Former Rep. Patrick Kennedy, D-R.I., was a senior in high school the first time he checked into rehab. His struggle with drug addiction and bipolar disorder continued to haunt him through his 16 years in Congress. But his first-hand experience with these illnesses also drives his long-standing interest in shaping public policies to confront the challenges faced by people with mental health problems.

One of Kennedy’s greatest legislative achievements is spearheading the passage — with the help of his father, the late Sen. Edward Kennedy, D-Mass. — of the landmark Mental Health Parity and Addiction Equity Act of 2008.

Since choosing to leave Capitol Hill in 2010, he has pushed to bring mental health policy out of what he says is “the dark ages” — using the advantages, he says, of coming “from a famous family with a powerful, nationally recognized name. [It] gives me a convening power.”

These days, he is most visible in his role as founder of The Kennedy Forum, an advocacy coalition for the mentally ill and mental health policy, and co-founder of the nonprofit research organization called One Mind.

“One Mind’s mission,” he says, “is to accelerate [mental health] cures and therapy by ensuring that we don’t duplicate science.” To this end, he adds, “we have already … created the largest platform to study traumatic brain injury and PTSD in the world,” bringing other countries into the effort.

Testifying last month before the House Energy and Commerce Subcommittee on Health, he said the pending Helping Families in Mental Health Crisis Act of 2015 would provide resources and programs for psychiatric care. “The time is now” for reform, he said, questioning why “with mental illness and addiction we wait for crisis” instead of intervening early.

KHN reporter Alana Pockros talked with Kennedy about problems he sees in the nation’s mental health system and the steps needed to fix them. The following interview has been edited and condensed.

Q. You’ve said that the health system is “stuck in the same mentality as five decades ago.” What does this mean?

A. Culturally, we still assign issues of mental health and addiction [to] moral character. We still assign blame to people with these diseases even though they have been known to be diseases for five decades. … Instead of saying “it’s your fault” to addicts, “you made this choice to start,” we now know to look at this as a biological disease.

So, we need to approach illnesses in a different way. Our science tells us one thing, but our culture has told us some completely different story. That’s why our public policy is medieval. In another 20 years from now, they are going to look back on this period like we look back on segregation [or] bigotry against gays and lesbians.

Q. This legislation encompasses a range of mental health issues. What do you think is the top priority?

A. I would say if we want to make a difference on a population basis, the number one issue is prevention. We know upon the first incident of psychosis how to interrupt the cycle of that illness with aggressive treatment, just as if we were to use aggressive treatment for cancer. If we did that, we would dramatically reduce incidence of disability in this country.

Today we are reacting to an epidemic of untreated mental illness. So the way to deal with that is to build a chronic care or intensive care system so that people are treated and cared for, and not abandoned. That goes back to the first point: we know these are chronic illnesses, yet we don’t employ a chronic care approach to their treatment. Treat it like asthma, treat it like diabetes; treat it in a chronic care management way.

Q. In terms of policy change and advocacy, are you targeting the federal level or state governments? How?

A. On the federal level, we are looking at The 21st Century Cures Act. [This bill is designed to speed the drug discovery and approval process. It includes provisions to improve communication and collaboration among researchers.]

It is littered with loopholes on data sharing. [The bill has] so many exceptions to [its] mandate that [scientists] share data, that it really undermines the whole purpose of making [research on mental illness] an urgent task. Even though the biggest [research] funders are taxpayers, through the National Institutes of Health, academia totally sequester and “secret away” all their data and don’t share with anyone else. [Universities] husband that data and try to sell it for profits, even though taxpayers pay for the data. That data belongs to the public, it doesn’t belong to universities. So we won’t learn whether there is an algorithm, because someone is holding back valuable information that could help to provide “the missing piece to the puzzle.” That’s what we are dealing with.

Q. How does your new role help you push for change? How has it affected your message?

A. I have been blessed by having led The Mental Health Parity and Addiction Equity Act fight. What that allowed me to have, even though I’m no longer in Congress, is a platform to organize and spur collaboration among the very disparate and fragmented stakeholders in neuroscience and for the clinical delivery of neuroscience. I’ve worked in both of those worlds and enjoyed a position of trust. … I still have some credibility in this space, and I’ve used it.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

CMS proposes major initiative for hip and knee replacements

Every month, a group of older adults goes to Washington, D.C.’s Sibley Memorial Hospital, but they don’t see a doctor or get tests. They’re not sick. They come just for laughs.

They gather in a room next to the hospital cafeteria for the “Laugh Cafe,” one of the activities offered to local seniors, including the 7,300 members of Sibley’s Senior Association. The price of admission is one joke, recited out loud. Experts say laughing can be good for your health, and everyone in the room strongly agrees.

“Absolutely, it’s the best medicine,” said Joanne Philleo, 79, from Bethesda, Md.

“I like to come with Joanne, and I love the jokes,” said Jean Altimont, 89. “I never dreamed of telling a joke in front of a group, and the first time I came, I was real nervous.”

Some jokes took a few twists before getting to the punchline, a few were almost R-rated, others were one-liners: My husband wanted more space, so I left him outside. I sold my vacuum because it was gathering dust. Why do men like smart women? Because opposites attract.

And if one had been told before, no one cared.

The association for those age 50 or older also offers other activities, including French and Italian conversation classes, day trips to museums, a current events group, and — the latest addition — tango lessons. In addition, members receive discounts on hospital parking and at the gift shop, pharmacy and restaurant. In all, more than 10,000 seniors participate.

“I call this a senior center without walls,” said Marti Bailey, the association’s director. The program started in 1987 with exercise and patient-support groups. Members pay a one-time $40 membership fee.

Concerns About Marketing

Sibley is one of several hospitals in the Washington area — along with others across the country — offering social activities and other benefits to help seniors stay healthy and out of the hospital, while encouraging them to visit. Participants do not need to have been patients.

But some hospital finance experts are concerned that the activities are less about health than about marketing to Medicare beneficiaries, especially those who can go to the hospital of their choice when they need care because they are not enrolled in private insurance plans with limited provider networks.

Gerard Anderson, director of the Center for Hospital Finance and Management at the Johns Hopkins Bloomberg School of Public Health in Baltimore, said such programs across the country can be a good business strategy. (Anderson was not speaking on behalf of Johns Hopkins Medicine, whose six hospitals include Sibley.)

“If they can get you in the door and you have a pleasant experience, then the next time you need to go to the hospital, you have a place you’ve been to and where you feel comfortable,” Anderson said.

Medicare, which covers 55 million older and disabled Americans, provides as much as half of some hospitals’ income. “Medicare may not be the best payer, but they are still a very good payer, and a filled bed is better than an unfilled bed,” he said.

While hospitals may be seeking brand loyalty, they can also appeal to the increasing number of older adults living independently who are looking beyond traditional senior centers and local social service agencies to meet their needs.

“Hospitals are trying to promote the notion of the health and wellness of aging and trying to change their image from places of sickness and death to ones of health and wellness,” said Fredda Vladeck, director of the Aging in Place Initiative at the United Hospital Fund, a health research and philanthropic organization.

And the strategy may be working.

“This is isn’t a hospital per se, because there’s so many things to do,” said Philleo, joining her friends for lunch in the Sibley cafeteria after the Laugh Cafe event. “This is a place that contains a hospital.”

“And they make a great Philly cheese steak,” said Tom Reynolds, 78, the Laugh Cafe’s volunteer leader and joker-in-chief.

The Virginia Hospital Center in Arlington runs a similar outreach project for seniors. Its program, called the Senior Health Department, offers free lectures on healthy aging, assessment of fall risk and memory, exercise classes (for a small fee), yoga and a mall-walking group. A separate Senior Associates program provides 1,600 members — who are at least 60 years old and pay an annual fee of $45 ($65 for couples) — with annual blood screenings, complimentary parking and discounts on exercise classes and meals.

“Some older people don’t like to cook for themselves, and this may be the only hot meal they get” for the day, said Cathy Turner, the hospital’s director of health promotion and senior health.

The hospital setting provides “a level of comfort,” said Turner, especially for seniors who may feel intimidated at a fitness club or YMCA.

‘Dance And Rock-And-Roll’

“You can exercise at home, but it’s not the same,” said Donna Miller, 56, who recently drove with her friend Glorious “Glo” Mary Cooper, 61, to downtown Silver Spring, Md., for an event run by Holy Cross Hospital’s Senior Source program. The main attraction was a dance class where participants practice routines set to Broadway show tunes — with top hats and canes — and Motown hits.

“The best way to stay healthy is to do things you like, like dance and rock-and-roll,” Cooper said.

“When you get into a group like this, it’s so inspiring, it just works, it flows,” Miller said.

Last year, 4,800 people 55 and older participated in Senior Source programs. Offerings include classes on disease management, financial planning, fall prevention, low-impact exercise, dance, art appreciation and a current-events discussion group. A class called “Are You Smarter Than Your Smartphone?” promises to unlock the secrets of cellphones.

The Senior Advantage program at George Washington University Hospital has about 9,000 members. Anyone 65 or older can join for a one-time $10 fee ($15 for couples) and receive hearing tests, health insurance counseling and discounts at the cafeteria and gift shop.

Several other Washington-area hospitals also offer programs for seniors, including Inova Health System and Suburban Hospital.

Some activities require a nominal fee, but the hospitals generally pick up the bulk of the cost. Nonprofit hospitals consider those expenses part of their community benefits, the wide variety of services that they offer along with free medical care for low-income patients that help maintain their tax-exempt status.

Although it may seem counterintuitive for hospitals to try to keep people healthy when they are in business to treat illness, new Medicare payment incentives and penalties encourage hospitals to reduce patient readmissions, improve care and make hospitals “think more broadly about what health care really is,” said J.B. Silvers, a professor of health-care finance at the Weatherhead School of Management at Case Western Reserve University in Cleveland.

During a break between classes at Sibley Hospital, Bailey acknowledged the hospital’s changing mission.

“Health-care transformation requires we do everything we can to increase people’s health, rather than waiting for them to get ill,” she said. “Health care doesn’t stop when you leave the hospital.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Backers of a bill that would have allowed terminally ill Californians to get lethal prescriptions to end their lives shelved the legislation Tuesday morning because they lacked the votes to move it out of a key committee.

The End of Life Option Act, had already cleared the state Senate, but faced opposition in the Assembly Health Committee.

Among those expected to vote against the bill were a group of southern California Democrats, almost all of whom are Latino, after the Archdiocese of Los Angeles increased its lobbying  efforts. Church officials argued that some poor residents could feel pressured into ending their lives prematurely if they couldn’t afford expensive medical treatment. Disability rights advocates have also fought against the legislation.

“We continue to work with Assembly members to ensure they are comfortable with the bill,” said a joint statement from Sens. Lois Wolk, D-Davis, and Bill Monning, D-Monterey, and Assemblywoman Susan Eggman, D-Stockton. “For dying Californians like Jennifer Glass, who was scheduled to testify today, this issue is urgent. We remain committed to passing the End of Life Option Act for all Californians who want and need the option of medical aid in dying.”

Under the bill, mentally competent adults who are terminally ill with less than six months to live could request lethal medication from a physician.

“We’re going to review our options,” Monning said in an interview later. “We walk away from the decision today knowing that we’re going to have to spend more time cultivating our colleagues in the Assembly.”

The aid-in-dying issue was brought home to Californians last year after 29-year-old resident Brittany Maynard moved to Oregon so she could get a lethal prescription under that state’s death with dignity law. Maynard was terminally ill with brain cancer and died last November. A video she recorded 19 days before she took life-ending drugs was shown at a Senate hearing in March.

Last month, a poll found that 69 percent of Californians and 70 percent of Latinos supported the bill. The poll was conducted by the advocacy group Compassion and Choices.

The bill also got a boost after the California Medical Association changed its stance from opposed to neutral.

It was modeled after a 1994 Oregon law that permits aid in dying. Four other states — Washington, Montana, Vermont and New Mexico — have similar laws.

This story is part of a reporting partnership with NPR, KQED and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Women are saving a lot of money as a result of a health law requirement that insurance cover most forms of prescription contraceptives with no additional out-of-pocket costs, according to a study released Tuesday. But the amount of those savings and the speed with which those savings occurred surprised researchers.

The study, in the July issue of the policy journal Health Affairs, found that the average birth control pill user saved $255 in the year after the requirement took effect. The average user of an intrauterine device (IUD) saved $248. Those savings represented a significant percentage of average out-of-pocket costs.

“These are healthy women and this on average is their No. 1 need from the health care system,” said Nora Becker, an MD-PhD candidate at the University of Pennsylvania and lead author of the study. “On average, these women were spending about 30 to 44 percent of their total out of pocket (health) spending just on birth control.”

The study looked at out-of-pocket spending from nearly 800,000 women between the ages of 13 and 45 from January 2008 through June 2013. For most plans, the requirement began Aug. 1, 2012, or Jan. 1, 2013. So-called “grandfathered” health plans, those that have not substantially changed their benefits since the health law was passed in 2010, are exempt from the mandate, as are a small subset of religious-based plans.

Becker said that while making birth control substantially cheaper may not increase the number of women who use it, the new requirements could well shift the type of birth control they use to longer-acting, more effective methods like the IUD. “If prior to the ACA a woman was facing $10 to $30 a month for the pill but hundreds of dollars upfront for an IUD and now both are free, we might see a different choice,” she said.

Researchers also found that while out-of-pocket spending dropped dramatically for most types of prescription contraceptive methods — “the majority of women were paying nothing by June 2013” –spending barely budged for the vaginal ring or hormonal patch.

That could be because under the original rules, many insurers declined to make the ring or patch free, since, like pills, they are essentially hormone delivery methods.  Earlier this year, the Obama administration issued a clarification saying that while insurers do not have to offer every brand of every method, they do have to cover at least one product in each category, including rings and patches.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.