Potential for PNHP Mental Health Working Group?

Overview Special considerations in mental illness insurance coverage, each improved with Medicare for All Identifying allies and resources in the mental illness advocacy family and consumer community Finding ways to connect with the psychiatrist base Appealing to primary care physicians who struggle to obtain mental illness treatment for their patients Is there a role for a PNHP working group on mental illness? Suggestions for priorities and strategies?

Common Insurance Problems Cost of premiums Cost-sharing increases/ underinsurance Pre-existing conditions Limited provider networks Limited formularies Unpublished/ nonstandard approval protocols for treatment

Common Insurance Problems Gaps in coverage for chronic conditions Fragmented system– Medicaid, Medicare, Private, Uninsured, Public Health, Military, VA Provider and Medication options change when job changes or if disability status changes– fragile and difficult to reach control for complex conditions can be lost quickly if a single element is changed Fear of working and losing disability status

Special Problems for Mental Health Insurance Carve-out subcontracts with difficult rules Removal of basic care from primary doctor Sharper demarcation between privately employed providers and state systems Increased variability in skill sets between provider systems/ hospital privileges Up-front payment required Provider shortages/ turnover/ burnout Special setting designations– partial hosp, residential Variable diagnostic categories– educational, developmental