Health care issues are of more concern than ever in this time of uncertainty in the United States. Americans are facing a higher nationwide rate of unemployment of 5.7 percent, which inevitably results in a rise in the percentage of Americans without health insurance. The level of uninsured people in the U.S. was a point of much concern even before September 11 and the recent economic downturn. Also, mental health care needs warrant attention, particularly in this time when worries over international conflict, employment instability, and uncertainties about domestic safety can trigger or exacerbate mental health problems. The need for a Patient's Bill of Rights is still a reality, but the issue has received little popular attention in recent months. Finally, renewed questions and concerns about stem cell research and cloning have arisen recently in light of announcements from the scientific community. This quarterly attempts to briefly address each of these issues in relation to public policy at present, knowing that this is hardly an exhaustive list of the health concerns of Americans today and many legislative decisions are still pending at print.

Economic Stimulus and Healthcare

Advocates for health care are particularly concerned with outcome of the economic stimulus package, given the estimate that 85 of every 100 workers laid off this year will also lose their health insurance. 1 The economic downturn, starting in March 2001, was only exacerbated by the events of September 11th and resulting damage to travel, service and other industries.

On December 12th the vice president of the Hotel Employees and Restaurant Employees International Union spoke in a panel sponsored by the Alliance for Health Reform, held in Washington, D.C. He said many employees in his union have either recently become unemployed or have had their hours cut drastically. Since benefits in the union are determined by employment and a minimum number of hours worked per week in that job, many workers are now finding themselves working too few hours to be eligible for health care. The COBRA program--which allows recently unemployed workers to continue their employer-based coverage by directly paying 102% of the premium--is unaffordable for the vast majority of low- and medium-wage workers. Moreover, even with the 75% subsidy proposed in one version of the economic stimulus package, most workers would be unable to come up with the rest to continue their health coverage.

Many legislators remain committed to keeping a significant health insurance component in the stimulus package. The House Ways and Means Committee chairman Rep. Bill Thomas (CA) committed to support a 13-week extension of unemployment benefits for people who lost jobs after March 14, when most economists estimate the downturn began. He also proposed that income taxes be suspended on the extended benefits and a 50 percent tax credit be given to defray the cost of buying private health insurance. 2

At this time, the economic stimulus package is far from being finalized. The hope is that the final version will contain adequate unemployment insurance and health care subsidies to the workers and families who have been most affected by the economic problems resulting from September 11 th and the prior economic downturn. Still, many health care and religious organizations fear that the package will focus too heavily on tax cuts and aid to large corporations. The Presbyterian Washington Office has recently signed on to a letter supported by many other religious and health care groups. The letter urges Congress to seriously address the health care and economic needs of the nation, advocating for the inclusion of the 75% COBRA assistance for recently unemployed workers, a Medicaid option for those unemployed who are not eligible for COBRA (persons laid off from businesses that employed 20 or fewer people are not eligible for COBRA), and a short-term increase in the Federal Medicaid matching rate to help states that are already hard pressed to meet the Medicaid needs of their citizens.

President Bush has shown that he is willing to make some compromises in his plan for economic stimulus. For example, Bush had wanted unemployment benefits to be extended only for workers in areas directly affected by the September 11 events. He now says he will accept nationwide expanded benefits that will also include aid for workers who experienced unemployment from March 2001 on to the present. Also, Bush has agreed to give tax rebates to low-income workers who did not earn enough to receive the full initial tax rebate earlier this year instead his original plan of instituting another round of across-the-board tax cuts. 3

In 1996 the 208th General Assembly approved "Eradicating Poverty and Improving the Human Habitat", wherein the Assembly calls for our government to "provide incentives for the unemployed, including a livable minimum wage, job training, protection against loss of benefits for persons on welfare seeking to becoming self-sufficient, protection of benefits for people temporarily unemployed or in transition, and protection of pension benefits [emphasis added]." 4

Mental Health Parity

The Mental Health Equitable Treatment Act of 2001 (S. 543) was added as an amendment to the Senate version of the Labor-HHS-Education appropriations bill, but not to the House version, and conferees sealed its fate during the week of December 10th.

In a December 11th statement Sen. Paul Wellstone (Minn.), a leading advocate for mental health parity, indicated that the mental health parity amendment would fail to make the final version of the Labor-HHS-Education appropriations bill this year. While the legislation had wide support among health care, education, and civil rights advocates and religious groups including the Presbyterian Church (U.S.A.), House conferees in the House-Senate conference did not agree to the inclusion of the amendment. The legislation's passage was made even more unlikely by a lack of support from the Bush Administration. Disagreement on the inclusion of the parity amendment was the final obstacle preventing passage of the Labor-HHS-appropriations bill, and Sen. Wellstone said that he doubts the legislation will be attached to another bill for passage this year.

This legislation would have built upon the limited Mental Health Parity Act of 1996 by prohibiting group health plans from providing unequal coverage of mental health care compared to medical/surgical health care. Currently, many group health plans set higher copayments and deductibles for mental health care and place strict limits on the number and length of covered hospital stays and doctor visits for mental illness as compared to physical ailments.

Opponents of mental health parity legislation argued that increased coverage of mental healthcare needs would result in misuse and overuse of mental health benefits. They also feared that group plans might reduce all coverage, limiting physical healthcare benefits as they have limited mental healthcare benefits in order to comply with the parity mandate. However, nearly three dozen states and the federal government have experimented with parity in treatment, and have found that costs have not been significant and premiums needed only to be raised by less that one percent.

The 213th General Assembly (2001) approved an overture that spoke directly to this issue: "Jesus calls us to ministries of healing and comfort with the outcasts of society. The more than 35 million people in the United States who suffer from serious mental illnesses too often receive inadequate health care and are socially isolated and outcast because of the stigma attached to these illnesses." Further, "Insurance parity marks a commitment to effective treatment for the mentally ill and to ending insurance discrimination against the mentally ill."

(From Rationale section of Overture 01-16 "On Advocating Passage of Legislation Requiring Health Insurance Plans to Provide Mental Health Benefits in Full Parity with Medical and Surgical Benefits." Minutes, 2001, p. 419.)

Patients' Bill of Rights

At the beginning of 2001, prospects for the passage of a patients' bill of rights were promising. In the first months of the year, at least seven different bills addressing the rights of people who receive their health care through managed care organizations (MCOs) were introduced in Congress, and Republicans and Democrats seemed to be coming to consensus on several areas of disagreement.

However, none of these bills has received any attention since September 11. HR. 2563, a proposed patients' bill of rights introduced by Greg Ganske (IA), passed the House and was sent to the Senate for consideration in August, but has remained untouched since September 6. Similarly, S. 283, a Senate version of a patients' bill of rights, has not gained a cosponsor since the end of June.

Stem Cell Research

In November a group of researchers from Advanced Cell Technology in Massachusetts made the announcement that they had begun to make cloned human embryos. Their goal, they said, was to grow human embryonic stem cells, which can be manipulated to grow into desired replacement tissues for patients suffering from degenerative diseases. While scientists said that none of the embryos were more than six cells in size before they died, 4 this news renewed calls for legislative action to address concerns about cloning and stem cell research.

Senator Brownback (KS) said he would push for a "sweeping ban" on human cloning before the end of this session. Other senators tempered their responses by citing the possible benefits of regulated stem cell research. "I strongly oppose the use of cloning technology to reproduce a human being, but we must also protect essential areas of medical research involving cloning technology, including stem cell research. This research holds enormous promise for achieving breakthrough cures for the dreaded diseases that touch almost every family in America," said Senator Edward Kennedy, as quoted in The Washington Post. 5

The House passed a ban in July that made it illegal to make cloned human babies or prohibited the creation of cloned embryos (resulting in a supply of stem cells) for research. Additionally, the Bush Administration said it would give support for any bill similar to the House bill. Still, with Congress under much pressure to pass certain pieces of legislation related to the economy and federal appropriations, a bill concerning stem cell research is unlikely to pass before the holiday recess.

The 213th General Assembly (2001) affirmed the use of fetal tissue and embryonic tissue for vital research, but was careful to explain that decisions surrounding this research must be made with the utmost care: "Our respect for life includes respect for the embryo and fetus, and we affirm that decisions about embryos and fetuses need to be made with responsibility." Further, the General Assembly strongly urges Presbyterians to educate themselves on the various ethical decisions involved in stem cell research and recognizes the need for continued public dialogue and information sharing on these issues. 6

Earlier, the 195th General Assembly (1983) called upon Presbyterians and legislators to see that research and development in science be guided by the human values of "survival, enhancement of life, justice and equity in access," and that "fetal and embryonic research be undertaken with caution and sensitivity." Further, the Assembly requested that the Washington Office monitor all U.S. legislation that concerns the application of biotechnology. 7