Addiction and
Mental Health Parity Legislation Advances in Both Senate and House
In the last week, both the Senate and the House have taken
separate action to move mental health and addiction parity legislation, S.558 and H.R. 1424, through the legislative process. On
Tuesday, September 18th the full Senate passed S. 558, the “Mental Health Parity Act of 2007,” under a unanimous consent motion;
passage by unanimous consent means that the matter is considered agreed to because no Member on the floor objects, thereby saving time by eliminating
the need for debate. On Wednesday, September 19th, the House Ways and Means Health Subcommittee favorably reported out H.R. 1424,
the “Paul Wellstone Mental Health and Addiction Equity Act of 2007,” by a vote of 10 to 3. The full House Ways and
Means Committee is scheduled to review H.R. 1424 on Wednesday, September 26th.
During the mark-up or review of H.R. 1424, Subcommittee members
were able to comment on the legislation and offer amendments to the bill. Subcommittee Chairman Pete Stark (D-CA) started the
session by commenting that although this country has come a long way in diagnosing and treating drug and alcohol addiction that the laws are behind,
which has resulted in people not getting the health care that they need. The Ranking Member on the Subcommittee, Rep. Dave Camp
(R-MI), expressed several concerns with H.R. 1424, mainly that it did not reflect the priorities of the Senate bill; Congressman Camp emphasized his
preference for S.558, the Senate version of mental health and addiction parity legislation. Several other Republican Subcommittee
members, including Representatives Sam Johnson (R-TX) and Kenny Hulshof (R-MO), also raised concerns with the impact of H.R. 1424 and offered several
amendments to change the bill to make it more similar to the Senate bill; none of these amendments were approved. H.R. 1424 chief sponsor Congressman
Jim Ramstad (R-MN) spoke strongly in favor of the bill, emphasizing that the bill’s provisions were a matter of life and death, and necessary
to remedy the fact that most people who need addiction treatment are unable to access care. Representative Ramstad voted with the Democrats against
all of the amendments offered to the bill; H.R. 1424 co-sponsor Congressman Phil English (R-PA) also voted with the Democrats to defeat several
amendments.
The four main amendments that were offered by the Republican
Subcommittee Members but were defeated included:
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Eliminating the requirement that parity be extended to out-of-network coverage;
the amendment failed by a vote of 7 to 4 with Representatives Camp, Hulshof, English and Johnson voting in favor of the amendment
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Substituting the Senate scope of coverage language that would eliminate
coverage for all diseases included in the DSM-IV; the amendment failed by a vote of 9 to 3 with Representatives Camp, Johnson, and Hulshof voting in
favor of the amendment
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Adding the Senate language that would specifically allow plans to use medical
management to determine medically necessary care; the amendment was defeated by a vote of 9 to 4 with Representatives Camp, Johnson, Hulshof and
English voting in favor of the amendment. It is important to note that medical management language was inserted by the House Education and Labor
Committee during their review of the bill. During the Ways and means Health Subcommittee mark-up session, Chairman Stark (D-CA)
stated that the amendment was unnecessary and that nothing in the bill would prevent plans from managing the benefit.
Additionally, Representative Earl Pomeroy (D-ND), a former insurance commissioner, stated that inclusion of this language would create an
appearance that a different level of benefit management would be appropriate for mental health and addiction benefits, which, Congressman Pomeroy
argued, was contrary to Congressional intent.
The House Energy and Commerce Committee, which also has jurisdiction over
H.R. 1424, is tentatively scheduled to consider the bill during the first week of October. Text and status of H.R. 1424 and S. 558
can be found at: http://thomas.loc.gov/.
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Legislation
Requiring a Review of Research on Methamphetamine Addiction and Treatment Introduced in the House of Representatives
On August 3rd, Representatives Steve Pearce (R-NM), Leonard Boswell
(D-IA), Darlene Hooley (D-OR), Michael Michaud (D-ME) and Zach Wamp (R-TN) introduced H.R. 3433, the “Methamphetamine Treatment and
Rehabilitation Best Practices Act of 2007.” H.R. 3433 would require the Secretary of Health and Human Services (HHS),
through the National Institutes of Health, to conduct a survey of research available on methamphetamine addiction, treatment and
recovery. The report would be required to include recommendations for additional research pathways that would focus on
methamphetamine addiction and treatment. Under H.R. 3433, the HHS Secretary would be required to submit a report to Congress on the survey’s
findings within six months of the legislation’s enactment.
In his introductory comments on H.R. 3433, Congressman Pearce
spoke in strong support of efforts to educate communities, parents, teachers and families about the dangers of methamphetamine. In
addition, Congressman Pearce asserted that people who are addicted to methamphetamine must receive the best available treatment, and that treatment
programs should be equipped with the best practices and methods to ensure long-term success. In his comments, Congressman Pearce
expressed that very little is understood in the treatment community about the best practices for treating addiction to methamphetamine and that he
had had a number of conversations with treatment professionals in his Congressional district who had told him that no one knew what the best
practices on treating methamphetamine addiction were. Congressman Pearce further expressed that he hoped H.R. 3433 would give
treatment professionals additional tools to treat people addicted to
methamphetamine.
Following its introduction, H.R. 3433 was referred to the House Energy and
Commerce Committee where the legislation awaits review. Text and status of H.R. 3433 can be found at:
http://thomas.loc.gov/.
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Legislation
Aimed at Addressing the Oral Health Needs of Incarcerated People with Methamphetamine Use and Addiction Histories Introduced in the
House
Recently, a number of pieces of legislation that seek to
address the oral health needs of incarcerated people who have used or been addicted to methamphetamine were introduced in Congress.
On July 26th, Congressman Rick Larsen (R-WA) introduced H.R. 3186,
the “Meth Mouth Prevention and Community Recovery Act.”
H.R. 3186 would:
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Require the SAMHSA Administrator to support training and offer technical
assistance to ensure that dentists and allied dental personnel are prepared to: recognize signs of alcohol or drug addiction in their patients and
their patients’ family members, discuss the nature of addiction as it relates to their area of expertise, understand how certain dental
therapies can affect the relapse potential of patients with addiction histories and help those with substance use disorders to find appropriate
treatment
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Authorize the SAMHSA Administrator to collaborate with professional accrediting
bodies to develop and support addiction training courses for oral health professionals, and to encourage that activities to educate dentists and
dental personnel about drug and alcohol addiction be recognized for continuing education purposes
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Authorize a grant program through SAMHSA’s Center for Substance Abuse
Prevention (CSAP) to public and private nonprofit entities to determine whether, how and to what degree educating youth about the oral health
implications of using methamphetamine is an effective strategy for preventing or reducing methamphetamine use; $1 million would be authorized for
this program for each of the 2009 through 2011 fiscal years
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Require the Secretary of Health and Human Services (HHS) to expand and
intensify the clinical, health services and public health research on associations between substance use disorders, oral health and the provision of
dental care
Also on July 26th, Congressman Brian Baird (D-WA) introduced H.R. 3187, the
“Meth Mouth Correctional Costs and Reentry Support Act.” H.R. 3187 would allow for the investigation of and
reporting on the oral health of incarcerated people and on the provision of dental care in correctional facilities. This
legislation also seeks to ensure that oral health and dental health care are accounted for in the Department of Justice (DOJ) prisoner reentry
initiatives.
H.R. 3187 would:
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Authorize two DOJ grant programs to States, localities, territories, and tribal
units to develop, enhance, or otherwise sustain dental programs that provide for the oral health of people incarcerated in jails and prisons; and to
identify, eliminate, and report on the degree to which poor oral health undermines or otherwise impedes a formerly incarcerated person’s
successful transition to a stable, productive, and law-abiding life following his or her release from jail or prison. $15 million would be authorized
for these two grant programs for each of the 2009 through 2011 fiscal years
Legislation similar to H.R. 3187, S. 1907, was recently introduced in the
Senate by Senators Max Baucus (D-MT) and Norm Coleman. S. 1907 is currently awaiting review in the Senate Judiciary
Committee.
Following introduction, H.R. 3186 was referred to the House Energy and Commerce
Committee where the legislation awaits review. H.R. 3186 currently has twenty bi-partisan co-sponsors. Following its introduction,
H.R. 3187 was referred to the House Judiciary Committee where it awaits review. H.R. 3187 has nineteen bi-partisan
co-sponsors. Text and status of H.R. 3186, H.R. 3187, and S. 1907 can be found at: http://thomas.loc.gov/.
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Anti-Poverty
Event Focuses on Initiatives Aimed at Improving Employment Opportunities for Men; Panelists Highlight Need to Connect Formerly Incarcerated Men to
Employment
On September 20th, the Brookings Institution, in
collaboration with the Woodrow Wilson School of Public and International Affairs, held a two-panel discussion and question/answer session on
“Antipoverty Policies: Incentives and Work Mandates for Young Men.” The first panel, which was introduced and
moderated by Ron Haskins, a Senior Fellow at the Brookings Institution, focused on new ideas for antipoverty policy. The second
panel, which was moderated by Isabel Sawhill, Senior Fellow at the Brookings Institution, focused on methods for the implementation of antipoverty
policies. In their comments, a number of panelists spoke about the need to connect formerly incarcerated people to
employment.
Mr. Harry Holzer, Professor of Public Policy at Georgetown
University’s Public Policy Institute, spoke about the many factors that contribute to young men becoming incarcerated at such high
rates. Mr. Holzer contended that there are high rates of illiteracy and drug and alcohol addiction, as well as mental health
issues and physical abuse that already make a number of these individuals difficult to employ. Moreover, Mr. Holzer asserted that employers are often
reluctant to hire people with criminal records, especially black men, and that we should not attempt to limit or cut-off their employment options,
particularly in light of state employment restrictions for people with criminal records.
Ms. Mindy Tarlow, the Executive Director and C.E.O of the Center
for Employment Opportunities, expressed that prison should be a last resort. Ms. Tarlow asserted that parole would be more effective if it focused on
finding immediate work options for those recently released from prison. Ms. Tarlow further argued that parole officers can serve as intermediaries,
rewarding positive behavior and providing consequences for negative behavior. In addition, Ms. Tarlow argued that since recidivism rates are
particularly high within the first few months after a formerly incarcerated person’s release, getting people connected to work early can help
to keep recidivism rates down.
Mr. Larry Mead, a Professor of Politics at New York University,
expressed that a major problem with the welfare reform initiatives of the late 1960s and the 1970s was that men were mostly left out. Mr. Mead
further asserted that while the problem of poverty may be strictly associated with economic decline, the economic boom of the 1990s showed that men
with low skills development were still not working. Mr. Mead also commented that with the 600,000 individuals released from prison each year, most of
whom are men, criminal justice systems should focus on creating increased and improved employment opportunities.
A number of panelists also spoke about the importance of
education in improving employment opportunities for men. In his comments, Hugh Price, a Senior Fellow at the Brookings Institution, argued that the
educational experiences of impoverished men have also contributed to setting them at the periphery of achieving economic success and growth. Mr.
Price asserted that public education is chronically ineffective and that the flaws in the public education system have contributed to the decline of
successful adults who are capable of entering into the mainstream labor market. Mr. Richard Claytor, the Director of Fatherhood Initiatives at the
Massachusetts Department of Revenue Child Support Division, spoke about the successes he had witnessed when young African-American men had been
provided with educational and life skills that enhanced their ability to be good parents and providers. Moreover, Mr. Claytor also
asserted that, because of the prevalence of racism and stereotyping, there is also a great need to work on relationships with
employers.
Additional information about this Brookings Institution event can be found at:http://www.brookings.edu/comm/events/20070920.htm.
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