In the final days before this year’s elections, a few noteworthy actions took place in Washington that will have an impact on local public health.
Public Health Funding Update
On September 30, President Bush signed a continuing resolution to keep government programs running through March 6, 2009. The legislation provides funding at FY2008 levels for the Health and Human Services Department. The next Administration will take up the work of finishing nine FY2009 Appropriations bills, including the Labor-HHS-Education Appropriations bill. House Appropriations Chairman David Obey (D-WI) has publicly stated that if the next President is Barack Obama, the bills will be funded at the level of the Congressional Budget Resolution which provides $23 billion more than the President's FY 2009 budget request.
Mental Health Parity Bill Passed
Legislation to create parity between insurance coverage of medical services and mental health care was attached to the financial bailout bill passed by Congress in September. President Bush signed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 on October 3. NACCHO, along with a broad coalition of mental health and public health advocates, has supported this bill throughout the past several years.
The Act requires mid-sized and large businesses that offer mental health coverage to provide benefits that are comparable to the benefits provided for physical ailments. It will cover 82 million individuals in self-insured employer health plans that are not governed by state parity laws and another 31 million in plans that are subject to state regulation. The Act will apply to plans beginning in the first plan coverage year that is one year after the date of enactment. For most plans, this will mean the effective date is January 1, 2010.
Below are the major provisions of the legislation:
Scope: The legislation imposes no requirement as to what conditions must be covered. But whatever is covered must be at parity with medical coverage (except to the extent that a state parity law requires broader coverage). Specifically, it prohibits group health plans that offer coverage for mental health and substance-use conditions from imposing treatment limitations and financial requirements on those benefits that are stricter than for medical and surgical benefits.
Out-of-network coverage: If a plan offers out-of-network benefits for medical/surgical care, it must also offer out-of-network coverage for mental health and addiction treatment and provide services at parity.
State Laws: The legislation preserves strong state parity and consumer laws. State parity laws vary widely from state to state.
Prevention Resolution Passed by House of Representatives
On September 23, the House of Representatives passed H.Res. 1381, a resolution expressing the sense of the House that there should be an increased Federal commitment to prioritizing prevention and public health for all Americans. This resolution was introduced by Representatives Roybal-Allard (D-CA), McGovern (D-WA), Granger (R-TX), Moran (D-VA), DeGette (D-CO), and Castle (R-DE).
The purpose of the resolution is to begin building support for strong prevention and public health provisions in health reform bills expected to be crafted next year. In the resolution, the House pledges to helping the United States be the healthiest nation by supporting an increased investment in Federal public health programs to at least 1 percent of total Federal spending within 5 years of the passage of this resolution. Senators Cardin (D-MD) and Clinton (D-NY) have sponsored a similar resolution in the Senate (S.Res. 640).
NACCHO Opposes HHS Provider Conscience Regulations
On August 26, the Bush Administration released regulations aimed at “ensuring that Department of Health and Human Services funds do not support coercive or discriminatory policies or practices in violation of federal law.” NACCHO submitted comments to HHS on September 24 opposing the proposed regulations. In addition, a letter opposing the regulations was signed by 28 Senators and 126 Representatives.
HHS claims that the regulations are needed to educate recipients of Department funds about their legal obligations under three statutes—often referred to as the Church Amendments (42 USC 300a-7), the Coats Amendment (42 USC 238n), and the Weldon Amendment (Consolidated Appropriations Act 2008, PL 110-161, Div. G, 508d). These laws are intended to give individuals and institutions the ability to refuse to provide, and to prohibit requiring the performance of or participation in, abortion and sterilization services.
However, NACCHO believes that the proposed regulations are unnecessary and threaten to significantly undermine patients’ access to critical services and information to safeguard their health. Title VII of the Civil Rights Act already requires employers to reasonably accommodate religious beliefs or practices unless doing so places an “undue hardship” on the employer’s business. The proposed rule ignores Title VII and the comprehensive Equal Employment Opportunity Commission guidance.
The nation’s local health departments serve a safety net role in many communities and are relied upon for reproductive health care and other services. The proposed rule has the potential to limit access to needed health services and exacerbate existing workforce shortages by further straining the ability of local health departments to attract a competent workforce by further limiting the pool of qualified staff. The rule purports to address only abortion and reproductive health services, but can potentially be generalized to other health services such as HIV counseling and provision of HPV vaccine.
