Senate passes bill to bolster parity for mental health benefits

Washington -- The Senate unanimously adopted a carefully negotiated mental health parity bill last month, but House lawmakers are trying to pass legislation with stronger provisions.

Supporters of the Senate Mental Health Parity Act of 2007 hailed its passage as a significant step forward after a decade of stalled attempts.

"The Senate bill is a strong measure that will advance the interests of mental health while balancing the interests of employers," said Neil Trautwein, vice president and employee benefits policy counsel for the National Retail Federation and a former parity opponent.

A collection of leading mental health advocacy groups, including the American Medical Association, American Psychiatric Assn., Mental Health America and Federation of American Hospitals also backed the measure. "We can't miss this opportunity to provide 113 million Americans with equitable coverage," said Pamela Greenberg, chair of the Coalition for Fairness in Mental Health.

A wide array of mental health advocates and former parity opponents in the business and insurance industries negotiated with three Senate bill sponsors for more than a year before reaching an agreement. Opinion varied as to whether the House bill's provisions -- if adopted into a final bill -- would unravel support in the Senate.

Both the Senate and House measures would expand the Mental Health Parity Act of 1996, which prohibits group health plans offering mental health benefits from placing lower limits on lifetime or annual spending for those services than they impose on physical health benefits.

The bills would address loopholes in the act by requiring group health plans also to bring parity to deductibles, co-pays, coinsurance, number of visits and days allowed in the hospital. The measures would exempt businesses with 50 or fewer employees and health plans whose costs increase by 2% the first year or 1% any following year. They would cover substance abuse treatment and would allow states to maintain stronger mental health parity laws. Both bills ensure mental health parity for at least 113.6 million people -- 82.2 million in group plans regulated by the federal Employee Retirement Income Security Act and 31.4 million in state-regulated plans. Forty-three states have adopted at least limited mental health parity laws, but they do not apply to plans governed by the federal Employee Retirement Income Security Act.

The House version of the legislation is the Paul Wellstone Mental Health and Addiction Equity Act of 2007, named after the late senator who co-sponsored the 1996 act. The bill, also supported by the AMA, would go beyond the Senate measure by requiring health plans offering mental health benefits to cover illnesses in the Diagnostic and Statistical Manual of Mental Disorders, rather than allowing health plans to determine their coverage. It also would require out-of-network mental health coverage if the plan offers out-of-network physical health coverage.

The House bill's future was unclear; it still needed approval from two House panels as of press time.

Could the House bill's stronger provisions fracture the coalition supporting the Senate legislation and send the debate back to where it's been stuck for a decade? Senate legislation supporters say that measure is exactly where it should be. "We see no further room for movement for the Senate bill," Trautwein said. Others saw the measures as reconcilable. Bill co-sponsor Sen. Edward Kennedy (D, Mass.) said he is "confident that we will be able to work out our differences and see a bill signed into law this year."

Opponents of the House bill -- including many House Republicans and others -- said it's flawed. It lacks the Senate bill's language specifically allowing plans to manage benefits medically using such methods as requiring prior authorization for appointments. It also would force insurers to provide wider out-of-network coverage for mental health than the Senate version. Each could lead to higher than expected cost increases for health plans and to plans dropping mental health coverage, the bill's foes said.

Rep. Dave Camp (R, Mich.) and other Republicans offered five amendments during a Sept. 19 Ways and Means subcommittee markup. Each would have brought the House and Senate versions closer, but all failed.

Rep. Jim Ramstad (R, Minn.), a House bill co-sponsor and long-time mental parity advocate, defended his measure by saying the Senate version has loopholes that will allow insurance companies to avoid covering eating disorders and other deadly mental illnesses. "The Senate bill is not true parity," he said.

This could be a situation where the perfect is the enemy of the good, said Ralph Ibson, vice president for government affairs for patient advocates Mental Health America. "The question ultimately is, can you pass the ideal bill at this time?" he asked. "Or will we pass a strong parity bill that does not have all of the protections that have been incorporated into [the House bill]?"