Health Legislation Awaits Congressional
Action
September 27, 2004
Congress plans an early October adjournment until after the
elections, making this a final chance for many important items
on the congressional health agenda. Congress has shown attention
to many critical health policy issues this year, but relatively
few bills are ready for final passage this year. Among the
items that appear likely to die are health disparities legislation,
genetic nondiscrimination legislation, health tax credits and
the Clinical Social Work Medicare Equity Act. Each of these
measures will certainly be brought back for congressional attention
in 2005, but for now attention is focused on a few remaining
items. Following is a summary of the significant health bills
that remain under consideration as this Congress draws to a
close.
Association Health Plans/Small Market Insurance Reforms
President Bush has continued his strong support for the Small
Business Health Fairness Act, S.545/H.R.660, which is a part
of his re-election campaign agenda. The bill aims to provide
small businesses with lower cost and bare bones health insurance
for their employees through association health plans (AHPs).
NASW is highly supportive of increasing access to health care
coverage for working people, but we oppose the bill because
it would exempt AHPs from state laws and regulations; eviscerate
behavioral health and other mandatory benefits; eliminate consumer
protections; and increase health insurance costs for employee
groups left out of the new plans. NASW and our coalition partners
have been successful in convincing the Senate to reject the
bill for now, but proponents have introduced new bills to nationalize
the regulation of the small group health insurance market.
This new and threatening legislation would end state regulation
of the small group insurance market, including state minimum
benefit laws. The bills are in the drafting stage in several
congressional committees and likely to see action later this
year in a lame-duck session.
Youth Suicide Prevention
Pushed by lawmakers who have experienced youth suicide within
their own families, Congress this month hurriedly approved
legislation to reduce suicide among young people. Known as
the Garrett Lee Smith Memorial Act (S.2634), the bill was just
completed and sent to the President for signature. The Act
authorizes $82 million for three-year grants to help states,
tribes, colleges and universities develop and expand early
intervention and prevention services and to provide coordinated
and appropriate mental health services to children and young
adults. The bipartisan legislation also encourages better data
sharing and dissemination of research on the most effective
ways to reduce youth suicide. Funding for the new law would
not appear until next year's appropriation's cycle.
SAMHSA Appropriations Moves Ahead
Two weeks ago the Senate Appropriations Committee approved
its version of the Labor/HHS spending bill (H.R.5006) supporting
the Substance Abuse and Mental Health Services Administration.
Among the new initiatives in the bill is a grant program to
help states formulate collaborative plans to transform their
fragmented public mental health systems. The President's New
Freedom Commission on Mental Health recommended creation of
the new program. The program is slated for $44 million in the
Senate bill, but just half that amount is in the House version.
Other programs within SAMHSA, including its large mental health
and substance abuse services block grants to states and communities,
are funded with slight increases. Unlike many other HHS agencies,
there are no program cuts within SAMHSA's budget. The House
completed action on its version of the FY 2005 Labor/HHS Appropriations
bill on September 9, but the Senate floor is not expected to
act before the expected October pre-election adjournment.
Child Health Legislation
The Family Opportunity Act (S.622/H.R.1811) would allow families
with incomes up to 250 percent of the federal poverty level
to buy into Medicaid on a sliding-scale basis. The Senate passed
the bill in May, and it has bipartisan support in the House.
However, it is unclear whether congressional disagreement over
the bill's financing will derail final passage. The Bush Administration
has announced a new outreach campaign called “Cover the Kids,” which
will direct $1 billion into efforts to reach more children
who are eligible for Medicaid or SCHIP coverage. The campaign
includes grants to states to expand enrollment outreach activities
and envisions grants to faith-based and community organizations
to help state offices enroll more low-income children with
health coverage. Unfortunately, this funding increase is offset
with an equal cut in SCHIP funds to the states in the President's
budget.
Mental Health Parity
The Mental Health Parity Act of 1996, which prohibits discriminatory
annual and lifetime dollar caps for mental health benefits,
is scheduled to sunset at the end of this year. In 2000, the
General Accounting Office found that the 1996 Act had a minimal
cost on employers, but that 87 percent of complying health
plans evaded the spirit of the law by replacing dollar limits
with arbitrary limits on inpatient days and outpatient visits.
Current legislation, the Wellstone Mental Health Equitable
Treatment Act (S.486/H.R.953) would address this shortcoming.
The Senate bill has 69 co-sponsors and lead sponsors Sens.
Domenici and Kennedy reportedly have commitments from both
parties' leadership to bring the bill to the floor. In the
House the bill has 248 co-sponsors, but it has fierce opposition
from House GOP leaders. NASW, along with a coalition of mental
health groups has strongly urged the House leadership to bring
the bill to the floor for a vote. At this time, Senator Domenici
plans to attach his bill to an unrelated must-pass Senate bill
to force it into a House and Senate conference. Domenici has
used this tactic unsuccessfully in the past, and it is unclear
whether he will be able to overcome the House leadership's
opposition.
Respite Care
The Lifespan Respite Care Act (S.538/ H.R.1083 ) authorizes
competitive grants to states to identify, coordinate and build
federal, state and community-based respite resources and funding
streams. It would also support respite provider recruitment
and training, caregiver training, and program evaluation. The
Senate passed the bill last year, and the House bill has 134
co-sponsors from both parties. The bill was recently incorporated
into the "Ronald Reagan Alzheimer's Breakthrough Act,” (S.2533/H.R.4595)
providing a second avenue for passage. The Lifespan Respite
Care Act is based on model r espite systems in Oregon , Nebraska
, Wisconsin and Oklahoma . House and Senate negotiators are
currently working behind the scenes on an agreement to quickly
pass the bill through the House.
For additional information, please contact Jim Finley,
senior government relations associate, at jfinley@naswdc.org or
202-336-8315. |
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