The politics and economics of mental health 'parity' laws.

The enactment of the Domenici-Wellstone amendment in September 1996, which calls for the elimination of certain limits on coverage for mental health care under private insurance, is being hailed as a major step forward in the quest for "parity" in mental health coverage. Parity legislation is being introduced in a number of state legislatures and is finding new enthusiasm in Congress. In this paper we consider the efficiency rationale for these laws and examine their likely impact in the era of managed care. We conclude that although such successes represent important political events, they may offer only small gains in the efficiency and fairness of insurance markets.

Child and family focus. Working together to develop integrated systems of care.

We've all heard the jokes about the nature of committee work: "A camel is a horse designed by committee." Or, "A committee is a group of the unwilling unprepared to do the unnecessary." In the current case, nothing could be farther from the truth. Over the past year, we were very fortunate to be able to gather a group of experts who were more than willing, and prepared, to do the very necessary. Representing all areas of children's behavioral healthcare, these respected leaders of the field worked assiduously to produce a blueprint for how child mental health and welfare workers, public purchasers, families, managed care leaders, and other stake-holders can work together to create well-managed "systems of care." The article they coauthored reflects some of the best thinking on the problems of emerging multiple managed care systems and the specific actions urgently needed to protect children and their families. We are pleased to present their recommendations to you in this month's Child and Family Focus. We feel that the hard work that went into this collaboration, and the resulting consensus, demonstrates that integration can, does, and must work to create better systems of care.

The Medicaid program and the Clinton plan: implications for mental health services.

This paper reviews problems that the Medicaid program poses for health care reformers and how the Clinton plan would deal with them. The Clinton plan represents a compromise between preserving or expanding the Medicaid program and eliminating. The plan would seek to extend services to those without insurance and reduce health care costs, partly by limiting services and increasing out-of-pocket costs for Medicaid beneficiaries. All Medicaid beneficiaries would be included in the same basic system of health care that the plan proposes for other Americans. All current beneficiaries would remain eligible for Medicaid, but services would be reduced for many of them. However, services that are important for persons with severe mental illness would be maintained. The plan also would increase out-of-pocket costs for premiums and services, and these increases could be significant for some beneficiaries.

The quiet success of the national plan for the chronically mentally ill.

In 1978 the President's Commission on Mental Health called for a national plan for the care of persons with chronic mental illness. The plan was completed and released in 1980, but was never adopted as the policy of the incoming Reagan Administration. Despite changes in attitudes in the 1980s toward the federal government's role in human services and an atmosphere of fiscal restraint, many of the plan's specific recommendations for changes in Supplemental Security Income, Social Security Disability Insurance, Medicaid, and Medicare have been implemented. In this paper, the implementation of these recommendations is analyzed. The authors discuss some of the strategies used by mental health advocacy groups to make gains in the 1980s. Recommendations for the 1990s are discussed.

On being very smart: the mental health community's response in the health care reform debate.

President Clinton's proposal for a health care system based on managed competition began a dialogue within the mental health community about whether such a system would work in the mental health area. In early March a large coalition representing more than 30 mental health organizations, including advocacy organizations, state systems, professional associations, provider agencies, families, and consumers, formally transmitted to the President's Task Force on National Health Care Reform a document presenting a unified position on how mental health care should be delivered within a reformed health care system. The consensus document, reproduced here, maintains that a full range of services must be available to all children and adults with mental or emotional disorders. The document presents guidelines for containing costs, for standards of delivery for mental health services, and for the role of the states and the federal government within the new health care system.