Bill Overview
Title: Mental and Physical Health Care Comorbidities Act of 2022
Description: This bill establishes a demonstration program to test hospital innovations that support low-income or uninsured individuals with serious mental and physical health comorbidities and to identify appropriate payment reforms under Medicare and Medicaid. Participating hospitals must (1) have a proportionally high number of Medicare or Medicaid patients, and (2) develop a plan and related quality metrics for innovations to provide coordinated care and address social determinants of health for individuals with serious mental illness or emotional disturbance and physical comorbidities (e.g., chronic conditions).
Sponsors: Sen. Bennet, Michael F. [D-CO]
Target Audience
Population: People with serious mental and physical health comorbidities who are low-income or uninsured
Estimated Size: 45000000
- The bill targets individuals with both serious mental and physical health issues who are low-income or uninsured.
- This is a global issue as low-income individuals face barriers in accessing healthcare worldwide.
- Estimates suggest over 1 billion people globally have some form of mental disorder, according to the World Health Organization.
- Physical health conditions such as chronic diseases affect billions of individuals globally, often intersecting with mental health issues.
- Access to healthcare is a major concern for low-income populations globally, with approximately 1.3 billion people living in poverty as reported by the World Bank.
Reasoning
- The Mental and Physical Health Care Comorbidities Act aims to support low-income or uninsured individuals with both mental and physical health issues.
- The policy specifically targets hospitals with a high number of Medicare and Medicaid patients, meaning those in poorer communities are prioritized.
- Given the budgetary constraints, the policy won't be able to reach everyone in need, especially outside of the target hospital regions.
- Low-income individuals face barriers when accessing healthcare, making them ideal beneficiaries of a program focused on social determinants of health.
- The program's effectiveness will vary depending on the individual's current access to healthcare services and their specific health challenges.
Simulated Interviews
unemployed (rural Arkansas)
Age: 35 | Gender: female
Wellbeing Before Policy: 3
Duration of Impact: 5.0 years
Commonness: 6/20
Statement of Opinion:
- I often have to choose between medication for my mood and my diabetes because I can't afford both.
- This program might let me get the care I need at a nearby hospital if they participate.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 3 |
| Year 2 | 6 | 3 |
| Year 3 | 7 | 3 |
| Year 5 | 8 | 3 |
| Year 10 | 8 | 2 |
| Year 20 | 7 | 2 |
part-time retail (Los Angeles, CA)
Age: 42 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- Access to mental health services has been a struggle despite living in a big city. The wait times are unbearable.
- If the local hospital adopts new measures, this could significantly improve access to coordinated care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 3 |
| Year 3 | 6 | 3 |
| Year 5 | 6 | 3 |
| Year 10 | 7 | 3 |
| Year 20 | 6 | 2 |
student (rural West Virginia)
Age: 28 | Gender: other
Wellbeing Before Policy: 5
Duration of Impact: 3.0 years
Commonness: 7/20
Statement of Opinion:
- Living in a rural area, it's hard to get quick treatment when I need it.
- The policy could mean I don't have to travel so far for integrated care services.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 4 |
| Year 5 | 5 | 3 |
| Year 10 | 5 | 3 |
| Year 20 | 4 | 3 |
retired (Chicago, IL)
Age: 60 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 20.0 years
Commonness: 10/20
Statement of Opinion:
- I've seen a lot of programs come and go without much improvement in service.
- If this changes how my Medicare is handled, I might see real improvement.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 4 |
| Year 20 | 7 | 3 |
caregiver (Houston, TX)
Age: 50 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 8.0 years
Commonness: 9/20
Statement of Opinion:
- I worry about my heart and my mind equally, but finding doctors to address both is a mess.
- Coordinated treatment sounds good, but will I really see these changes?
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 6 | 3 |
| Year 10 | 7 | 3 |
| Year 20 | 7 | 2 |
retired teacher (Orange County, CA)
Age: 62 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 15.0 years
Commonness: 11/20
Statement of Opinion:
- I want to remain healthy in mind and body, but everything is so compartmentalized now.
- This policy could help make the process smoother and less frustrating when seeking care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 5 |
| Year 3 | 5 | 5 |
| Year 5 | 5 | 4 |
| Year 10 | 6 | 3 |
| Year 20 | 7 | 2 |
freelance artist (New York City, NY)
Age: 23 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 5.0 years
Commonness: 7/20
Statement of Opinion:
- It feels like I have to choose between mental health support and physical health needs due to costs.
- If this policy lessens some of the financial burden, it could really change things for me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 5 | 2 |
| Year 5 | 6 | 2 |
| Year 10 | 5 | 2 |
| Year 20 | 4 | 2 |
factory worker (Detroit, MI)
Age: 54 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- This lack of insurance is terrifying, especially with my health history.
- This policy might help people like me get back on their feet without worrying too much about medical bills.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 3 |
| Year 5 | 7 | 2 |
| Year 10 | 6 | 2 |
| Year 20 | 5 | 1 |
full-time parent (Miami, FL)
Age: 31 | Gender: female
Wellbeing Before Policy: 3
Duration of Impact: 8.0 years
Commonness: 7/20
Statement of Opinion:
- I feel like every day is a balancing act between my mental and physical health.
- Having better access to coordinated services could make life less overwhelming.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 6 | 2 |
| Year 5 | 7 | 2 |
| Year 10 | 8 | 2 |
| Year 20 | 7 | 2 |
software developer (Seattle, WA)
Age: 47 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 0.0 years
Commonness: 15/20
Statement of Opinion:
- I can afford care but coordinating between my providers is frustrating and inefficient.
- Large hospitals might not prioritize someone like me even with this policy.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 6 | 6 |
| Year 10 | 6 | 5 |
| Year 20 | 6 | 5 |
Cost Estimates
Year 1: $500000000 (Low: $400000000, High: $600000000)
Year 2: $450000000 (Low: $350000000, High: $550000000)
Year 3: $400000000 (Low: $300000000, High: $500000000)
Year 5: $350000000 (Low: $300000000, High: $450000000)
Year 10: $300000000 (Low: $250000000, High: $400000000)
Year 100: $200000000 (Low: $150000000, High: $300000000)
Key Considerations
- Coordinated care models have to consider cultural, social, and rural needs specific to patient demographics.
- The program requires robust monitoring and evaluation systems to ensure accountability and measurable outcomes.
- Incorporating social determinants of health will necessitate partnerships beyond traditional healthcare providers, including social services and community organizations.
- Payment reform strategies under Medicare and Medicaid need to be aligned with the innovations being tested to ensure onward implementation post-demonstration.