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Health reform's fate uncertain as Congress returns

September 9, 2009
by Daniel Guarnera
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The addiction field fights for inclusion of key provisions in the current proposals

Congress returned to Washington from its August recess on Sept. 8 with health reform at the top of its agenda. Procedurally, health reform picks up exactly where it left off—the House of Representatives is nearly ready to pass a final bill, whereas the outlook in the Senate remains less clear. A bipartisan team of six senators from the Senate Finance Committee, which must approve any Senate health reform bill, has been meeting for months but is still far from consensus.

Politically, however, it remains to be seen how the month-long break will affect the process going forward. As negotiations resume, the addiction prevention, treatment and recovery community is looking to ensure that the provisions that it has secured to this point remain part of the health reform proposals.

The Obama administration and congressional leaders had originally set Congress’s summer break as a deadline for passing health reform legislation, and the events of the past month have confirmed the political wisdom of that goal. For the past month, media coverage of health reform has focused on “death panels,” contentious town hall meetings, and whether or not it’s appropriate to carry firearms to a protest. Pushback on various elements of the health reform proposals has led some key members of Congress to reconsider their support for reform.

Looking to regain momentum lost during the recess, President Obama is scheduled to address the nation on Sept. 9 to “make the case” for reform. President Clinton made a similar address in 1993, which though well-received did not avert the spectacular collapse of his reform efforts. Key policy questions that remain on the table this year include:

• Should there be a “public option,” i.e., a Medicare-like insurance plan run by the government that will compete with private insurance plans?
• What form will the insurance “exchanges” take? The exchanges are a key component of the current proposals and involve creating organized marketplaces (with large beneficiary pools) where individuals and small businesses can buy insurance.
• How much should the total plan cost? The answer to this question will determine the scale and scope of many of the proposals.

Pro-reform advocates must strike the delicate balance of moderating their proposals enough to attract centrist legislators while at the same time maintaining the Progressive Caucus’s support.

Of interest to the field

There are numerous provisions of the current proposals that relate to addiction services. Among the most significant is the fact that mental health and substance use disorder benefits would have to be included, at parity, in every plan (even those that were exempt under 2008’s Wellstone-Domenici Parity Act, which will go into effect in 2010 regardless of the state of health reform).

Other addiction-related provisions that have been included in proposals passed by committees in the House of Representatives include requiring screening, brief intervention and referral to treatment (SBIRT) to be a reimbursable service in all plans; authorizing a $60 million workforce development initiative for addiction and mental health professionals; mandating that plans in Medicaid demonstrate that they have an adequate number of providers offering addiction services; and enabling programs receiving Substance Abuse Prevention & Treatment Block Grant funds to receive discounted pharmaceuticals.

With large majorities in both chambers of Congress, the Obama administration remains in a strong position to bring some manner of a health reform bill up for a vote (though, especially after this past month, nothing is certain). However, the political maneuvering that takes place in the next few weeks will likely determine exactly how modest—or ambitious—that bill is. Check Addiction Professional magazine’s blog at for updates as they develop. If you would like to contact your members of Congress to ask that any proposal under consideration fully and fairly include addiction services, please click here.

Daniel Guarnera is Director of Government Relations at NAADAC, The Association for Addiction Professionals. His e-mail address is