Achieving Mental Health Parity: A Rhetorical Analysis of Social Change

2018-08-22T00:00:00Z (GMT) by Julia Deems
Congressional rhetoric has commonly taken one of two forms: studies of political leaders or studies of the settling of political argument. Our understanding of other components of congressional rhetoric, including the role of public testimony, is less well developed. Further study of congressional rhetoric is critical to our understanding of political decision-making. Public testimony is central to deliberative democracy, in which an engaged citizenry provides reasons for policy decisions. I examine public testimony, the written response to legislation prepared in advance and presented orally before congressional committee.
Public testimony benefits the public as a forum in which to express support or concerns and as a public record of congressional reasoning; it simultaneously benefits legislators, in that testimony clarifies problems, identifies goals, suggests solutions, and provides a source for rhetorical strategy. Public testimony on mental health parity legislation, including the Mental Health Parity Act of 1996 and legislation integrated into the Affordable Care Act, and was considered by Congress for more than two decades and offers a rich site for investigation. In part, this research examines claims made by stakeholder groups as they define the policy problem. Findings suggest that public testimony does more than respond to the legislation: it expands the policy issue and sets the agenda for additional legislative change. Better understanding the role of public testimony can expand and strengthen its use.
Mental health parity legislation aims to address discrepancies between insurance provisions for mental health care relative to medical care. While public opinion polls have long demonstrated support for parity, enacting legislation proved challenging. Legislation was introduced repeatedly, and much legislation was sent to committee for public response. The most direct beneficiaries, the mentally ill and their families, testify. This dissertation asks: Do the mentally ill and their supporters have rhetorical agency? If so, what strategies do they employ? Findings suggest that those that focus on mental illness employ one set of rhetorical strategies, including personal narratives of tragedy and luck, while those that focus on mental wellness employ other strategies. This research has significance for congressional rhetoric, public deliberation, and deliberative democracy.