Pacific Progressive

Despite Parity Law, Mental Health Coverage May Still Fall Short

By Kate Steadman, KHN Staff Writer

This article was published by Kaiser Health News.

For decades, mental health advocates have fought to get health insurance "equal rights" for patients with mental illnesses or brain disorders. The first taste of success came when President Bill Clinton signed the Mental Health Parity Act of 1996, which prevented employer health plans from setting different annual or lifetime limits for mental health services than they did for other coverage. And then, the Mental Health Parity and Addiction Equity Act of 2008 expanded the rules to include substance abuse treatment and barred employers who include mental health services in their insurance plans from covering them at a lower level than other medical conditions. As a result, an estimated 140 million Americans no longer face higher deductibles, steeper co-payments or other restrictions when they seek mental health and substance abuse treatment services.

In general, these rules apply to health insurance plans that include mental health coverage, which is not required under the law, and are offered by employers with more than 50 employees. While the law took effect in October 2009, health plans could wait until the start of the next plan year to comply.

To get a progress report on the law's implementation, KHN's Kate Steadman checked in with Andrew Sperling, the director of federal legislative advocacy for the National Alliance on Mental Illness. He has some concerns, including the continued exemption of small businesses and individual health insurance plans from parity requirements, but is optimistic that the new health reform law will advance the effort to "eradicate" differences in how mental health treatment is covered by insurers. Here are edited excerpts of the interview: 

Q: What are the main changes made by the 2008 law regarding health insurance coverage of mental health and substance abuse services?

A: [The measure] expands the 1996 law in two very specific and big areas. The old law required equitable coverage, but only in respect to annual and lifetime dollar limits. The GAO did a study in 2000 that found health plans reacted to the requirements by "squeezing the balloon" in other areas, so to keep costs from escalating they pushed other limits like higher deductibles and higher cost-sharing.

Why is the Public Suddenly Down on Unions? - The Economy's to Blame - Support Should Recover When the Economy Does

By David Madland, Karla Walter

This article was created by the Center for American Progress Action Fund.

Download this memo (pdf)

Additional references for this memo are contained in the PDF.

Americans have expressed generally positive attitudes toward unions for as long as pollsters have been asking, and for decades public approval of labor unions has hovered around 60 percent. But starting in 2009 public opinion toward labor unions dropped precipitously. Why?

Last summer less than half of Americans said they approved of labor unions. This is the first time this happened in the over 70 years the Gallup survey research group has asked. Just one year earlier nearly 60 percent of respondents approved of labor unions. Similarly, a 2010 Pew Center for the People and the Press survey found union favorability was at just 41 percent, while in 2007—the last time they asked the question—favorability was 58 percent. The Pew survey also found that the decline in support was widespread, falling for virtually every demographic and political group.

What happened? And what does this mean for the U.S. labor movement’s future given that membership is already at 30-year lows?

The answer is largely that the public is angry about the weak economy and is blaming major economic institutions such as business, government, and organized labor. As a result, support for unions should improve when the economy gets back on track. Moreover, despite the drop in overall approval the public continues to value many of the functions unions perform—such as helping workers.

Still, labor unions may have suffered a more lasting blow. It’s hard to know the longer-term effect of the government’s bailout of GM and Chrysler, but the bailout was deeply unpopular and may have sullied unions’ reputations. Likewise, the conservative campaign to criticize unionized public sector workers’ compensation and work ethic—although very unlikely a major source of the decline—may have some effect on the public’s opinion of unions in the future, though data limitations make it hard to know this for certain.

In short, public support for labor unions should recover when the economy improves. But unions may need to take some different actions and work on their public image to bring their approval ratings back up to pre-recession levels.

This brief will examine these issues in more detail by surveying opinion polls on unions taken over the last several decades.

The public’s recent decline in support for labor unions

Out of Network ER Visits Won't Cost More Under New Health Law

by Michelle Andrews

This article was published by the Center for American Progress.

In the middle of a medical emergency, you don't have time to wonder whether the doctor who is reading your X-rays is in your insurance network. Starting this fall, changes under the health-care overhaul will take some of the worry out of emergency room visits. But the new provisions don't cover all the bases, and in some instances you may still get blindsided by unexpected costs.

Accidents and other mishaps sometimes happen far from home. When they do, you may discover that you owe a bigger chunk of the ER costs because the hospital, doctors and other medical staff who patched you up were out of network — that is, your health plan didn't have a contract with them to provide services at an agreed-upon rate. In those instances, a health plan often covers a lower percentage of the costs than it would if you had been treated within the network.

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This can be a problem even if you break your leg in your back yard rather than skiing at Vail. Often unbeknownst to patients, some of the doctors and other providers at their in-network hospital may themselves be out of network and not under contract to a particular insurer.

Doomed to Repeat History: The Right Re-Embraces Lunatic Legal Arguments from the Past

By Ian Millhiser

This article was published by the Center for American Progress.

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Spend a week listening to the right, and you’ll think the founders were all modern-day Tea Partiers. Senator Tom Coburn (R-OK) thinks the Constitution forbids Congress to spend federal money on programs he personally disapproves of. Justice Clarence Thomas thinks that the minimum wage, child labor laws, and the federal ban on whites-only lunch counters all violate the Constitution. And of course, everyone on the right thinks that health reform is unconstitutional.

It’s enough to make you think they’re just making it up as they go along. It clearly can’t be the case that every single law cherished by progressives just happens to be unconstitutional.

the reality is even worse. When the right’s view of the Constitution was ascendant 75 years ago, basic protections such as a restriction on child labor were declared unconstitutional; laws banning discrimination were unthinkable; and Social Security was widely viewed as next in line for the Supreme Court’s chopping block.

America’s right now wants nothing more than to revive this discredited theory of the Constitution. These conservatives are over-reading the Tenth Amendment, a provision of the Constitution that provides Congress’s power is not unlimited. So-called “tenther” conservatives are determined to use their twisted reinterpretation to shrink national leaders’ power to the point where it can be drowned in a bathtub. They must not be allowed to succeed for three reasons:

• Tentherism is dangerous. Monopolists seized control of entire industries during tentherism’s last period of ascendance. Workers were denied the most basic protections, while management happily invoked the long arm of the law when a labor dispute arose. Worst of all, Congress was powerless against this effort. And the Court swiftly declared congressional action unconstitutional when elected officials took even the most modest steps to protect workers or limit corporate power.
• Tentherism has no basis in constitutional text or history. Nothing in the Constitution supports tenther arguments. And tenther claims are nothing new. Each of them was raised as early as the Washington administration, and each was rejected by George Washington himself.
• Tentherism is authoritarian. Health reform, Social Security, and the Civil Rights Act all exist because the people’s representatives said they should exist. The tenthers express goal is to make the Supreme Court strip these elected representatives of power and impose a conservative agenda upon the nation.

The right’s quizzical lawsuits challenging health reform are just the tip of the tenther iceberg. If these lawsuits succeed, much of America’s most cherished laws could be next against the wall.

Think Again: Kabuki Democracy: The Response

By Eric Alterman 

This article was published by the Center for American Progress.

Late last week I published a 17,000 word article on The Nation’s website called “Kabuki Democracy: Why a Progressive Presidency Is Impossible, for Now.” The article is here and the Altanticwire.com did a short summary of it here. Thanks, I’m guessing in considerable measure, to the incredible reach of Mike Allen’s “Playbook,” where it was generously featured on the morning it appeared, the article garnered a tremendous number ofresponses in the blogosphere and in the larger media.

The various reactions have been extremely instructive. Given the length of the piece an awful lot of people did not bother to read most of it or even enough of it to understand its central argument before commenting on it. My main point—as I understood it anyway—was that while Barack Obama has unarguably failed to make good on many of his most significant campaign promises so far, this is less a reflection of the administration’s strategic errors or any demonstrable backing away by Obama from those promises in most but not all instances. Rather this failure results from a series of structural bottlenecks in our system that encourage conservative transformative change but stand in the way of its progressive counterpart.

Broadly speaking, I identified:

• The legacy of the Bush administration
• The structure of our political system and the antiquated rules of the Senate
• The political power of money
• The ideological antipathy of many Americans to strong government
• The power of right-wing media
• The varying weaknesses of mainstream media
• And the disciplined and yet entirely-divorced-from-reality character of contemporary conservatism coupled with the disparate ideological composition of the Democratic Party, among others

A California Campaign with Global Consequences

By Araceli Ruano, Sean Pool 

This article was published by the Center for American Progress.

This November, California voters are in danger of undoing one of the most progressive pieces of environmental legislation ever passed.

Texas oil companies have taken advantage of California’s quirky initiative system to place Proposition 23 on the ballot. This proposition has one purpose: to undo California’s Global Warming Solutions Act (also known as Assembly Bill 32, or “A.B. 32”), which stands as a landmark piece of bipartisan clean energy legislation and is a model for federal action. A.B. 32 has catalyzed billions of dollars in private sector investment in clean energy in the state—creating jobs, businesses, and new technologies that are leading the nation toward a cleaner energy future.

Repealing the law would damage California’s clean energy economy, severely inhibit the functioning of the United States’ clean energy innovation engine, increase pollution and dependence on foreign oil, and harm chances for comprehensive federal action. Defeating Proposition 23 at the ballot box would be not only a victory for California but also one of the strongest messages California’s voters can send to Washington and the world that we the people have the will to beat Big Oil.

Assembly Bill 32 is a model of bipartisan clean energy action

The bipartisan Global Warming Solutions Act of 2006 was passed by a Democratic-controlled legislature with support from businesses, labor, environmental, and health organizations and signed into law by Republican Gov. Arnold Schwarzenegger. It established the first-ever mandatory reporting guidelines for global warming pollution, and set a statewide limit for carbon that will guide emissions back down to 1990 levels by 2020. This limit is implemented through a scoping plan that includes establishing a price for carbon in addition to tailpipe-emissions standards, a low-carbon fuel standard, building energy-efficiency standards, and a statewide renewable electricity standard of 33 percent by 2020.

Two Steps Forward, One Step Back: The Presbyterian Church's Journey Toward LGBT Equality

By Marta Cook

This article was published by the Center for American Progress.

The Presbyterian Church, one of the mainline Protestant denominations in the United States, has been struggling for decades—along with many other religious institutions—over how inclusive it should be with its congregations’ LGBT members. But the church’s recent conference should give the gay rights movement cause for hope that the arc of history may be bending toward justice sooner than they might think.

Last week in Minneapolis the U.S. Presbyterian Church, or PCUSA, held its 219th General Assembly, a biennial convention in which Presbyterians come together from across the country to worship and discuss church bylaws and policy. This year the church took important steps toward becoming a truly inclusive and just place of worship and community for its fellow LGBT brothers and sisters in Christ. Representatives voted to allow ordination of LGBT church leaders, extend benefits to same-sex partners of church staff, and increase education and awareness regarding HIV/AIDS.

The passage of a proposed change to the PCUSA constitution that would allow LGBT people to be ordained as leaders (ministers, deacons, and elders) in the church was one of the most exciting votes of the assembly. The current constitution, until amended, forbids sexual relationships outside of heterosexual marriage. The proposed amendment drops that requirement. Now a majority of U.S. presbyteries—governing bodies of ordained church ministers and elders—must pass the amendment for it to become church law.

How House Calls May Help Frail Elderly

by Michelle Andrews

This article was published by Kaiser Health News.

From the back window of his rowhouse, Karl Schwengel can see the U.S. Capitol. But the 11 blocks might as well be so many miles, because he can barely walk across his bedroom, let alone go for a stroll.

Schwengel, 79, has congestive heart failure and arthritis. And though he lost 60 pounds during a recent hospital stay, he still weighs in at 260 pounds.

Last year, he was retaining so much fluid that his calves were "almost the size of basketballs," he says, and walking became nearly impossible. When he traveled to a clinic or the hospital for medical treatment — an ordeal in and of itself — he relied on neighbors and an unofficial godson to take him.

More From This Series:Insuring Your Health

All that began to change about six months ago when a local community group put him in contact with the Medical House Call Program at Washington Hospital Center. Now a doctor or nurse practitioner visits him every month to check his vital signs and medications and work with him to improve his health. A physical therapist recently joined the Schwengel team, and now he's practicing using a walker at home. "The doctor says we’re going to work on one problem at a time," he says.

Latino Attitudes About Women and Society

John Halpin, Ruy Teixeira

This article was published by the Center for American Progress.

Download this memo (pdf)

The Center for American Progress, in conjunction with A Woman’s Nation, the Rockefeller Foundation, and TIME magazine, conducted a landmark study in the summer of 2009 into public attitudes about women, society, and the workplace. Women are approaching the historic milestone of constituting half of the workforce, and the study sought to determine how Americans felt about a range of changes in the nature of modern family life and work.

The study found striking consistency in men and women’s attitudes about many formerly contentious issues of gender relations and the working status of women. The study overall found strong majorities of men and women agreeing that the rise of women in the workforce is a positive development for society—a belief that crossed partisan, ideological, racial and ethnic, and even generational lines.

The survey of 3,413 adults, conducted by Abt SRBI, included an oversample of Latinos, allowing us to dive somewhat deeper into the beliefs of this important and growing group, and to compare their attitudes with those of the population at large. This survey was not designed as a comprehensive examination of Latino attitudes and subgroups, but the results provide interesting and useful attitudinal trends that will be worth pursuing in more detail in future studies.

It is important to note upfront that Latino attitudes were basically in line with those of other groups on nearly every indicator in the survey. Some minor differences did emerge in terms of the intensity of these beliefs and the degree of consensus about an issue. But, as was found with the overall population, Latinos accept and welcome the rising status of women in American life and report many of the same needs as others in terms of balancing work and family life.

Some of the more interesting findings that emerged from our analysis include:

Latino attitudes about the rise of women in the workforce are as positive as any group in America

We asked Americans to evaluate the fact that women today constitute about one-half of all workers compared to 40 years ago when women made up one-third of all workers. More than three-quarters of Americans (77 percent) overall viewed this development positively, with less than one-fifth (19 percent) viewing this change negatively. Positive views about the rise of women in the economy cut across nearly every demographic and ideological group. But Latinos were among the most favorable groups in the survey, with 87 percent of Latino women and 82 percent of Latino men viewing this change positively—7 to 10 points higher than men and women overall (Figure 1).

Latinos are more focused on having a fulfilling a job and are much more likely to want their daughters to have an interesting career

Latinos express a strong desire for better and more fulfilling job opportunities in life. The rank ordering of life goals is roughly similar between Latinos and the overall population, but larger percentages of Latino men and women rate “having a fulfilling job” as a very important life goal (Figure 2).

Taking Action Against Arizona: Federal Lawsuit Against Arizona Protects People and Constitution

By Gebe Martinez, Angela Maria Kelley

This article was published by the Center for American Progress.

It is not often that the federal government files a lawsuit against a state; so when it does, it must have good reason.

It had plenty of good reasons this week when the Obama administration reasserted the federal government’s responsibility to set and enforce immigration policy by filing a lawsuit challenging the legality of Arizona’s new immigration control law.

The U.S. Department of Justice was forced to take action because Arizona’s immigration law violates the U.S. Constitution. Allowing Arizona S.B. 1070 to stand would only invite other states and cities to enact their own immigration enforcement laws and usurp the federal responsibility over an issue that must be handled at the national level.

It is clear that the architects of our federal government understood the importance and role of immigration policy when they placed it firmly in federal hands. States cannot make up their own immigration laws anymore than they can print their own money or enter into treaties with foreign countries.

Arizona crossed a constitutional line when it enacted its immigration law, which requires police to question the legal status of suspects when there is “reasonable suspicion” they are undocumented immigrants. The law also sets “attrition through enforcement,” as the official state policy, which is the intent to enforce the law so harshly that immigrants voluntarily leave the state. Attorney General Eric Holder concluded the law “only creates more problems than it solves.”

Think Again: "No Opinions Except Ours," Says the Washington Post

By Eric Alterman 

This article was published by the Center for American Progress.

Debate continues over The Washington Post’s forcing out of blogger Dave Weigel for writing uncomplimentary things about the conservatives he covered in a Washington Post blog. This is unfortunate since not only did Weigel get the short end of the stick, but the incident raises myriad issues simultaneously. I addressed a few of these in my last Nation column, but the discussion has continued and this column by the Washington Post’s conflict-of-interest-king, Howard Kurtz, among others, raise new questions about the Post’s behavior and its meaning for the future of journalism.

Kurtz notes that “Weigel's departure sparked a backlash—not so much against him as the newspaper that employed him.” Kurtz rejects all such criticism as he defends the institution that provides one of his paychecks. “Weigel's resignation was accepted,” he insists, “because, as he quickly recognized, his vituperative language against Matt Drudge, Rush Limbaugh and other conservatives had embarrassed the paper that hired him three months earlier to cover the right…. Whoever leaked those messages from Journolist, an off-the-record group founded by Post blogger Ezra Klein, was out to torpedo Weigel, and it worked.”

He goes on to add that “the truth is it’s difficult for a mainstream organization to stand behind someone who wishes, however jokingly, for Drudge to set himself on fire, Limbaugh to die of a heart attack and other things (including an epithet beginning with "rat") that can't be reprinted here. Sure, Weigel was hired for his viewpoint (and reporting), but the MSM have certain boundaries, and always will.” Kurtz says he wishes “The Post's Web site had managed to find a real conservative voice in recent years.”

Preventing Pregnancy: Should Patients Get Contraceptives From Health Plans At No Cost?

by Michelle Andrews

This article was published by Kaiser Health News.

The average American woman who wants two children spends roughly five years trying to get pregnant or being pregnant. She spends a much longer time - 30 years, on average - trying to avoid pregnancy, often at no small expense.

That may soon change, at least the expense part. Starting this fall, the health-care overhaul will require new  health plans to begin providing a range of preventive health services at no cost to patients. Many people, including women's health advocates and some employer groups, think contraception should be one of the required free services.

More From This Series:Insuring Your Health

"It's basic preventive health care," says Laura Hessburg, a senior health policy adviser at the National Partnership for Women and Families. Among other health benefits, women who plan their pregnancies are more likely to get necessary prenatal care and avoid closely spaced births, which can put a strain on their bodies and their parenting skills, and may result in low-birth-weight babies.

Public Opinion Snapshot: Public Warms to Health Care Reform Law

By Ruy Teixeira

This article was published by the Center for American Progress.

Conservatives loudly predicted that health care reform, once it became law, would generate a tidal wave of opposition that would lead to its repeal and a devastating defeat for progressives. Recent data suggest their predictions are, to put it mildly, off the mark.

The June Kaiser Health Care Tracking poll found that public favorability toward the bill has risen over the last month to 48 percent favorable and 41 percent unfavorable, which is up from 41 percent favorable and 44 percent unfavorable in May. This result is consistent with trends found in a number of other public polls.

Back at the Interior Department Ranch: Salazar Has Some Clean Up to Do in Utah, Too

By Tom Kenworthy

This article was published by the Center for American Progress.

No question, Interior Secretary Ken Salazar has his hands full these days with the Gulf of Mexico oil disaster. Holding BP’s feet to the fire and rooting out the oil-soaked culture at the Minerals Management Service is more than a full-time job.

But back at the Interior Department ranch, there are a couple of pieces of unfinished business that he, or someone at his direction, should attend to. Both involve Utah, and both—like the gulf oil mess—have their roots in the previous administration’s cavalier abdication of its responsibility to protect public resources.

Just months before the Obama administration took office, the Interior Department’s Bureau of Land Management issued a flurry of new 20-year management plans for 11 million acres of federal land in Utah. The six plans opened up about 80 percent of the lands in question to oil and gas development—much of it spectacular red rock canyon country full of archaeological treasures and prized for its wilderness characteristics. Some 17,000 miles of trails were designated as routes for off-road vehicles.

If there was any question that the new plans were a giveaway to those who think public lands are for plundering, the answer came immediately as the Bush administration sold oil and gas leases on scores of Utah parcels covering 130,000 acres. The package would have opened areas near some of Utah’s iconic landscapes for energy development, including Arches National Park, Dinosaur National Monument, and Nine Mile Canyon.

Turn Off the Oil Subsidy Spigot

By Sima J. Gandhi 

This article was published by the Center for American Progress.

lost by a vote of 35-61, with every Republican voting against it.

The vote to preserve outdated subsidies that make rich oil companies richer while creating little benefit to the taxpayers who foot the bill was a victory for the oil industry and its lobbyists. They hailed the “vote to preserve a domestic manufacturing industry that is critical to our nation's energy security and to the nascent economic recovery,” in the words of Charles T. Drevna, president of the National Petrochemical and Refiners Association.

Lawmakers must end tax subsidies to the oil industry. But the Senate’s action makes clear that doing so will require Congress to overcome lobbyist arguments that killing subsidies will harm the economy. Profitable and powerful oil companies, such as BP and ExxonMobil, pay lobbyists millions of dollars to scare lawmakers into believing that ending subsidies to oil companies will wreak havoc on the American economy. These arguments are advanced by trade organizations such as the American Petroleum Institute, and they suggest that eliminating subsidies “could mean less U.S. energy production, fewer American jobs,” and higher oil prices.

The evidence suggests otherwise:

• Tax subsidies for oil companies don’t decrease our reliance on foreign oil. Oil companies often argue that without subsidies, domestic production will decline and our reliance on foreign oil will increase. Yet U.S. production has steadily declined since its 1970s peak. We produce about the same amount of oil now that we produced in the 1950s despite billions in subsidies over the past 30 years, as seen in this graph.