Parity Supporters Intensify Fight For Congressional Backing
Long-stalled federal legislation to require health insurers to provide equal coverage for mental and general physical health conditions received a small surge of support before Congress recessed for the election. Supporters of mental health parity launched a late-session drive to force a vote on the popular legislation when legislators return after the November elections.
Supporters of the parity bill (HR 1402) began to circulate a petition to invoke a little-used parliamentary maneuver— called a “motion of discharge”—that would require the entire chamber to vote on the bill. The petition must have the signature of 218 members for the motion to be voted on by the entire chamber. In the two days supporters had to collect signatures before the election recess, 165 members had signed the petition.
Supporters hope the pre-election push will encourage Republican members to buck their leadership and sign the petition.
“We're hoping mental health advocates take this issue out on the campaign trail, because members of Congress are particularly responsive right now,” said Michael Zamore, policy adviser to Rep. Patrick Kennedy (D-R.I.), the bill's lead sponsor.
APA and other organizations in the Mental Health Liaison Group have urged their members to push their federal representatives on the issue of parity and to support the discharge motion, in particular.
The bill, called the Paul Wellstone Mental Health Equitable Treatment Act of 2005, would amend the Employee Retirement Income Security Act of 1974 (ERISA) to prohibit insurers that offer some form of mental health coverage in their health plans from imposing treatment limitations or financial requirements not placed on “medical and surgical benefits.”
The measure would not apply to the insurance programs used by businesses with fewer than 50 employees.
Progress Stymied
The bill had not advanced in the House since it was introduced on March 17, 2005, and was referred to several committees. Supporters said its progress has been stymied by opposition from the House Republican leadership, which is concerned about the financial burden it would impose on employers and insurers, despite research evidence that parity coverage imposes little or no additional cost. The bill has run into the same opposition as similar legislation introduced in the last three Congresses.
The latest iteration of the parity bill has garnered significant support among rank-and-file members of the House, with 229 members co-sponsoring it. One of those co-sponsors, Rep. Jim Ramstad (R-Minn.), said people with mental illness urgently need congressional action on this bill.
“People living with mental illness have been discriminated against by our nation's health care system for far too long,” Ramstad told Psychiatric News. “Congress must knock down the barriers to treatment and end the discrimination against people with mental illness.”
For the discharge motion to succeed, it will need significant Democratic support and about 25 Republican supporters. House sources said, however, that a successful discharge motion could embarrass the Republican leadership, which could make many Republican parity supporters hesitant to support it.
Supporters Turn to Research
In addition to pressure from their constituents, supporters of the parity bill hope recent research will help convince House members to support the effort to force a vote. A study led by psychiatrist Howard Goldman, M.D., Ph.D., published in the March 30 New England Journal of Medicine, found that the provision of mental health parity coverage for Federal Employees under the Federal Employees Health Benefits (FEHB) program, available since 2001, resulted in no statistically significant increase in spending. Supporters of the FEHB study said it is a solid test of the impact of parity because the FEHB is the largest U.S. employer-sponsored health insurance program, with more than $29 billion in benefits provided to 8.5 million federal employees and their dependents.
Mental health parity advocates said the study provides the largest body of evidence yet that private insurers' requirements for higher copayments for mental health care, fewer allowed doctor visits or days in the hospital, and higher deductibles than those required for other medical illnesses cannot be justified as needed cost-control measures.
“The financial and human cost of untreated mental illness is great, while data clearly show that the cost of instituting equal coverage for treatment of mental illnesses is low,” said Nicholas Meyers, director of APA's Department of Government Relations.
Senate supporters of parity, principally Sens. Pete Domenici (R-N.M.) and Edward Kennedy (D-Mass.), have held multiple discussions with insurers and business leaders to address their objections to a federal parity law. Previous parity bills in the Senate have garnered veto-proof majorities, but parity supporters said the discussions aim to prevent a single senator from putting a hold on the legislation.
The Senate bill under discussion is similar to the House bill in some ways but, according to sources familiar with the unintroduced legislation, it differs in important ways. For instance, the Senate version would not require insurers to provide parity coverage for treatment of addiction disorders. This version also would pre-empt state laws, including those with stronger parity requirements.
The efforts to require parity coverage have to walk a fine line to keep from further limiting mental health coverage, according to supporters. The measures would require parity coverage only from insurers who already offer some mental health coverage. Because the legislation would expand parity requirements to ERISA-regulated health plans—which cover 123 million people—and 95 percent of those currently provide some mental health option, supporters hope few would drop all mental health coverage.
“We're hoping mental health advocates take this issue out on the campaign trail, because members of Congress are particularly responsive right now.”
Despite the extensive Senate discussions, no bill had been introduced by Congress's October recess. Supporters said they hoped that would change in the post-election session of Congress.
“There are lots of people affected by this issue, but they have not yet made the full weight of their concerns clear to policymakers,” Zamore said to Psychiatric News.
The parity bill, H 1402, is posted at<http://thomas.loc.gov/cgi-bin/bdquery/z?d109:h.r.01402:>▪
