Advocates Vow to Fend Off Parity Bill Compromises
Advocates for mental health insurance parity in the House of Representatives introduced their version of a mental health parity bill in March, not long after the Senate Health, Education, Labor and Pensions (HELP) Committee approved its version. While supporters are optimistic about parity's chances of passage, problems could arise later because the House bill differs in several key ways from the Senate's, whose details had been worked out in a compromise with insurers and business groups.
The Paul Wellstone Mental Health and Addiction Equity Act (HR 1367), introduced March 7, would require health insurance plans that offer mental health coverage to provide mental health benefits at parity with benefits for other types of health care.
The bill's sponsor, Rep. Patrick Kennedy (D-R.I.), said its 255 cosponsors and support from Democratic leaders in the House demonstrate the considerable momentum the legislation has this year.
“If there was ever a time for mental health advocates to come together, it is now under the issue of mental health parity,” Kennedy said at a gathering of mental health advocates in March in Washington, D.C.
The bill would amend the Mental Health Parity Act of 1996, which requires equality only for annual and lifetime dollar limits.
Kennedy, who has held field hearings on parity with Rep. Jim Ramstad (R-Minn.) across the country in recent weeks, warned that parity supporters need to take advantage of the best chance the legislation has had for becoming law since he first introduced it 10 years earlier by pushing hard for its passage.
“This year we need to get our bill through, and we can't cut any deals with insurers because we have momentum on our side,” he said.
Make No Compromises
Kennedy said lobbyists for the health insurance industry have pushed for limits on the types of mental illness covered under the bill and the length of treatment they would have to allow. Insurers, he noted, have challenged whether some disorders, such as eating disorders, meet the definition of mental illness. “You've got to be aggressive to be successful in treating mental illness,” Kennedy said.
The Kennedy bill requires coverage of every disorder in DSM-IV, which is the same standard applied since 2001 in the Federal Employees Health Benefits Program for 8.5 million federal employees and members of Congress.
Research by the Government Accountability Office found 90 percent of health insurance plans impose financial limitations and treatment restrictions on addiction and mental health care.
“The legislation closes the loopholes that allow plans to charge higher copayments, coinsurance, deductibles, and maximum out-of-pocket limits and impose lower day and visit limits on mental health and addiction care,” Ramstad said.
APA President Pedro Ruiz, M.D., said that providing equal coverage for all illnesses makes good economic sense. In a statement on the Kennedy bill, he described research findings showing that depressed employees have between 1.5 and 3.2 more short-term work-disability days in a 30-day period than other workers and a monthly productivity loss averaging between $182 and $395.
“When mental illnesses go untreated, costs escalate,” Ruiz said.
Although Democratic leaders in the House and Senate have listed parity as one of their health care priorities, there is no assurance that parity will take the form outlined in the Kennedy bill.
Sen. Pete Domenici (R-N.M.) introduced a bill with some of the same parity measures in February. However, the Senate bill was developed as a compromise measure after extensive discussions with parity supporters, business organizations, and insurance representatives, which led to key differences from the House version
Another barrier to passage of any parity measure is that it would mark the first significant change to federal insurance law since enactment of the Employee Retirement Income Security Act of 1974 (ERISA). The federal parity measures would expand equal mental health coverage requirements for the first time to the ERISA-based insurance plans that cover 87 million Americans. Existing parity laws in 41 states do not cover this population.
State Laws Could Be Preempted
Among the key differences between the two versions is a provision in the Senate bill that would preempt some state parity treatment and financial requirements if they are stronger than federal ones.
The Senate measure also would override state laws that require coverage of specified mental health services at a higher level than what is required for medical and surgical services. Although there are only a few such laws, insurers have made the adoption of a single federal standard a key part of the compromise agreement.
Another factor that could complicate approval of a federal parity bill is that its provisions would also apply to public health programs such as Medicaid and the State Children's Health Insurance Program. The requirement may have significant cost consequences for states that fund part of the costs of those programs, though no one has yet developed an estimate of what those costs could be.
“We're not going to take [a parity mandate for publicly funded programs] out because states need to find a way to fund that,” said Connie Garner, disability-policy director for Sen. Edward Kennedy (D-Mass.), in comments to mental health advocates in March.
Congressional officials said discussions on the most viable parity approach are under way, even as the Senate bill has begun to advance (Psychiatric News, March 2).
Information on the House parity bill is posted at<http://thomas.loc.gov/cgi-bin/>.Information on the Senate version (S 558) is posted at<http://thomas.loc.gov/>.▪
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Published online: 6 April 2007
Published in print: April 6, 2007
Notes
Supporters of a House version of mental health parity legislation vow to fight efforts to “cut any deals” with insurers to allow them to decide the length of reimbursable treatment for mental illness.
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