Psychiatr News November 4, 2005
Volume 40, Number 21, page 10
© 2005 American Psychiatric Association
Picture Clears as Congress Nears Action on Budget Issues
Nicholas Meyers
Nicholas Meyers is director of APA's Department of Government
Relations.
As this column goes to press the week of October 21, key committees in the
Senate and House are preparing to take action on budget reconciliation, the
process by which Congress specifies how it will reach spending targets set by
the 2006 budget. After weeks of struggling, the outlines of spending cuts (and
new spending) are becoming much clearer.
Chair Charles Grassley (R-Iowa) announced that the Senate Finance Committee
will begin working on the budget package on October 24. The Finance package
offers good news for APA members because it
- replaces the projected 4.4 percent reduction in the Medicare physician
payment update with a positive 1 percent update. The change means a net gain
of nearly $11 billion over 10 years.
- includes a version of the APA-supported Family Opportunity Act, which
allows families with incomes of up to 300 percent of the poverty level to
purchase Medicaid coverage for disabled children.
- mitigates the impact of changes to targeted case management.
- includes about $2 billion in Hurricane Katrina health-related relief.
The package achieves most of its net Medicare and Medicaid savings of $10
billion through restrictions on asset transfers for nursing-home eligibility,
changes in drug pricing and pharmacy payments, and repeal of a Medicare fund
for special payments to Medicare Advantage plans.
Notably, the Finance Committee markup includes a phase-in of pay for
performance for physicians. We are analyzing the proposal and will provide
detailed information later. "Value-based" payments to physicians
submitting required quality data would begin in 2009; quality-improvement data
measures would be developed in consultation with impacted practitioners.
The picture in the House is less clear; the GOP leadership has deferred
action pending resolution of disagreements over how to achieve the net savings
target of $50 billion, up from the $35 billion called for in the budget.
What's likely is that key committees in the House will start work in late
October on a package of savings within their jurisdiction. The major
committees charged with the heavy lifting are Ways and Means, Energy and
Commerce, Education and Workforce, and Agriculture. Programs on the table for
cuts include Medicare (elimination of or cut in the Medicare stabilization
fund), Medicaid (where cuts reportedly will mirror much of the Finance
package), along with pension fund premiums, cuts in student loan programs, and
savings from farm and other payments.
Earlier this month, the House appeared to be ready to consider an
across-the-board 2 percent cut in domestic discretionary spending, but support
has waned.
As of press time, the House leadership was still attempting to find the
votes to pass a package that would increase savings from mandatory programs to
$50 billion from the $35 billion originally called for in the 2006 budget. The
GOP leadership postponed action late October, when spending reductions will be
achieved in key House committees.
Programs on the table for cuts include Medicare (where Ways and Means may
cut the Medicare stabilization fund designed to bolster drug and health
coverage), Medicaid (where cuts include changes to pharmacy payments, new
copayments for enrollees, and restrictions on asset transfers for nursing-home
care), along with pension fund premiums, cuts in student loan programs, and
savings from farm and other payments.
APA and other health and mental health advocates have strongly objected to
mandated cuts that target health programs for the poor and elderly. APA joined
with other members of the Campaign for Mental Health Reform in strongly
opposing reconciliation efforts to cut vital Medicaid programs such as
targeted case management and rehabilitative services and expressing concern
about copayments for Medicaid enrollees.
APA has also joined with 250 medical, health, mental health, and other
organizations in urging the speaker of the House and the Senate majority
leader to acknowledge the immediate and long-term mental health needs of
Americans impacted by Hurricane Katrina by passing a comprehensive mental
health parity law in 2005.
APA is separately urging Congress to act on APA-supported legislation to
end Medicare's historic, discriminatory 50 percent coinsurance requirement for
outpatient psychiatric services, to restore benzodiazepines to the list of
medications that must be covered under the new Medicare Part D prescription
drug program, and to clarify Part D coverage rules impacting medications used
in the treatment of addictions.
Capitol Hill Symposium
As part of 2005 Mental Illness Awareness Week, APA and the National
Alliance on Mental Illness (NAMI) hosted their annual luncheon in late
September for members of Congress and their aides focusing on posttraumatic
stress disorder (PTSD) and trauma research (Psychiatric News, October
4). Following introductory remarks by APA President Steven Sharfstein, M.D.,
attendees heard from Thomas Insel, M.D., director of the National Institute of
Mental Health; researcher Roger Pitman, M.D.; Col. E. Cameron Ritchie, M.C.,
an Army psychiatrist who advises the Army's surgeon general; David Post, M.D.,
a past president of the Louisiana Psychiatric Medical Association; and Harold
Ginzburg, M.D., a Louisiana psychiatrist who is a victim of Hurricane Katrina
and has treated many evacuees.
The speakers addressed PTSD research, postcombat needs of soldiers, and
ways in which relief workers have addressed PTSD and other mental health
issues as part of the hurricane response efforts.
Reps. Grace Napolitano (D-Calif.), Howard Coble (R-N.C.), Dutch
Ruppersberger (D-Md.), and Patrick Kennedy (D-R.I.) made brief remarks. After
the lunch, staff of APA's Department of Government Relations took Drs. Post
and Ginzburg to meet with members of the Louisiana congressional
delegation.
Privacy Under Patriot Act
APA has joined with other organizations to oppose provisions in the Patriot
Act allowing seizure of medical records. APA supports Senate language to offer
greater protections to health and mental health records. APA also objects to
"gag order" language that forbids physicians from informing
patients or other parties that records have been taken.
DGR Staffing Changes
I'm pleased to announce the addition of two members to our DGR lobbying
team. Clare Jenkins joins APA as our House lead on major issues including
nondiscriminatory coverage of treatment for mental illness and all issues
related to Medicare. Clare joins us after serving as legislative assistant for
health to Rep. Earl Pomeroy (D-N.D.), a member of the House Ways and Means
Committee.
Tom Leibfried joins us as Clare's counterpart lead lobbyist for related
issues in the Senate. Tom arrives at APA from the National Council for
Community Behavioral Healthcare, where he led the government relations
operation. Both have demonstrated interest and expertise in health and mental
health issues. 
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