Government

Momentum grows in Congress for mental health parity bill

Old foes have joined to support a bill expanding mental health benefits, but two House members are working on their own version.

By Doug Trapp — Posted March 5, 2007

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After more than a year of intense discussions, mental health advocates, insurance and business associations, and key senators have agreed on a mental health parity bill.

If passed by both chambers, the legislation would end a decade-long congressional deadlock on the issue of equal insurance treatment for mental and physical illnesses.

The measure was introduced Feb. 12 and approved 18-3 two days later by a Senate panel. Supporters are optimistic that with Democrats in power in the House and Senate, a final bill will reach President Bush this Congress. Bush has not commented on the legislation but has supported mental health parity in general. Previous Republican leadership in the House and Senate opposed similar bills.

The Mental Health Parity Act of 2007, as the bill is formally known, would require group health plans with mental health benefits to offer them at the same level as physical health benefits. The measure does not affect the individual insurance market.

Group plans would not be able to offer different deductibles, co-pays, coinsurance, number of visits, annual or lifetime limits, or days of coverage, for example. The bill, which has 31 co-sponsors, also would institute parity for substance abuse treatment. It would fill holes left by the 1996 mental health parity law, which requires lifetime and annual dollar limits on coverage to be equal for mental health and physical conditions.

The legislation is supported by the Coalition for Fairness in Mental Illness Coverage, which includes the American Medical Association, American Psychiatric Assn. and American Hospital Assn.

"This has been an issue of primary importance, certainly for the mental health professions and also for the AMA," said Jeremy A. Lazarus, MD, vice speaker of the AMA House of Delegates and a psychiatrist from Denver. "The time to act on this is now."

The bill would lessen the burden on primary care doctors by letting more people with mental illness see psychiatrists, Dr. Lazarus said.

Carolyn Robinowitz, MD, president-elect of the APA, said the bill destigmatizes mental illness. "It reinforces that mental illness is real, diagnosable and has treatments that work and that don't break the bank," she said.

About one in four U.S. adults has a diagnosable mental disorder in any given year. About one in 17 has a serious mental illness, states research cited by the National Institutes of Mental Health.

Change is needed because today's payment system for psychiatrists has no logic, said Aradhana Bela Sood, MD, medical director of the Virginia Treatment Center for Children and a child psychiatrist in Richmond.

Major insurance companies pay Dr. Sood $15 for an office visit, not including the patient's co-payment. Some private insurance rates for office visits are as little as 70% of Medicaid rates, she said.

Many psychiatrists are forced to do five- or 10-minute medicine checks to be cost effective instead of the longer office visits that are sometimes more appropriate, she said.

The legislation would provide mental health parity to about 113 million Americans working for firms with 50 or more employees. Businesses with fewer workers would be exempt.

Health plans could opt out of the mandate for one year if their costs increase by 2% the first year or 1% in any following year, said a release by three of the bill's sponsors, Sens. Mike Enzi (R, Wyo.), Pete Domenici (R, N.M.) and Edward Kennedy (D, Mass.).

Various estimates predict a cost increase ranging from less than 1% up to 3.6% for insurance plans adopting mental health parity.

America's Health Insurance Plans and the National Retail Federation support the bill and were involved in the negotiations prompted by Enzi, chair of the Senate Health, Education, Labor and Pensions Committee when the talks began. Kennedy -- now chair of that panel -- and Domenici also played important roles in the discussions.

The proposal represents "significant progress" from earlier bills, which would have applied to all conditions -- including caffeine addiction and jet lag -- in the Diagnostic and Statistical Manual of Mental Disorders, wrote Karen Ignagni, president and CEO of America's Health Insurance Plans, in a letter to the senators.

Neil Trautwein, vice president at the National Retail Federation, said the compromise came about because old opponents tackled specific problems in mental health care instead of fighting. "Eventually trench warfare gets a little old," he said.

One key compromise for the retailers was a provision preempting stronger state laws on cost sharing and treatment limits for mental illness. Forty-six states have adopted some form of mental health parity.

House version differs

The House mental parity bill -- expected to be introduced in early March by Reps. Patrick Kennedy (D, R.I.) and Jim Ramstad (R, Minn.) -- doesn't offer this preemption, according to aides for the two lawmakers.

The House version, also unlike the Senate legislation, would use federal employee benefits as a guide for mental health coverage, a Patrick Kennedy aide said. Federal benefits cover illnesses in the DSM-IV.

The Senate bill would allow insurance plans to set the range of illnesses covered but would let states mandate higher standards, such as the DSM, the aide said.

Some backers of the Senate version have clearly stated their opposition to significant amendments to the Senate bill. "If there are changes that undercut the bill, then our support is gone," Trautwein said.

Nicholas Meyers, APA director of government relations, said he believes the differences can be worked out in a conference committee if different versions are passed.

An aide to Ramstad said House lawmakers have the same goals as the Senate. They want to pass the most comprehensive bill possible while maintaining the bipartisan consensus that attracted more than 200 co-sponsors to previous House parity bills.

Reps. Kennedy and Ramstad have been touring together to promote their bill in 13 congressional districts. Their trip is scheduled to end March 30 in Dallas. So far, the House legislation has about 100 co-sponsors.

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ADDITIONAL INFORMATION

Plans for parity

The Senate bill would:

  • Require group plans providing mental health benefits to restrict them no further than physical health benefits. Plans would not be able to offer different deductibles, co-pays, coinsurance, annual or lifetime limits, numbers of visits or days of coverage.
  • Include substance abuse treatment in mental health benefits.
  • Preempt state laws concerning financial and treatment limits of mental health benefits. It would not override state laws specifying other standards, such as the types of mental illness covered.
  • Not affect the individual insurance market or employers with fewer than 50 employees. It does not affect Medicare but would apply to Medicaid managed care plans, the State Children's Insurance Program, and some state and local plans.
  • Allow health plans to opt out for one plan year if their total costs increase by 2% the first year or by 1% in any one following year due to the measure.
  • Not require group plans to provide new out-of-network coverage for mental health benefits and not prevent group plans from negotiating different payment rates for different doctors.
  • Take effect no more than one year after passage.

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