurance coverage and access between now and the November 2008 election.
In the meantime - in the next eleven months prior to the election - my question is: What are policy makers actively doing now to move forward the health insurance access policy issues currently on the legislative docket? And for that matter, while the senators and representatives campaign, why are some not showing up to vote and/or remain involved in such debates on the floor of their respective legislatures? I find this disconcerting.
My questions arise because an important issue in the mental health community is starting to get lost, namely the mental health parity bill-the bill that requires health insurance companies to cover treatment for mental illnesses the same as physical illnesses. This bill is not yet law. The fact remains that there is still discrimination within the current health insurance industry regarding mental illness health coverage. If equal access to health insurance by all Americans is important, doesn't this parity issue fall under the same category of equal access?
The Senate passed their version of the mental health parity bill in September 2007. This was indeed cause for celebration. The House of Representatives, however, is still hammering out their version of the bill. The President has publicly stated he is open to the passage of such a parity bill, and the good news is that there is widespread agreement on this issue by policy makers on both sides of the aisle. The differences lie in the details.
The Senate bill is less restrictive and the House bill defines which mental illnesses should be included (such as substance abuse and PTSD, which are important issues, particularly for our returning veterans). Only when the House bill gets passed can the subcommittees from both legislative arms meet to create a "compromise bill" that will be presented for passage before the House and Senate (again) before it may be given to the President for signage into law.
It takes a long time for an idea to become a bill, and then for that bill to become law. Even with the House and Senate and the President in agreement, bills do not get approved quickly into law, never mind the date slated for implementation, nor the exact content of what will get implemented.
My second health insurance access policy concern is the delay in the reauthorization of the SCHIP (State Children's Health Insurance Program). Here again, the House and Senate and President agree on the continuance of this program; but again, the differences lie in the details.
The SCHIP was implemented in 1997 and was slated to run for ten years. The purpose of the SCHIP is to provide health insurance to children who do not meet the poverty level qualification for Medicaid, but whose parents still can not afford health coverage for their children. It is "gap" insurance for millions of children, and is a joint program run by the states with federal revenue.
The reauthorization bill for the SCHIP has gone before the president twice, and has been sent back twice. Veto-override has not occurred either. The president has made it clear that he will reauthorize the SCHIP program, but he will not expand it beyond adding additional federal monies. (In its first ten years, the SCHIP program expanded to provide coverage for adults, as individual states were allowed to extend access to insurance resources once the children at the 200 percent level of poverty were covered first.) In my opinion, the SCHIP is undergoing growing pains, and it does require some reform before its reauthorization; however, if the program is intended for children then it would seem that maintaining its intended purpose would be the core issue. I do feel it is a hard line to draw when it comes to anyone who is uninsured, particularly as parental health is essential for quality of living for all families. How far to expand the program is holding up passage, and meeting the intention of the program no longer seems to be the priority.
The more I understand politics, the more I understand that reform occurs in steps. Government-sponsored insurance like Medicaid and Medicare (as we know them today) are outgrowths of over thirty years of bill debates originally stemming from the Social Security Act of 1935 under President Roosevelt. Further, the formal passage of Medicaid and Medicare occurred only as recently as forty-two years ago as part of the Social Security Act Amendments of 1965. Aid to the disabled under Social Security began as far back as 1956, but its inclusions are now of greater overall benefit. The addition of a prescription drug plan benefit for Medicare passed in December 2003 (the Medicare Prescription Drug, Improvement and Modernization Act [MMA]) but only went into effect on January 1, 2006.
The Iowa caucuses will be upon us next month, and our attention will (and should) be on many issues as America decides its leadership. In the meantime, taking part in the discussion (and contacting our representatives in the House and Senate) regarding these two policies of insurance accessibility still requires our attention. These politicians hold their offices because we elected them. They are to be our voice on the hill. Is your voice represented in the meantime?
Published On: December 12, 2007