Thursday, August 13, 2015

Q & A with Our Very Own Carol McDaid

Carol McDaid is a registered federal lobbyist with over 25 years of legislative experience in Washington. Her past successes include leading the Parity NOW coalition that supported the passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. The Q&A below features information on the policy aspects and future directions of the recovery movement.

How did you get started as a lobbyist for recovery?

By sheer luck, grace, and synchronicity.  During the Clintons’ early 90’s failed effort to pass health reform, health lobbyists were in high demand.  I was asked to come and interview at a boutique government relations firm to lead their healthcare practice.  I was a mid-level trade association lobbyist at Blue Cross Blue Shield Association, so leading the health practice for a firm with Fortune 500 clients would be a big promotion for me.  As I was interviewing, the head of the firm hands me a written list of clients I would have to service and Hazelden was on the list.  He asked me, “Do you know who they are and what they want out of health reform?”
Three years earlier I was a patient at Hazelden and I was convinced him mentioning Hazelden was part of a grand conspiracy.  I envisioned that my potentially new boss had checked up on me and knew I had a drug and alcohol problem and had been to rehab.  While I was currently silent about being in recovery, I had not been quiet in the way I practiced my alcohol and drug use.
I was offered the job two weeks later and ultimately had to tell my boss I had been a patient at Hazelden before he found out during our first client visit to Hazelden.
The conversation went something like this:
Me: Duffy, before we go to Minnesota, I want you to know I went to Hazelden.
Duffy: What, for a conference?
Me: No, I was a patient there.
Duffy: (Pregnant pause) YOU have a drinking problem? You look so… girl next door!
Me: (Looking at my feet) Drinking and drug problem…
Duffy: Long sigh, pacing back and forth, then with hands raised in the air – MACDAID! These people are going to think I’m a genius; that I have gone and hired one of their own to lobby for them!  Here’s what we are going to do… play along in Minnesota and act like I knew you went there, and then we will get Betty Ford and the rest of them [rehabs] as clients and you can become THE addiction lobbyist in Washington.

What interested you in the policy aspects of recovery?

Initially it was my own experience in 1989 of needing addiction residential care while working at a large employee benefits consulting practice.  Even some of the smartest folks at the practice that helped intervene on me, and were experts in employee benefits, had no idea that our health plan (which indicated it covered up to 30 days of residential addiction treatment) in fact did not allow access to the coverage.  I had failed at outpatient two times, but the plan said I had not met the “fail first requirement” in the plan because the “fail first clock” started over if I missed an outpatient appointment.  I felt angry about that because I know many people do not have family who can pay for their care like mine did for me.
As I continued to work in the field, my husband and I started an addiction peer recovery organization where I live in Richmond, Virginia called the McShin Foundation.  This endeavor was due in large part to the long waiting lists for publicly provided addiction resources in our state.  Once we started working with more individuals and families in or seeking addiction recovery, I realized how involvement in the criminal justice system over alcohol and drug charges could wreck an individual’s life.  Not only did I see individuals get multiple, often in my view inflated, drug charges, but once they got out they couldn’t drive, get a job, a student loan, an apartment, or public housing.  Having had my life transformed as a result of my recovery, these injustices make me angry and compel my work in the addiction policy area.  Many have asked me, “How have you hung in there over 20 years doing this work?”  I do so because I feel I have an obligation to use the skills I have to fix these discriminatory laws and policies.

What are the most challenging aspects of advocating for recovery in Washington?

Four things: lack of resources and reimbursement, shame and discrimination, public safety impact, and lack of payer recognition of the cost benefit analysis of investing in addiction prevention, treatment and recovery.
Not only is prevention, treatment, recovery and research underfunded in Washington, but the entire advocacy effort on addiction is much smaller and has fewer resources than other advocacy groups such as the prison and health insurance industries.
The shame associated with those having and treating this illness is an externally and internally driven problem, as is the volitional nature of the illness.  Policymakers often contend that individuals choose to take that first drink or drug and sometimes commit crimes in the acute phase of the illness.  Moreover, both public and private payers often ignore the growing costs of untreated addiction and fail to see the benefits of investing in quality addiction care and recovery.

 What are the three biggest changes that need to be made from a policy standpoint which would enhance the effectiveness of our current approaches to addiction?

1) Fully implement and enforce the Mental Health Parity and Addiction Equity Act (MHPAEA).
2) Financial investments in addiction prevention, treatment, recovery, and research.
3) Repeal discriminatory laws that prevent people in or seeking recovery from addiction from getting education, employment, health care, and housing (just to name a few) the same way individuals without criminal records related to this illness do.

Since passing the Mental Health Parity and Addiction Equity Act, what are some of the remaining challenges in ensuring that people have access to treatment and services that are on par with other kinds of medical conditions?

I work at the ground level with individuals and providers seeking addiction and mental health services through my work with the Parity Implementation Coalition (PIC).  The four biggest issues we see are:
1)      Lack of public education campaigns that individuals know about the law and the rights and benefits that are included in it.
2)      Lack of disclosure including how and why health plans make adverse benefit determinations and how that compares with the how and why plans make denials of other medical conditions.
3)      Lack of information about plans applying medical management techniques (known as non-quantitative treatment limitations or NQTLs in the parity law) to both medical and addiction/mental health benefits.
4)      Lack of full state and federal implementation and enforcement of the law.

What needs to happen next to ensure people gain access to addiction services at the intensity needed to support long term recovery?

Full implementation and enforcement of MHPAEA in the public and private sectors along with routine public and private coverage and adequate reimbursement for recovery support services.  We also need more research on which services help sustain recovery including recovery support services and housing.

If you could tell the general public one thing about recovery, what would it be?

Over 23 million people are in long term recovery.  We are your neighbors, co-workers, and family members, not derelicts.  Recovery saves lives, dollars, helps build stronger communities, and is a good investment of tax payer dollars.

Reposted from:
Originally published on: August 1, 2015