Path to Passage: Psychology Workforce Provisions in Health Care Reform Law - 2010
Nina Gail Levitt, EdD, APA Education Government Relations Office
The basis for the APA Education Government Relations Office (GRO) advocacy efforts on psychology workforce development issues for the historic passage of health care reform legislation, P.L. 111-148, the Patient Protection and Affordable Care Act of 2010 was the Graduate Psychology Education Act of 2009 (S. 1811 sponsored by Senator Daniel Inouye (D-HI) and H.R. 2066 sponsored by Congressmen Gene Green (D-TX) and Tim Murphy (R-PA).
APA members Drs. Patrick DeLeon and James Bray were instrumental in securing those sponsors, respectively, for the bills to explicitly authorize the Graduate Psychology Education (GPE) Program, a nationally competitive grant program that was established through a Congressional appropriation in 2002 for the interdisciplinary training of psychologists for the provision of mental and behavioral health services to underserved children, older adults, chronically ill persons, victims of abuse and trauma, including veterans, disaster victims and unemployed persons. In its eight years, the GPE Program provided 70 grants in 30 states including the District of Columbia for a total of $26.5 million.
With the legislative action on health care reform beginning in the Senate, the Education GRO focused its attention on the two committees of jurisdiction, the Finance Committee and the Health, Education, Labor, Pensions (HELP) Committee (both had separate bills that were later combined). Education GRO collaborated with APAPO in successfully lobbying Senator Jeff Bingaman (D-NM), who sits on both of those committees, to amend S. 3708, Health Access and Health Professions Supply Act of 2009 to include psychology in the following provisions that later became part of the Senate HCR legislation: establishes a National Health Care Workforce Commission, that would include a mental/behavioral health member and a National Center for Workforce Analysis, a Public Health Science Track that includes psychology, and assurances that psychology is eligible for both the National Health Service Corps Loan Repayment and Scholarship Programs.
Later in the process, Education GRO teamed with Public Interest GRO in reaching out to Senator Jack Reed (D-RI), who at that time was the lead on workforce issues, to successfully secure the inclusion of a psychology workforce provision using S. 1811 as well as promoting integrated health care that included mental and behavioral health services. The problem was that workforce development was not among the top priorities and as a result the lead on the issue kept changing. Ultimately the lead on workforce issues was shared by Senator Patty Murray (D-WA) and HELP Committee staff, on behalf of Senator Edward Kennedy (D-MA).
Education GRO approached those offices with only days before the final HELP Committee mark-up (consideration and vote on the legislation) and was told that the staff were too busy for an in-person meeting and that negotiations would have to occur over the phone. The stumbling block was the addition of eligibility of masters-level psychologists that would significantly change the purpose of the GPE Program. Negotiations to remove or separate the two culminated in over a 12-hour, back-and-forth communication the day before the mark-up. With only a half hour to go, the final effort getting two members of the HELP committee to agree to separately fund masters and doctoral/postdoctoral with $2 million for masters and $10 million for doctoral/ postdoctoral was successful.
In addition, Public Interest GRO with support from Education GRO was successful in securing eligibility for psychology in training provisions on child and adolescent mental health and geriatric mental health.
Next came outreach by Education GRO to the House Energy and Commerce Health Subcommittee, which had jurisdiction over workforce issues for the House Tri Committee Health Care Reform bill. However, the bill basically contained very limited workforce provisions and none for mental and behavioral health. Education GRO asked Congressman Green to take the lead on adding the Graduate Psychology Education Act of which he was an original sponsor. While his staff paved the way and worked behind the scenes, Education GRO negotiated (again) through a couple of telephone calls. Eventually the committee staff said that despite the merit, they were reluctant to expand the very limited workforce section. Education GRO expressed its gratitude to Congressman Green and his staff for all they did; however, they became more resolved and offered an amendment with support from other committee members, who in exchange got other mental and behavioral health providers added. The amendment passed with the only protected set-aside for psychology for a total of $9 million.
There were other bills in the House that contained similar language as in the Graduate Psychology Education Act as a result of advocacy by Education and Public Interest GRO including House: H.R. 7309 Health Access and Health Professions Supply Act of 2009 sponsored by Congressman Harry Teaque (D-NM) and H.R.7302 Health Professions and Primary Care Reinvestment Act of 2009 sponsored by Congresswoman Diane DeGette (D-CO).
The final legislation, P.L. 111-148, the Patient Protection and Affordable Care Act of 2010, contains the Senate provisions on workforce development including the authorization of appropriations of $10 million for training in doctoral, postdoctoral, internship and residency in psychology.