Health Care Reform: Status of CHADD’s 13 Principles

The House and Senate have each passed health care reform legislation. What is the status of CHADD's 13 principles?

On August 13, CHADD issued 13 principles to consider in health care reform. On October 15, CHADD and five national sister organizations (AACAP, ASA, CABF, MHA, and NAMI) issued five principles to consider. The five are a merged and consistent statement with the previous thirteen.

CHADD's 13 principles and their legislative status:

1. Provide health care coverage for all Americans.

Health care coverage is greatly expanded in both bills. The Congressional Budget Office (CBO) anticipates 94% coverage in the Senate bill and 96% insurance coverage in the House bill once the bills are fully implemented.

The Senate bill expands Medicaid mandatory eligibility to 133% of the federal poverty level, while the House bill expands mandatory eligibility to 150%. Both bills create a "National High Risk Pool," the Senate bill for uninsured people denied coverage due to a pre-existing condition, the House bill for the insured and those denied coverage due to a pre-existing condition. These pools would terminate upon the enactment of "insurance exchanges."

The Senate bill would establish state-based health insurance exchanges for individuals and small businesses by 2014. The House bill would establish a National Health Insurance Exchange for those uninsured without Medicare and Medicaid coverage and for small employers. Data is inconsistent over the true extent of coverage.

Both bills require individual mandates to have insurance (2013 in the House, 2014 in the Senate) and non-small employer mandates to offer insurance. There is much debate on whether these coverage options are "affordable."

2. Require "parity" for mental health assessment and treatment, including prohibiting non-discrimination between health conditions.

The Senate non-discrimination requirement, including health status, medical condition, and disability, becomes effective 2014. The House bill includes mental health and substance abuse parity requirement and authorizes a Health Choice Commission to define the extent of the non-discrimination requirement. The Senate bill also requires mental health parity. It is covered as part of the essential health benefits package, but the language is not as clear as the House bill in terms of parity.

3. Prohibit discrimination on the basis of pre-existing conditions.

The Senate prohibition begins immediately for children and the prohibition becomes effective in 2014. The House bill reduces the "look back" period from 6 months to 30 days and the prohibition becomes effective in 2013.

4. Prohibit health plans terminating coverage when people become seriously ill or when they are treated for long-term chronic conditions and eliminate lifetime conditions.

"Rescissions," the practice of terminating health plan coverage, is prohibited, 2011 in the Senate bill and July 1, 2010 in the House bill. The House bill prohibits lifetime limits in 2010; the Senate bill contains a variety of approaches, 2011-2014.

5. Prohibit exorbitant out-of-pocket deductibles and co-pays.

This is a difficult to define goal and one subject to lots of debate.

6. Allow young adults to stay covered on their parents' plan until the age of 26.

The Senate bill allows coverage through the age of 25, effective 2011. The House bill allows coverage through the age of 26, effective 2010.

7. Target specific coverage of young adults, particularly those with special health care needs.

Not specifically addressed. A new long term care program, named CLASS, would be created by both bills.

8. Target specific coverage of children, particularly those with special health care needs.

Not specifically addressed. A new long term care, named CLASS, would be created by both bills.

9. Require continued affordable coverage when one loses or changes jobs.

The Senate bill requires guaranteed issue and renewal, effective 2014. The House bill requires guaranteed issue and renewal, effective 2010.

10. Include wellness and prevention services.

Both bills authorize the creation of a variety of wellness and prevention services. The Senate authorizes comprehensive workplace wellness programs with premium incentives and the House authorizes a grant program to small employers.

11. Promote integrated primary care with specialty services, including promotion of the "medical home" concept and including consumer-oriented and meaningful use of electronic medical records and personal health records.

Both bills would establish "accountable care organizations" and "medical homes," and expand the use of electronic medical records and personal health records.

12. Allow consumers a choice of health plans.

Both bills create government-sponsored health insurance exchanges. The Senate is state-based, while the House is national (with a state option to create their own exchange). The House bill has a public health insurance option, to be offered as one health insurance choice through the exchanges. This is an area of confusion and controversy. Regarding buying insurance across state lines, neither bill permits it as we know it today (e.g., a Massachusetts citizen won't now be permitted to buy Virginia Insurance Policy X). Under both bills, states may form regional compacts to offer insurance, but these can't be used to bypass state insurance regulations and consumer protections. Any citizen would still be buying insurance from within his or her own state's regulatory structure. Of course, once the new coverage/package requirements become effective (i.e., what qualifies as a qualified health plan), every plan must, at a minimum, satisfy these requirements.

13. Include culturally and linguistically appropriate programs that affirmatively address racial and ethnic disparities, including the recognition of disability-based health disparities.

Both bills promote work force diversity, require diversity data collection, and authorize grants to increase diversity services and expand services to the medically underserved. Disability is a recognized disparity.

I hope this summary is helpful as you sort through the issues of national health care reform. While many disagree about the role of the national government and the financial impact of taxes and fees, people with AD/HD and related and co-occurring disorders would greatly benefit from this legislation. People who have faced discrimination and lack of insurance coverage because of their disability would benefit from this legislation. Issues of affordability continue to be confusing and controversial. CHADD works with roughly 200 sister national voluntary health agencies, mental health, and disability organizations through a variety of coalitions to advocate a public policy agenda developed by our unpaid volunteer public policy committee and national board of directors. These coalitions have been identified in our previous public policy postings. We recognize that some of our members and constituents oppose these forms of national health care reform.

Clarke

You can read this blog and others like it at the HealthCentral website.

FDA to Promote Life Cycle Protections

On December 8, the new Food and Drug Administration Commissioner, Margaret Hamburg, MD, told the National Health Council, which includes CHADD, that the FDA will be tracking and responding to a "life cycle" approach to medication treatment. Rather than approve medications for sale on the market after approved clinical trials and waiting for adverse reactions to be reported, the FDA (pending additional resources by Congress) plans to track medications over the course of a lifetime (termed "life cycle" tracking).

CHADD and roughly 50 other voluntary health agencies (VHAs) are members of the National Health Council. VHAs are organizations governed by unpaid volunteers, who raise memberships and donations from the public, and are focused on diseases, disabilities, and disorders. Dr. Hamburg was the featured speaker at the NHC December 8 annual meeting.

Dr. Hamburg emphasized the public health protection role of the FDA—anticipating public health change and modifying the FDA regulatory approach. She stressed the need for "personalized medicine," recognizing that while the great mass of the population will do well with a medication, the FDA must do a more effective job of identifying and then regulating adverse medication reactions by small subsets of the population. Part of this approach is to better identify at-risk populations.

The commissioner emphasized protection of food and nutrition and a more aggressive approach to regulating tobacco. She did not mention dietary supplements, other than eliminating hazardous supplements. I still hope that Congress one day will give the FDA the legal authority to regulate the quality and integrity of diet supplement ingredients and the legal authority to substantiate diet supplement claims. Many diet supplement manufacturers and distributors make unsubstantiated claims regarding the healing nature of such products for a variety of learning, developmental, and mental disorders. My family uses dietary supplements and we think they are helpful, but desire an objective third party to substantiate claims and integrity.

It is nice and reassuring to hear the new FDA commissioner thinking about a more proactive consumer and family protection focus. It was nice to see the FDA commissioner interested in communicating with roughly 50 national VHAs.

Clarke

You can read this blog and others like it at the HealthCentral website.