The Mental Healthcare Crisis and Single Payer

Potential for PNHP Mental Health Working Group?

OverviewSpecial 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 premiumsCost-sharing increases/ underinsurancePre-existing conditionsLimited provider networksLimited formulariesUnpublished/ nonstandard approval protocols

for treatment

Common Insurance Problems

Gaps in coverage for chronic conditionsFragmented 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 rulesRemoval of basic care from primary doctorSharper demarcation between privately employed

providers and state systemsIncreased variability in skill sets between provider

systems/ hospital privilegesUp-front payment requiredProvider shortages/ turnover/ burnoutSpecial setting designations– partial hosp, residentialVariable diagnostic categories– educational,

developmental