By Andrew Siddons, CQ Roll Call
August 29, 2016 -- Hillary Clinton's plan for mental health care has a lot in common with proposals in Congress to improve mental health treatment and expand access, including potential hurdles—namely, how to pay for it.
The Democratic presidential candidate's plan, released on Monday, would aim to promote early diagnosis and intervention, especially for children. It would emphasize treatment instead of jail time for low-level criminal offenders with mental illness. Clinton says she would enforce so-called parity laws, which require insurance providers that offer mental health coverage to provide benefits that are just as good as those for physical health care.
The proposal addresses issues similar to those tackled by various bills making their way through Congress. A bill (HR 2646) that passed the House in July and a Senate companion (S 2680) awaiting floor time share the overall goals of early prevention for children, improving the national suicide prevention system and promoting parity. Related language in a bill (S 2002) from Sen. John Cornyn, R-Texas, that would try to better integrate treatment into the criminal justice system is a potential candidate to ride along on a final compromise.
The Clinton plan also would build on an initiative championed by Sen. Debbie Stabenow, D-Mich. Stabenow, who has been actively stumping for Clinton during the campaign, wants to expand a program launched in 2014 that makes community behavioral health centers eligible for higher federal reimbursement rates. Stabenow has introduced a bill (S 2525) that would expand the number of states eligible for this program from eight to 24. Clinton's plan would invest $5 billion to bring it to every state.
"Mental illness touches the lives of one out of four people. And this is just one more example of how Hillary Clinton understands the issues American families face and will make them a priority when she is President," Stabenow said in a statement.
Such an expansion has bipartisan support in both chambers of Congress, but likely not enough for lawmakers to actually find a way to pay for it. Funding to improve mental health care has proven a stumbling block for both chambers as they have tried to advance legislation. The House bill was delayed for months after a Congressional Budget Office (CBO) analysis estimated a cost of at least $60 billion over 10 years to expand Medicaid access to inpatient mental health treatment. That provision was ultimately dropped from the version of the bill that passed.
Still, many lawmakers believe that making those investments could reap rewards that the CBO didn't consider, such as the savings incurred by helping people become productive members of society and keeping them out of emergency rooms and jails. The American Psychiatric Association, which praised Clinton's plan on Monday, pointed to its analysis that predicted a savings of between $26 billion to $48 billion if the physical and mental health care systems were more fully integrated.
The plan was generally met with praise from groups specializing in mental health treatment.
"We applaud Secretary Clinton for giving us an inclusive plan that promotes early identification and intervention, ensures access in all communities to skilled staff delivering effective services, addresses the unchecked rise of suicides, offers the promise of technology, strengthens mental health and addiction parity, and supports the research needed if we are going to make progress," said Linda Rosenberg, president of the National Council for Behavioral Health.
In addition to questions over paying for mental health care, enforcing parity laws might also be a difficult proposition. Clinton says she would launch randomized audits to detect violations, strengthen compliance monitoring and create an easier process to report problems.
But ever since the law was enacted in 2008 and addressed again during the 2010 healthcare overhaul, some health care providers have said they aren't been totally sure what is required of them and consumers haven't been totally sure what their rights are. The mental health bills in Congress would attempt to improve compliance by issuing guidance documents and requiring federal officials to clarify existing parity rules.
It might still be some time before patients can expect more coherent implementation. States generally are in charge of making sure that insurers comply with parity laws, but according to the Pew Charitable Trusts, only New York and California are consistent in enforcement.