Mental Health Parity Legislation Research Articles

Comprehensiveness of State Insurance Laws and Perceived Access to Pediatric Mental Health Care

Many US children and adolescents with mental and behavioral health (MBH) conditions do not access MBH services. One contributing factor is limited insurance coverage, which is influenced by state MBH insurance parity legislation. To investigate the association of patient-level factors and the comprehensiveness of state MBH insurance legislation with perceived poor access to MBH care and perceived inadequate MBH insurance coverage for US children and adolescents. This retrospective cross-sectional study was conducted using responses by caregivers of children and adolescents aged 6 to 17 years with MBH conditions in the National Survey of Children's Health and State Mental Health Insurance Laws Dataset from 2016 to 2019. Data analyses were conducted from May 2022 to January 2024. MBH insurance legislation comprehensiveness defined by State Mental Health Insurance Laws Dataset (SMHILD) scores (range, 0-7). Perceived poor access to MBH care and perceived inadequacy of MBH insurance were assessed. Multivariable regression models adjusted for individual-level characteristics. There were 29 876 caregivers of children and adolescents with MBH conditions during the study period representing 14 292 300 youths nationally (7 816 727 aged 12-17 years [54.7%]; 8 455 171 male [59.2%]; 292 543 Asian [2.0%], 2 076 442 Black [14.5%], and 9 942 088 White [69.6%%]; 3 202 525 Hispanic [22.4%]). A total of 3193 caregivers representing 1 770 492 children and adolescents (12.4%) perceived poor access to MBH care, and 3517 caregivers representing 1 643 260 of 13 175 295 children and adolescents (12.5%) perceived inadequate MBH insurance coverage. In multivariable models, there were higher odds of perceived poor access to MBH care among caregivers of Black (adjusted odds ratio [aOR], 1.35; 95% CI, 1.04-1.75) and Asian (aOR, 1.69; 95% CI, 1.01-2.84) compared with White children and adolescents. As exposures to adverse childhood experiences (ACEs) increased, the odds of perceived poor access to MBH care increased (aORs ranged from 1.68; 95%, CI 1.32-2.13 for 1 ACE to 4.28; 95% CI, 3.17-5.77 for ≥4 ACEs compared with no ACEs). Compared with living in states with the least comprehensive MBH insurance legislation (SMHILD score, 0-2), living in states with the most comprehensive legislation (SMHILD score, 5-7) was associated with lower odds of perceived poor access to MBH care (aOR, 0.79; 95% CI, 0.63-0.99), while living in states with moderately comprehensive legislation (score, 4) was associated with higher odds of perceived inadequate MBH insurance coverage (aOR, 1.23; 95% CI, 1.01-1.49). In this study, living in states with the most comprehensive MBH insurance legislation was associated with lower odds of perceived poor access to MBH care among caregivers for children and adolescents with MBH conditions. This finding suggests that advocacy for comprehensive mental health parity legislation may promote improved child and adolescent access to MBH services.

Health care administration and drug policy.

The American healthcare system faces a potential reorganization of the way in which services are provided and financed. We argue that healthcare administrators need to be increasingly aware of the ways in which our nation's illicit drug policy, commonly referred to as the 'War on Drugs', affects the provision of health services. A large and growing portion of the US population uses one or more of the currently illegal drugs and some of these persons suffer from an addiction or other substance use disorder. This is clearly demonstrated by the current opioid epidemic which is not yet being adequately controlled. Providing specialty treatment for drug abuse disorders will be increasingly important for healthcare administrators thanks to recent mental health parity legislation. At the same time, drug users and abusers will be increasingly encountered while providing care not specifically tied to drug use or abuse. The character of our current national drug policy has an important impact on how drug abuse disorders are treated and how the health delivery system responds to drug users who are increasingly often encountered in primary care, emergency care, specialty care, and long-term care settings.

An Examination of Factors Affecting State Legislators' Support for Parity Laws for Different Mental Illnesses.

Mental health parity legislation can improve mental health outcomes. U.S. state legislators determine whether state parity laws are adopted, making it critical to assess factors affecting policy support. This study examines the prevalence and demographic correlates of legislators’ support for state parity laws for four mental illnesses— major depression disorder, post-traumatic stress disorder (PTSD), schizophrenia, and anorexia/bulimia. Using a 2017 cross-sectional survey of 475 U.S. legislators, we conducted bivariate analyses and multivariate logistic regression. Support for parity was highest for schizophrenia (57%), PTSD (55%), and major depression (53%) and lowest for anorexia/bulimia (40%). Support for parity was generally higher among females, more liberal legislators, legislators in the Northeast region of the country, and those who had previously sought treatment for mental illness. These findings highlight the importance of better disseminating evidence about anorexia/bulimia and can inform dissemination efforts about mental health parity laws to state legislators.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10597-022-00991-1.

APA’s Government, Policy, and Advocacy Update (June 2021)

Back to table of contents Previous article Next article Government & LegalFull AccessAPA’s Government, Policy, and Advocacy Update (June 2021)Search for more papers by this authorPublished Online:18 May 2021https://doi.org/10.1176/appi.pn.2021.6.37APA Provides Congress With Testimony On MH Parity, TelehealthAPA provided testimony to the House of Representatives’ Health, Employment, Labor, and Pensions (HELP) Subcommittee for its hearing, “Meeting the Moment: Improving Access to Behavioral and Mental Health Care.” Witnesses during the hearing discussed network adequacy; enforcement of mental health parity; and last year’s mental health parity legislation, which APA helped enact.In written testimony, APA emphasized the importance of ensuring equitable access to mental health and substance use disorder (SUD) treatment. APA applauded the inclusion of new parity compliance requirements for health insurers in last year’s appropriations package and recommended additional funding so states and federal agencies have the resources necessary to ensure health plans are in compliance with the law.The testimony also outlined data related to health disparities. “[W]e cannot begin to improve our country’s overall mental health without concurrently addressing health disparities,” the testimony stated. APA urged Congress to investigate opportunities to recruit and retain more Black, Indigenous, and People of Color into health care to improve access to culturally competent care and to invest in community-based support systems to help communities address social determinants of health.APA similarly provided testimony to the House Ways and Means Committee for its hearing, “Charting the Path Forward on Telehealth.” The testimony explained how telehealth flexibilities allowed during the COVID-19 public health emergency enabled large numbers of people to access care.“APA agrees that telehealth should not replace in-person services; it should amplify and enhance access to needed services when clinically appropriate,” the testimony stated. “We encourage Congress to extend the current telehealth flexibilities beyond the current public health emergency to avoid an abrupt halt and disruption to the access and delivery of mental health and SUD services via telehealth.”Senate Passes COVID-19 Hate Crimes ActAPA-supported legislation addressing the rise of hate crimes and violence toward Asian Americans and Pacific Islanders during the COVID-19 pandemic passed the Senate in late April.Sponsored by Sen. Mazie Hirono (D-Hawaii), the legislation would assign a designated Department of Justice employee to facilitate the review of hate crimes; require the department to issue guidance to state, local, and tribal law enforcement agencies to establish online hate crime reporting processes; and establish grants for states to create reporting hotlines for hate crimes.Group of Six Praises Investment in Gun Violence InterventionsAPA and its five partner organizations, collectively known as the Group of Six, issued a news release praising the recent Biden administration’s announcement of actions it will take to address gun violence. “Gun violence is a public health epidemic, and recent mass shootings around the country, along with other sources of firearm violence and injury, underscore that this remains a serious issue,” the release stated.The Biden administration announced six initial actions to address gun violence, such as investing in evidence-based community violence interventions, publishing model red flag legislation (which allows family members or law enforcement to petition courts to bar people in crisis from accessing firearms) for states, and requiring the Department of Justice to issue an annual report on firearms trafficking.“The administration’s commitment to investing in programs and resources at the local level for violence intervention is a welcome first step to help provide for healthy and safe communities,” the release stated. It further urged legislative action to comprehensively address the gun violence epidemic.APA Develops Quality Measures to Advance Measurement-Based CareIn 2018, the Centers for Medicare and Medicaid Services announced that APA was awarded funding to develop a suite of measures aimed at promoting and advancing measurement-based care (MBC). The set includes a measure assessing adherence to MBC processes, outcome measures based on patient-reported assessments of function and recovery, and measures assessing suicide safety planning processes and outcomes. The measures were recently posted for public comment, and submitted comments were reviewed by the project’s Technical Expert and Consumer and Family panels. More information is posted here. ■ ISSUES NewArchived

Arizona Passes Sweeping Legislation on MH Parity, Access to Care

Arizona Passes Sweeping Legislation on MH Parity, Access to Care

Association of Federal Mental Health Parity Legislation With Health Care Use and Spending Among High Utilizers of Services.

Decades-long efforts to require parity between behavioral and physical health insurance coverage culminated in the comprehensive federal Mental Health Parity and Addiction Equity Act. To determine the association between federal parity and changes in mental health care utilization and spending, particularly among high utilizers. Difference-in-differences analyses compared changes before and after exposure to federal parity versus a comparison group. Commercially insured enrollees aged 18-64 with a mental health disorder drawn from 24 states where self-insured employers were newly subject to federal parity in 2010 (exposure group), but small employers were exempt before-and-after parity (comparison group). A total of 11,226 exposure group members were propensity score matched (1:1) to comparison group members, all of whom were continuously enrolled from 1 year prepolicy to 1-2 years postpolicy. Mental health outpatient visits, out-of-pocket spending for these visits, emergency department visits, and hospitalizations. Relative to comparison group members, mean out-of-pocket spending per outpatient mental health visit declined among exposure enrollees by $0.74 (1.40, 0.07) and $2.03 (3.17, 0.89) in years 1 and 2 after the policy, respectively. Corresponding annual mental health visits increased by 0.31 (0.12, 0.51) and 0.59 (0.37, 0.81) per enrollee. Difference-in-difference changes were larger for the highest baseline quartile mental health care utilizers [year 2: 0.76 visits per enrollee (0.14, 1.38); relative increase 10.07%] and spenders [year 2: $-2.28 (-3.76, -0.79); relative reduction 5.91%]. There were no significant difference-in-differences changes in emergency department visits or hospitalizations. In 24 states, commercially insured high utilizers of mental health services experienced modest increases in outpatient mental health visits 2 years postparity.

A quarter century of psychological practice in mental health and health care: 1990-2016.

Powerful forces have shaped professional psychology over the past 25 years, including significant changes in health policy and health care delivery systems. Examples include managed care cost containment, rapid growth of nondoctoral mental health providers, federal mental health parity legislation, and passage of the Affordable Care Act of 2010, with its emphasis on primary care-behavioral health integration and alternatives to fee-for-service reimbursement. This article considers these factors for psychology as a mental health profession and as a health profession more broadly defined, and describes the American Psychological Association's advocacy about the value of psychology in each domain. While challenging to psychology's traditional models of care, these changes offer significant promise for the future of psychology in health care. (PsycINFO Database Record

An audience research study to disseminate evidence about comprehensive state mental health parity legislation to US State policymakers: protocol

BackgroundA large proportion of the US population has limited access to mental health treatments because insurance providers limit the utilization of mental health services in ways that are more restrictive than for physical health services. Comprehensive state mental health parity legislation (C-SMHPL) is an evidence-based policy intervention that enhances mental health insurance coverage and improves access to care. Implementation of C-SMHPL, however, is limited. State policymakers have the exclusive authority to implement C-SMHPL, but sparse guidance exists to inform the design of strategies to disseminate evidence about C-SMHPL, and more broadly, evidence-based treatments and mental illness, to this audience. The aims of this exploratory audience research study are to (1) characterize US State policymakers’ knowledge and attitudes about C-SMHPL and identify individual- and state-level attributes associated with support for C-SMHPL; and (2) integrate quantitative and qualitative data to develop a conceptual framework to disseminate evidence about C-SMHPL, evidence-based treatments, and mental illness to US State policymakers.MethodsThe study uses a multi-level (policymaker, state), mixed method (QUAN→qual) approach and is guided by Kingdon’s Multiple Streams Framework, adapted to incorporate constructs from Aarons’ Model of Evidence-Based Implementation in Public Sectors. A multi-modal survey (telephone, post-mail, e-mail) of 600 US State policymakers (500 legislative, 100 administrative) will be conducted and responses will be linked to state-level variables. The survey will span domains such as support for C-SMHPL, knowledge and attitudes about C-SMHPL and evidence-based treatments, mental illness stigma, and research dissemination preferences. State-level variables will measure factors associated with C-SMHPL implementation, such as economic climate and political environment. Multi-level regression will determine the relative strength of individual- and state-level variables on policymaker support for C-SMHPL. Informed by survey results, semi-structured interviews will be conducted with approximately 50 US State policymakers to elaborate upon quantitative findings. Then, using a systematic process, quantitative and qualitative data will be integrated and a US State policymaker-focused C-SMHPL dissemination framework will be developed.DiscussionStudy results will provide the foundation for hypothesis-driven, experimental studies testing the effects of different dissemination strategies on state policymakers’ support for, and implementation of, evidence-based mental health policy interventions.

Availability of Network Psychiatrists Among the Largest Health Insurance Carriers in Washington, D.C.

Lack of access to mental health treatment remains a significant problem in the United States, even after implementation of mental health parity legislation. This study examined availability of psychiatrists listed in insurance carrier network provider databases in the Washington, D.C., area. Contact information was obtained for 1,184 psychiatrists listed in online directories for three of the largest insurance carriers serving the Washington, D.C., area. The "mystery shopper" method was used to assess the accuracy of listed contact information, new outpatient appointment availability, and average wait times for 50 psychiatrists randomly selected from each insurance directory. Most (77%) physicians were successfully contacted, meaning that someone answered the phone or returned a voice mail message, and 51% of the psychiatrists had working telephone numbers verified to be correct. Fifteen percent of the psychiatrists were accepting new outpatients with the target insurance, with average wait times of 19 days; only 7% were able to schedule an appointment within two weeks. Inaccuracy of insurance provider directories significantly affected the ability of patients to obtain timely mental care.

Effects of Mental Health Parity on High Utilizers of Services: Pre-Post Evidence From a Large, Self-Insured Employer.

This study evaluated utilization of mental health and substance use services among enrollees at a large employee health plan following changes to benefit limits after passage in 2008 of federal mental health parity legislation. This study used a pre-post design. Benefits and claims data for 43,855 enrollees in the health plan in 2009 and 2010 were analyzed for utilization and costs after removal of a 30-visit cap on the number of covered mental health visits. There was a large increase in the proportion of health plan enrollees with more than 30 outpatient visits after the cap's removal, an increase of 255% among subscribers and 176% among dependents (p<.001). The number of people near the 30-visit limit for substance use disorders was too few to observe an effect. Federal mental health parity legislation is likely to increase utilization of mental health services by individuals who had previously met their benefit limit.

Annual Report on Health Care for Children and Youth in the United States: National Estimates of Cost, Utilization and Expenditures for Children With Mental Health Conditions

ObjectiveTo examine national trends in hospital utilization, costs, and expenditures for children with mental health conditions. MethodsThe analyses of children aged 1 to 17 are based on AHRQ's 2006 and 2011 Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS) databases, and on AHRQ's pooled 2006 to 2011 Medical Expenditure Panel Survey (MEPS). All estimates are nationally representative, and standard errors account for the complex survey designs. ResultsAlthough overall all-cause children's hospitalizations did not increase between 2006 and 2011, hospitalizations for all listed mental health conditions increased by nearly 50% among children aged 10 to 14 years, and by 21% for emergency department (ED) visits. Behavioral disorders experienced a shift in underlying patterns between 2006 and 2011: inpatient stays for alcohol-related disorders declined by 44%, but ED visits increased by 34% for substance-related disorders and by 71% for impulse control disorders. Inpatient visits for suicide, suicidal ideation, and self-injury increased by 104% for children ages 1 to 17 years, and by 151% for children ages 10 to 14 years during this period. A total of $11.6 billion was spent on hospital visits for mental health during this period. Medicaid covered half of the inpatient visits, but with 50% to 30% longer length of stays in 2006 and 2011, respectively, than private payers. Medicaid's overall share of the ED visits increased from 45% in 2006 to 53% in 2011. ConclusionsThese alarming trends highlight the renewed need for research on mental health care for children. This study also provides a baseline for evaluating the impact of the Affordable Care Act and the mental health parity legislation on mental health utilization and expenditures for children.

Mis-Detection Controlled Estimation: Explaining Variations in the Observed Incidence of Autism

We estimate the prevalence of true and falsely-observed autism using a maximum likelihood technique that accounts for the presence of both false positive and false negative realizations of the disorder's underlying incidence. This approach, which we label mis-detection corrected estimation (MCE), is the maximum likelihood equivalent of a two-part model where both the first and second stages are binary outcomes. Using the 2007 and 2011 National Survey of Children's Health, we estimate the impact of factors that may be driving variation in autism diagnoses, including individual-level demographics and state-level policies such as education quality, health care access, and mental health parity. Results show that age, access to hospitals, unemployment, and poverty increase the likelihood that autism is detected, while black and Hispanic children are less likely to be detected. The only policy measure that improves detection is autism-specific mental health parity legislation. We also estimate the rate of false positives across selected variables and find that girls, blacks, Hispanics, and children in poverty are more likely to be mis-detected.

Mental health parity legislation: Anticipating costs and benefits

Mental health parity legislation: Anticipating costs and benefits

Mental Health Parity Legislation: Implications for Children and Youth With Serious Emotional Disturbance

Ensuring access to appropriate treatment for children and adolescents with mental health needs is a major policy concern. Recent legislation in the form of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) offers hope for mental health care to a large number of families; however, the lack of a federal definition of mental illness and state differences in coverage, often excluding children's diagnoses, are major limitations in coverage that perhaps might not meet the needs of youth with serious emotional disturbances. Implications of this parity legislation for children and youth are discussed with a particular focus on children and youth with Severe Emotional Disturbance.

Mental health parity legislation, cost-sharing and substance-abuse treatment admissions

Treatment is highly cost-effective in reducing an individual's substance abuse (SA) and associated harms. However, data from Treatment Episodes (TEDS) indicate that per capita treatment admissions substantially lagged behind increases in heavy drug use from 1992 to 2007. Only 10% of individuals with clinical SA disorders receive treatment, and almost half who forgo treatment point to accessibility and cost constraints as barriers to care. This study investigates the impact of state mental health and SA parity legislation on treatment admission flows and cost-sharing. Fixed effects specifications indicate that mandating comprehensive parity for mental health and SA disorders raises the probability that a treatment admission is privately insured, lowering costs for the individual. Despite some crowd-out of charity care for private insurance, mandates reduce the uninsured probability by a net 2.4 percentage points. States mandating comprehensive parity also see an increase in treatment admissions. Thus, increasing cost-sharing and reducing financial barriers may aid the at-risk population in obtaining adequate SA treatment. Supply constraints mute effect sizes, suggesting that demand-focused interventions need to be complemented with policies supporting treatment providers. These results have implications for the effectiveness of the 2008 Federal Mental Health Parity and Addiction Equity Act in increasing SA treatment admissions and promoting cost-sharing.

Mental Health Parity Legislation

Although recognition and treatment of mental health disorders have become integrated into routine medical care, inequities remain regarding limits on mental health outpatient visits and higher copayments and deductibles required for mental health services when accessed. Two federal laws were passed by Congress in 2008: The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act and the Medicare Improvements for Patients and Providers Act. Both laws became effective on January 1, 2010. The purpose of this article is to discuss provisions of each act and provide clinical examples describing how patients are affected by lack of parity and may potentially benefit from implementation of these new laws. Using available evidence, we examine the potential strengths and limitations of mental health parity legislation from the health policy perspectives of health care access, cost, and quality and identify the important role of nurses as patient and mental health parity advocates.

Focus on Transformation: A Public Health Model of Mental Health for the 21st Century

Focus on Transformation: A Public Health Model of Mental Health for the 21st Century

Inertia Mires Bills to Fix Biased Medicare Copay

Inertia Mires Bills to Fix Biased Medicare Copay

Treating Elderly Patients Means More Questions Than Answers

Back to table of contents Next article Professional NewsFull AccessTreating Elderly Patients Means More Questions Than AnswersJun YanJun YanSearch for more papers by this authorPublished Online:18 Apr 2008https://doi.org/10.1176/pn.43.8.0001American Association for Geriatric Psychiatry President Bruce Pollock, M.D., Ph.D., discusses the urgent need for more clinical evidence for geriatric psychopharmacotherapy at the association's annual meeting in March.Credit: AAGPElderly patients make up a large and growing portion of psychiatric medication users and suffer more adverse reactions than younger adults, yet research pays little attention to this unique population.Geriatric psychopharmacology presents both serious challenges and vast opportunities to clinicians and academics. Bruce Pollock, M.D., Ph.D., president of the American Association for Geriatric Psychiatry (AAGP), discussed the paucity of clinical evidence to guide safe and effective treatment of elderly patients with mental illness in his plenary speech,“ Medicine and Toxicity: Dose and Intent,” at the AAGP annual meeting in March in Orlando.Pollock is chair of neuropsychiatry and professor and head of the University of Toronto's Division of Geriatric Psychiatry. He emphasized that adverse drug reactions (ADRs) pose significantly higher risks to older patients, and as much as 20 percent of hospital admissions of people over age 70 have been blamed on ADRs. Of all the medications routinely taken by the elderly, psychoactive drugs and anticoagulants are the most commonly associated with preventable ADRs and result in millions of dollars in health care expenses and significant suffering, he noted.Elderly patients are more sensitive to the side effects of many drugs because of physiological changes of aging, he added. The pharmacokinetics in elderly patients are more variable and unpredictable, sometimes resulting in dangerously high drug concentrations from “normal” adult doses of a medication.In addition, elderly people often have more comorbid conditions that affect their organ systems and in turn their physiological response to psychoactive drugs than do other populations. They also tend to take more medications for thesse multiple illnesses, which greatly increases the risk of drug-drug interactions.However, there is a dearth of high-quality clinical evidence on both efficacy and safety specifically clarifying the appropriate doses of pharmacotherapy in this vulnerable population. “It's a public-health scandal that medications are not adequately researched in the bulk of patients who will be taking them,” Pollock said. He cited a U.S. Government Accountability Office report released in September 2007, which noted that the Food and Drug Administration (FDA) does not devote enough effort to evaluating drug applications for treatment in elderly patients.Although the FDA's guidelines require pharmaceutical companies to include a“ Geriatric Use” section in product labeling, this section is usually very short and often contains few patient data from clinical trials, Pollock commented. This is primarily because clinical trials designed to seek FDA approval often exclude a large subset of elderly patients who are sicker and more frail, have more comorbidities, and have lower socioeconomic status. Data are particularly thin on the very old, namely those above age 80. Physicians are often left with the trial-and-error approach to treating these patients whose care is the most complicated.In addition, Pollock emphasized that clinicians must take a rational and careful approach to prescribing medications for geriatric patients. Because of the high risk of toxicity associated with most drugs in the frail elderly, it is crucial “to be very clear why we are giving a particular medicine and what we expect to happen,” he told Psychiatric News in a subsequent interview. In other words, clinicians should avoid prescribing more and more drugs simply to treat the side effects caused by other drugs.In his plenary speech, Pollock urged psychiatrists early in their careers to become involved in geriatric research. “The positive side is that there is such a huge deficit of information that almost any [research] we do in a systematic fashion will have a huge impact,” he said.He cited a study he cowrote with Charles Reynolds, M.D., and others on the effectiveness of maintenance antidepressants in older patients as an example.“The study had only 116 subjects,” he noted, “and it was published in the New England Journal of Medicine.”Pollock concluded that in his term as the AAGP president he would“ continue the advocacy for expanding the evidence base, practice networks, and funding for late-life research from NIMH and other federal agencies, so that more older adults are included in clinical trials.”Pollock's other priorities include advocating for mental health parity legislation and securing additional incentives, such as student loan repayment legislation, to encourage more young practitioners and researchers to enter the geriatric psychiatry specialty. ▪ ISSUES NewArchived

AMA Campaigns for Tax Credits to Bring Coverage to the Uninsured

Back to table of contents Previous article Next article Professional NewsFull AccessAMA Campaigns for Tax Credits to Bring Coverage to the UninsuredRich DalyRich DalySearch for more papers by this authorPublished Online:21 Sep 2007https://doi.org/10.1176/pn.42.18.0001aThe AMA launched a multimillion-dollar media campaign in August to promote its proposals to provide health insurance to the record number of uninsured Americans.The AMA campaign, called “Voices for the Uninsured,” is spending $5 million initially to coincide with the 2008 U.S. presidential election. It involves newspaper, television, and radio ads that will run in early-primary states including Iowa, New Hampshire, and South Carolina. The campaign will go national next year and will include lobbying Congress to pass comprehensive insurance legislation.The campaign was announced the week before the latest census figures showed the number of uninsured Americans rose 2.2 million in 2006 to 47 million. The Current Population Survey found that 15.8 percent of Americans lacked coverage last year, up from 15.3 percent in 2005. The increase equaled 1998 as the year with the highest percentage of uninsured people over the last two decades.The impact on children was trouble-some as well, according to data from t U.S. Census Bureau, which found t 11.7 percent of U.S. citizens under age 18 had no health insurance in 2006, up from 10.9 percent in the previous year. The percentage of uninsured children has increased two years in a row after declining for at least five years, according to the census data.“It is unconscionable that the number of uninsured children has substantially increased over the past year,” said AMA Board member Joseph Heyman, M.D., in a written statement. “Children are our future, and for kids to get a good start in life, they need access to regular visits to the doctor.”The AMA's insurance campaign supports tax credits for the purchase of health insurance and for increasing federal funds to expand government health programs such as the State Children's Health Insurance Program (SCHIP) and Medicaid. Both houses of Congress have passed SCHIP expansions but President Bush has threatened to veto both versions because of their cost (Psychiatric News, September 7).The AMA insurance proposal was created with several other groups as part of an alliance called the Health Coverage Coalition for the Uninsured, which includes AARP and the U.S. Chamber of Commerce.However, AMA leaders said the 250,000-member organization could support other approaches.“If [elected officials] don't like our plan, then let's meet and come up with a common plan,” said Nancy Nielsen, M.D., AMA president-elect, during an August press conference.Nielsen said part of the campaign aims to educate the public and political candidates that people without insurance are not just among the ranks of those who are homeless or unemployed. As many as 82 percent of people without health insurance are in working families.The AMA doesn't endorse candidates for president but is urging presidential hopefuls to incorporate its proposals into their health care platforms.“We want candidates to make a commitment to reducing the number of uninsured,” Nielsen said.Although APA has not endorsed the AMA plan specifically, APA President Carolyn Robinowitz, M.D., said that the Association does support any effort that will increase Americans' access to health care, including treatment for mental illness. Many uninsured Americans end up using emergency rooms as their main source of medical care, Robinowitz told Psychiatric News, which means they are unlikely to receive preventive care and early interventions that avoid further suffering and save money that will have to be spent on acute care.“Even the business community has realized the long-term benefits from wide access to quality health care,” Robinowitz said, citing business groups' recent support for Senate mental health parity legislation that their earlier opposition had stalled.More information on the AMA's “Voice for the Uninsured” campaign is posted at<www.ama-assn.org/ama/pub/category/17712.html>.▪ ISSUES NewArchived