Health-care reform: No one left behind

Efforts to reform America's health-care system have revolved around key issues of universal coverage, cost reduction, prevention and wellness, and quality of care. Serious questions have been raised, the answers to which will ultimately determine America's health-care policy.

Beyond providing coverage, how do we remove additional barriers to an appropriate range of services for individuals who previously had experienced significant access problems? How can we guarantee that health-care reform maximizes outcomes for diverse groups? How will society rise to the challenges posed by an increased demand for services?

APA has responded to such questions through strong advocacy efforts that the association and psychology consider among the most critical, such as integrated care, prevention and wellness, elimination of health disparities, and workforce development.

The Public Interest Government Relations Office (PI-GRO) staff has been working tirelessly throughout the health reform process, in collaboration with other directorates, to advance integrated models of care, including the adoption of the Positive Aging Act (H.R. 3191), which focuses on integrated health care for an aging population. Such models hold vast potential to extend much-improved health-care services to individuals who currently do not have access to care beyond their most basic needs.

In keeping with Public Interest's mission and goals, PI-GRO has done much to emphasize the special needs of particular populations. PI-GRO staff appealed directly to Secretary of Health and Human Services Kathleen Sebelius and Director of the White House Office of Health Reform Nancy-Ann DeParle to ensure that the elimination of health disparities is included in health-care reform legislation. Furthermore, working with former first lady Rosalynn Carter and the National Center for Children and Poverty, PI-GRO urged Congress to improve and enhance the children's mental health system.

APA also gained traction for its primary policy priority that addresses health disparities experienced by lesbian, gay, bisexual and transgender populations—the inclusion of data collection on sexual and gender minorities within federal health surveys. Through collaborative efforts among the Committee on Lesbian, Gay, Bisexual, and Transgender Affairs, the APA Office on LGBT Concerns, PI-GRO, and the National Coalition for LGBT Health, this principle was included both in the House of Representatives health-care reform efforts, and the Ending Health Disparities for LGBT Americans Act (H.R. 3001), which represents the first federal legislative effort to address the issue in a comprehensive way.

Struggles to identify and respond to myriad issues inherent in providing universal health care have illuminated another obstacle of concern: expanding work force shortages throughout many health care fields, including psychology. In response, health-care reform provisions sought by PI-GRO staff, in collaboration with Education GRO, specified the inclusion of psychology and psychologists in existing federal awards and training programs and the creation of new financial supports for those pursuing advanced degrees in geriatrics.

"Prevention" is a term used frequently in discussions about health-care reform. APA has vigorously advocated for a policy that fully integrates a robust prevention and wellness strategy. Once again, PI-GRO staff, in collaboration with other directorates, succeeded in expanding the scope of coverage for screening, prevention and wellness services. Furthermore, PI-GRO highlighted the potential of behavioral and psychological interventions to maintain health and productivity, supported community prevention, and urged the inclusion of clinical counseling and behavioral services for primary care patients.

Acknowledging APA's efforts in these priority areas and highlighting the unique and vital role of psychology is only part of the breadth of our staff's daily work on health-care reform. Efforts continue toward the ultimate goal of a guarantee that no one in our country, particularly those who are most vulnerable, is forgotten in the reform process, and that mental and behavioral health are given the same level of importance as biological health in these deliberations.