House GOP Vote Dashes Hopes For Parity Bill Passage

House Republicans dealt a severe blow to people with mental illness and those who treat them last month when they killed legislation that would have required health plans that cover mental illness to do so at the same level they cover other medical illnesses. Nonetheless, just after word of the defeat reached APA and its partner organizations in the Coalition for Fairness in Mental Illness Coverage, they vowed to renew their battle for parity in the new year.

The legislation, which was in the form of an amendment to the Labor–Health and Human Services appropriations bill for 2002, was voted down during deliberations of a House and Senate conference committee.

Conferees were able to agree only to a one-year extension of the 1996 Mental Health Parity Act, which expired last September. Congress passed the appropriations bill with the extension only days before its December recess.

The parity amendment, the Mental Health Equitable Treatment Act (S 543), was originally introduced by Sens. Pete Domenici (R-N.M.) and Paul Wellstone (D-Minn.) in March. In August it sailed through the Senate Health, Education, Labor, and Pensions Committee, chaired by parity supporter Sen. Edward Kennedy (D-Mass.) (Psychiatric News, September 7, 2001). The Senate then unanimously passed the legislation as an amendment to the appropriations bill, which conferees began debating last month (Psychiatric News, November 16, 2001).

The Coalition for Fairness in Mental Illness Coverage has urged Congress for years to pass a comprehensive mental health parity bill. It achieved some measure of success when President Bill Clinton signed the 1996 Mental Health Parity Act, but that law barred only discriminatory annual and lifetime dollar limits in health plans that cover both “physical” and mental illnesses.

By contrast, the Domenici-Wellstone amendment would have barred any limits on mental illness treatment and financial requirements that are not imposed on the treatment of other medical illnesses. That means that health plans must have the same limits on the frequency of treatment; number of visits or days covered; and the same deductibles, coinsurance amounts, copayments, and other cost-sharing requirements.

Despite some limitations, APA leaders believed that the new legislation was an acceptable compromise for the time being.

APA President Richard Harding, M.D., called the conferees’ decision to extend the limited 1996 bill a “stop-gap measure. It is difficult to understand the objections of a few key House members to the Domenici-Wellstone parity amendment, given the failure of House committees to so much as hold a hearing on parity, let alone mark up any meaningful parity legislation over the past six years.”

Although parity fared well in the Senate, it did not do so in the House. The House’s version of the Domenici-Wellstone bill was the Mental Health and Substance Abuse Parity Act (HR 162), which was introduced by Marge Roukema (R-N.J.) a year ago. It languished in the health subcommittees of the Ways and Means, Education and the Workforce, and Energy and Commerce committees since last February. Roukema and Rep. Patrick Kennedy (D-R.I.), another key parity supporters and House conferee, urged conferees last November to support the parity amendment in a letter signed by 224 House members, according to Roukema’s office.

That wasn’t enough to persuade the House Republican conferees, who complained that the parity amendment wasn’t approved by the Ways and Means, Education and the Workforce, and Energy and Commerce committees, according to a report in the December 10, 2001, CQ Daily Monitor. The Republican chairs of those committees wrote to House conferees opposing the amendment.

Moreover, Jay Cutler, J.D., director of APA’s Division of Government Relations, said business coalitions and antipsychiatry groups lobbied against the parity amendment. But he was heartened by Rep. Ralph Regula’s (R-Ohio) pledge last month to work with Rep. Kennedy on the language in the final Labor-HHS report authorizing the relevant House committees to take action on parity this year. ▪