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Two sides to every story

December 10, 2009
by Lindsay Barba, Associate Editor
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The House and Senate develop different plans for the future of behavioral healthcare

Throughout the past year, we’ve stood by as healthcare reform deadlines came and went, leaving little to no progress in their wake. But finally, in early November, the House passed its version of U.S. healthcare reform: the Affordable Health Care for America Act.

That act has now been moved to the Senate, where Senators are working to draw up their own set of reforms—known as the Patient Protection and Affordable Care Act—as an amendment to the House bill. Because the Senate is notorious for its long, drawn-out debates, followed by numerous agenda-fueled additions and concessions, the wait for reform continues. However, there has been a fair amount of progress made in both houses of Congress in their pursuits—progress that will even impact behavioral healthcare.

Although both houses first agreed to require the creation of a public option, that condition now appears unlikely to make it to the final legislation. Instead, members of the Senate proposed the creation of several national insurance policies which would be managed by private insurers in conjunction with the Office of Personnel Management. With this plan, adults 55 and older would also be allowed to buy in to a Medicare plan early under certain conditions.

Both houses support prohibiting insurance companies from discriminating against patients on the basis of preexisting conditions, as well as the need to cover uninsured citizens.

Children are also finding combined support from both houses of Congress, as the House and Senate bills plan to prohibit states from passing laws that will negatively impact current Children’s Health Insurance Programs (CHIP) guidelines or change current regulation.

But progress begins to deviate from this mostly unified path when it comes to behavioral health. While the House and the Senate have both proposed plans to apply mental health and substance abuse parity to all insurance plans, other factors pertinent to the behavioral health field are not as readily agreed upon.

The House plan lacks in its support for integrated primary and behavioral healthcare, as it does not allocate any funding for the co-location of these providers. However, it has specified criteria for the creation of federally qualified behavioral health centers (FQBHCs). Meanwhile, the Senate plan would provide $50 million in grants for the development of such integrated care facilities, although it does not address the need for FQBHCs specifically.

In regards to behavioral health continuing education, the House has allocated $60 million per year from 2011-2015 to support the establishment of a behavioral health continuing education program. This program would cross-train professionals in several disciplines, as well as teach providers how to better integrate primary and behavioral healthcare. The Senate takes a far less direct approach to this particular issue and proposes to award an unspecified amount of funding to schools to create or further support behavioral health education programs.

While the movement towards progress is apparent in both the House and Senate healthcare reform bills, many things are still left unplanned or altogether unaddressed. And before any such planning and implementation can take place, the two houses of Congress must come to a consensus on reform, leaving patients in need of care and providers in need of a plan to wait just a while longer for real progress.

To see a side-by-side comparison of the House and Senate health reform bills, visit the National Council for Community Behavioral Healthcare at http://www.thenationalcouncil.org/galleries/policy-file/House_Senate%20HC%20Reform%20Bill%20Comparison.pdf.

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