House Passes Parity Bill, but Negotiations Needed

The house of representatives overcame the objections of most republicans and the White house to pass its version of mental health parity legislation.

The bill, sponsored by Rep. Patrick Kennedy (D-R.I.), would expand mental health regulations and require insurance plans that offer mental health benefits to make them “equal in cost and scope to any medical or surgical benefits offered.” The bill also mandates that insurers consider coverage for all mental health conditions in DSM-IV.

The House passed the bill by a vote of 268-148 on March 5.

A less-comprehensive Senate parity bill, sponsored by Sens. Edward Kennedy (D-Mass.) and Pete Domenici (R-N.M.), has the support of business and insurance groups; it easily passed the Senate last September.

The White House and most House Republicans blasted the House version as an overly broad mandate that ultimately would undermine access to care.

The House bill “would effectively mandate coverage of a broad range of diseases and conditions and would have a negative effect on the accessibility and affordability of employer-provided health benefits and would undermine the uniform administration of employee benefit plans,” according to a March 5 White House statement.

The House action comes after informal negotiations that had been ongoing over the last several months deadlocked between members of the Senate and House over differences between the House and Senate (S 558) version of broad mental health insurance parity (Psychiatric News, January 18).

The two bills have engendered different levels of support among mental health advocates because the House measure is considered stronger, while the Senate version is thought more likely to become law. APA has endorsed both measures, arguing that the differences between the two are not great and that either bill would be a vast improvement over the current, limited federal parity requirement.

One of the main differences over which negotiators are deadlocked is that the House bill would direct any plan that provides mental health parity coverage to consider—but would not mandate—coverage of all illnesses in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The Senate version would leave it up to insurance plans to determine the psychiatric conditions they would cover, without having to conclude whether treatment for a given mental disorder is medically necessary.

Both bills are designed to maintain any existing state parity protections, including requirements for coverage of a given condition.

The House bill's approach to state parity laws also drew the fire of the Bush administration for including “confusing preemption provisions [that] could be read to add a patchwork of remedies that vary from State to State.”

The White House also opposed several provisions in the House bill unrelated to parity, including an effective ban on new physician-owned hospitals and an increase in the rebate that drug companies are required to give state Medicaid programs.

Congressional negotiations over a parity bill also have stalled over differences between the bills in out-of-network benefits. The House bill would require plans that include an out-of-network benefit for physical health care to also offer out-of-network parity mental health coverage.

The Senate version would allow plans to offer a medical/surgical out-of-network benefit without offering a corresponding mental health benefit. If the plans did offer an out-of-network mental health benefit, they would have to do so at parity.

Some supporters of the Senate version, including Kennedy, its cosponor, raised doubts in comments to the media about whether a compromise is possible in light of what they see as significant differences between the two bills.

Mental health advocates remain optimistic that common ground can be found.

“Clearly there is going to have to be some kind of consensus building between the House and Senate,” said Nicholas Meyers, director of APA's Department of Government Relations.

In a separate action, on February 7 the House easily passed a noncontroversial one-year extension (Hr 4848) of the existing limited mental health parity law. The measure would extend until the end of this year a law (PL 104-204) that bans health plans that offer medical and surgical benefits from using different lifetime or annual limits on coverage for mental health care. The law does not require coverage for any mental health conditions. Its mandate only applies to policies that already offer some type of mental health coverage.

The text of the insurance parity bills can be accessed at<http://thomas.loc.gov> by searching on the bill numbers, HR 4848, HR 1424, and S 558.▪