THE PROGNOSIS

It was fall 2008 and the economy was plummeting. The financial crisis was the only issue on anyone's mind.

So, as Patrick Kennedy tells it, he called his ailing father to ask for a favor. 

Kennedy, then a Democratic congressman from Rhode Island, was the lead sponsor of legislation aimed at getting insurance companies to cover behavioral health services in the same way they did physical health. But, with Congress focused on saving the economy, Kennedy saw chances for his bill's passage slipping away.

The late-Sen. Ted Kennedy (D-Mass.) had co-sponsored a similar measure in the Senate. The young congressman asked his father to use his goodwill to press colleagues to take up their mental health bill. The elder Kennedy called his friend, then-Sen. Chris Dodd (D-Conn.), who at that moment was the most powerful man in Washington, as the chairman of the Senate Banking Committee, to see what could be done. 

And something could: Dodd used Rep. Kennedy's mental-health bill as the vehicle for the bank bailout known as the Troubled Asset Relief Program, or TARP.

"I'm the sponsor of the largest federal bailout in American history," Kennedy said in a recent interview. "The good news was [mental health parity] passed. The bad news was that no one knew about it because it was overshadowed by the economic aspect of the bill."

The law requires an insurance company to offer mental health and addiction treatment coverage on par with its physical health benefits. The requirement was then bolstered a few years later by the Affordable Care Act, which made behavioral health an essential benefit in plans offered on the individual and small-group marketplaces.

Yet in the decade since that law's passage, there still remain barriers to care for people with mental-health conditions or substance-abuse disorders. Congress took another big step yesterday when it passed a large package of bills aimed at the opioid epidemic -- but experts warn that it is far from enough to truly tackle the scope of the problem.

So, to mark the 10th anniversary of Kennedy's bill passing, the former congressman, with a group of other mental-health advocates, released an analysis that found 32 states did not ensure equal coverage for behavioral health. 

The report, a joint effort by the Kennedy-Satcher Center for Mental Health Equity, The Kennedy ForumThe Carter Center, and Well Being Trust, gave each state a letter grade on questions like whether an insurer requires a patient to pay a separate deductible or higher co-pays for behavioral health or sets limits on how many times they can see a behavioral health provider.

The worst offenders, according to the report, were Wyoming, Arizona, Idaho and Indiana, which all received Fs. The only state to receive an A was Illinois. 

"When you’re in the midst of a mental health crisis you don’t have the time to fight with your insurance company," said Dr. Glenda Wrenn, director of the Kennedy-Satcher Center for Mental Health Equity at Morehouse School of Medicine. "We put so much on the shoulders of people in the worst possible places in their life."

Americans also have no idea what consumer protections they're supposed to have for mental-health care, so they don't know how to fight back. An American Psychological Association survey in 2014 found only four percent were even aware of the parity law's existence.

Yet one positive dramatic shift in the past decade is the increase in Americans talking about and sharing their experiences with mental health. There's been a growing public awareness of the magnitude and seriousness of the issue, which was punctuated this year with the suicides of fashion icon Kate Spade and TV travel host Anthony Bourdain.

From Prince Harry to Michael Phelps to Kristen Bell to everyday people on social media, people are increasingly disclosing their illnesses. Just this week, a rising star in the Democratic Party, Jason Kander, dropped out of his race to be mayor of Kansas City to focus on treatment for his depression and PTSD from his service in Afghanistan:

The statistics can be staggering. While one in five Americans experiences a mental illness in a given year, more than half of them didn't receive treatment, according to the National Alliance on Mental Illness. Suicide rates are rising in nearly every demographic, but especially among teens. The World Health Organization named depression the leading cause of disability worldwide. 

Every person who "comes out" does his or her part to chip away at the social and self stigma that has long kept people from telling loved ones or their workplaces when they are sick. But, as I wrote in June 2016, there was has been a sea change in the way people with mental health conditions, mostly on social media, share and are now being celebrated as brave and strong for sharing their stories. Those adjectives alone are incredibly powerful — when someone is in the throes of depression, they do not see themselves as either. 

But Kennedy, who has struggled with addiction and depression and said he watched his father silently suffer from post-traumatic stress disorder over the murders of his two brothers, told me that what has been missing from the movement is an organized effort to hold the government and lawmakers accountable. 

Kennedy also launched a website this week called "Don't Deny Me," to give consumers a place to report insurance companies that decline to cover their mental health and substance use disorder treatments. It will take, Kennedy told me, a true grassroots mobilization to finally get these issues prioritized. 

"There are plenty of solutions to bring people the care they need, but what is missing is the political will and the economic and legal pressure to make it happen and that’s why we’re marking the anniversary," he said. "We look at it as the medical version of the civil rights movement."

AHH, OOF and OUCH

AHH: New research has found that drug users who know the heroin they consume is laced with fentanyl are more likely to take precautions and reduce the chances they will overdose.

A small study of 125 injection drug users in North Carolina led by researchers at RTI International examined the use of fentanyl test strips. It found that users whose strip tested positive were five times as likely to adjust their behavior than those whose strips were negative. The research was set to be published Wednesday morning in the International Journal of Drug Policy, our Post colleague Lenny Bernstein reports.

“The users’ precautions included taking a small ‘test shot,’ using less of the drug mixture, pushing the syringe plunger in more slowly and snorting instead of injecting the drugs, the researchers reported. None of the respondents — who were habitual drug users — threw away their drugs,” Lenny writes. 

The research found 43 percent of  users said the strips moved them to change their drug consumption behavior. It also found 77 percent of those involved in the study said the strips made them feel safer.

OOF: House Democrats are quietly planning a series of investigations into the Trump administration’s health-care policies should they win enough seats to retake the House in the midterm elections, Politico’s Adam Cancryn and Alice Miranda Ollstein report.

“The wide-ranging inquiries, coordinated across multiple committees, would focus on the administration’s most controversial actions on health care, which include chipping away at the Affordable Care Act, urging the courts to gut the health law's protections for pre-existing conditions, and separating migrant families at the border,” they report. The plan is to investigate what Democrats see as the Trump administration’s “sabotage of Obamacare,” Adam and Alice write. They add outside groups have also urged a look at the administration’s green-lighting Medicaid work requirements.

“It’s mainly trying to figure out what they’ve been doing to sabotage the ACA, and what can be done [about it]," Rep. Frank Pallone Jr. (D-N.J.), the top Democrat on the Energy and Commerce Committee, told Politico.

Some Democrats are urging a measured approach. They’re also worried that an aggressive effort could prohibit the chances of passing bipartisan health-care measures, such as on efforts to lower drug prices, Alice and Adam add.

OUCH: Across the country, more emergency-room doctors are facing all sorts of violence.

A new report from the American College of Emergency Physicians surveyed 3,500 emergency physicians and found nearly half of doctors say they’ve been physically assaulted while on duty, two-thirds said they were assaulted in the last year. It found 71 percent reported they witnessed someone getting assaulted on the job, and nearly 70 percent also said such violence had grown overall in the last five years.

“The report comes as debate here has intensified over whether hospital administrators are doing enough to prevent violence against employees, and a few hospitals have taken the unusual step of installing metal detectors,” the Boston Globe’s Liz Kowalczyk reports. “Some doctors and nurses argue that tough new laws are needed to force improvements and deter assaults. They say the violence hurts all patients seeking medical care, creating longer waits, anxiety, and distractions for staff.”

HEALTH ON THE HILL

— The Senate passed, 98 to 1, a final version of a sweeping package aimed at tackling the opioid epidemic, sending the package to the White House for President Trump's signature just before the midterm elections. 

The bill is the product of hundreds of lawmakers sponsoring dozens of smaller proposals to create, expand and reauthorize programs and policies across almost every federal agency, aiming to address different aspects of the  epidemic, including prevention, treatment and recovery. It is lauded as a major legislative achievement, but advocates caution there is still much more work that needs to be done to get at the root of the problem. 

Read more about the bill in this story Colby wrote yesterday. 

— Here’s yet another Republican lawmaker who is campaigning on the message of protecting preexisting health conditions.

A new ad released Wednesday from Rep. Dana Rohrabacher (R-Calif.) highlights the congressman’s personal experience with preexisting illnesses, as he speaks about his daughter who was diagnosed with leukemia when she was eight. “So for her and all our families, we must protect America’s health care system. That’s why I’m taking on both parties, and fighting for those with preexisting conditions,” Rohrabacher says in the digital ad.

Rohrabacher, himself in a tight reelection bid in California, joins other House Republicans who have expressed support for preexisting conditions even as Democrats have targeted Republicans who have tried to undermine the ACA and those who voted to repeal the health care law.  

TRUMP TEMPERATURE

— In early morning tweets, the White House said it had received the FBI’s report on Supreme Court nominee Brett M. Kavanaugh and that it was “fully confident” the Senate would confirm the president’s nominee.

In anticipation of the arrival of the FBI’s report, Senate Majority Leader Mitch McConnell (R-Ky.) late last night filed a motion to end debate on Kavanaugh's nomination, setting up an expected procedural vote to advance the  nomination for Friday. Early this morning, the Senate Judiciary Committee said it had received the FBI report.

“Until that vote, senators will be rushing in and out of a secure facility at the Capitol to review the sensitive FBI report that the bureau has compiled, looking into allegations of sexual misconduct against Kavanaugh,” our Post colleagues Seung Min Kim, John Wagner and Josh Dawsey report.

“The developments came as Senate Democrats opened a new front in their objections to the investigations of Kavanaugh’s conduct, suggesting in a letter to Senate Judiciary Committee Chairman Charles E. Grassley (R-Iowa) that past FBI background checks of Kavanaugh include evidence of inappropriate behavior, without disclosing specifics,” they add.

Seung Min, Josh and John report that even before the report was delivered to senators, attorneys for Christine Blasey Ford said it was incomplete. They criticized the FBI for not interviewing Ford, the first woman who accused Kavanaugh of sexual assault.

Meanwhile, Republicans turned to challenging Ford’s credibility, and leveling personal attacks on the other women who have come forward with allegations against the judge, an effort that is “shattering Senate norms at a critical moment for Kavanaugh, and it signals that the GOP is embracing the tactics of President Trump, who mocked Ford at a political rally Tuesday night days after calling her credible,” our colleagues Sean Sullivan and Gabriel Pogrund report.

The attacks, which include a statement about the sex life of accuser Julie Swetnick, have “drawn condemnation, and it has even raised questions about whether Republicans have violated a provision of the Violence Against Women Act by disclosing Swetnick’s purported sexual preferences,” Sean and Gabriel report.

All eyes have also been on Sens. Jeff Flake (R-Ariz.), Susan Collins (R-Maine), Lisa Murkowski (R-Alaska), as well as Heidi Heitkamp (D-N.D.) and Joe Manchin III (D-W.Va.), some potential key swing votes who have not yet publicly announced how they plan to vote on Kavanaugh.

Flake, Collins and Murkowski separately called out the president for mocking Ford and her testimony during his Mississippi rally. While Flake said it was “just not right” and “kind of appalling,” he said it would not impact his thinking on the nomination. Collins also called Trump’s remarks “plain wrong” but did not say whether it would affect her vote. Murkowski told reporters Trump’s comments were “wholly inappropriate, and, in my view, unacceptable” and said she is “taking everything into account.”  

INDUSTRY RX

— Annual premiums for employer-sponsored health coverage went up this year, yet another sign of surging health-care costs.

Premiums for employer-sponsored family health plans increased 5 percent to an average $19,616 this year, according to a new report from the Kaiser Family Foundation. For these plans, employees paid an average of $5,547 toward the cost, while employers cover the rest. For single health-coverage plans, premiums also increased 3 percent to $6,896, and those employees contributed an average of $1,186. The new data continues a seven-year trend of moderate increases for coverage costs, per the report.

Meanwhile, deductibles also increased for workers in employer health plans. The average single deductible this year is $1,573, up slightly from $1,505 on average last year, and compared with $735 in 2008, according to the survey.

REPRODUCTIVE WARS

— There’s just one clinic left in Missouri that provides abortions.

The abortion license for the only other clinic in the state expired on Tuesday. The expiration came after it failed to follow state standards after a federal appeals court ruling last month that doctors in the state must have admitting privileges at nearby hospitals in order to perform abortions, the Associated Press’s Summer Ballentine reports. The judge issued a mandate on Monday for the rule to be implemented.

"The Columbia Planned Parenthood clinic has been unable to secure physician privileges or find a doctor with those privileges after a panel of medical staff at University of Missouri Health Care voted to stop offering those privileges altogether in 2015 amid a Republican-led legislative investigation on abortion in the state," Summer writes. "Planned Parenthood Great Plains spokeswoman Emily Miller] said the clinic cancelled abortions scheduled for Wednesday in Columbia, which would have been the first since the mandate was issued. The clinic continues to provide other health care services."

— And here are a few more good reads from The Post and beyond: 

Fact Checker
A torrent of GOP attack ads has targeted Democrats with supporting a government takeover of health care that they do not actually support.
Glenn Kessler
Politics
Republican candidates vow to defend expanded insurance coverage, which would be excluded under measures they sought, but they have not said how.
Tracy Jan
The Department of Justice is siding with plaintiffs in a lawsuit that it said, if successful, would end Affordable Care Act protections for those with preexisting conditions. Yet, President Donald Trump claimed that "preexisting conditions are safe" and that he "will always fight for ... patients with preexisting conditions."
FactCheck.org
Juul Labs, the e-cigarette maker at the heart of a U.S. crackdown on youth vapin...
Reuters
National Security
The FBI has interviewed six witnesses and has not been allowed to probe Kavanaugh’s youthful drinking.
Matt Zapotosky, Robert O'Harrow Jr., Tom Hamburger and Devlin Barrett
Several people who knew the Supreme Court nominee in high school or college have tried to share their stories with the F.B.I., but not all of them have been successful.
The New Yorker
Politics
“I didn’t make a decision to reveal that; that just sort of happened," White House counselor Kellyanne Conway said Tuesday.
Alex Horton
The Fix
The day before, Sen. John Neely Kennedy (R-La.) said that those who thought the FBI investigation was about searching for the truth "ought to put down the bong."
Amy Wang
The government started a program to distribute the HPV vaccine for free to girls more than a decade ago.
Associated Press
The Switch
We asked seniors to help review the new Apple Watch Series 4, which can detect hard falls and run an electrocardiogram. They were hard to impress.
Geoffrey Fowler
Lawsuits and deaths have drawn scrutiny and raise questions about oversight of the addiction-treatment industry
USA Today
DAYBOOK

Coming Up

  • The Alliance for Health Policy holds a briefing on improving care for children with complex medical needs on Friday.
SUGAR RUSH
Fact-checking Republican ads on single-payer health care | Fact Checker