Senate Committee Approves Comprehensive MH Parity Bill

A long-awaited mental health parity bill was introduced and approved by the Senate Health, Education, Labor, and Pensions (HELP) Committee last month (Psychiatric News, March 2), despite what supporters said is a need to “clarify” the measure.

The mental Health Parity Act of 2007 (S 558) would require group health insurers to cover the costs of treating mental health conditions, including substance abuse, under the same terms they do for other illness types.

The bill, which supporters estimate will benefit 113 million Americans, was the result of years of discussions and negotiations between mental health advocates, including APA, and health insurance and business representatives. The measure also would apply to self-insured employer plans, which cover 87 million Americans, that existing state parity laws do not cover.

“We are here today after years of hard work,” said Sen. Pete Domenici (R-N.M.), about the legislation supported by 97 organizations, including APA, the National Retail Federation, and America's Health Insurance Plans. “We have worked with the mental health community, the business community, and insurance groups to carefully construct a fair bill.”

APA President Pedro Ruiz, M.D., said the legislation is needed to keep insurance plans from singling out Americans with mental illnesses by requiring them to pay higher copayments, allowing them fewer doctor visits or days in the hospital, or making them pay higher deductibles than beneficiaries with other medical illnesses.

The legislation builds on a limited federal mental health parity law passed in 1996—and renewed annually since then— that provides parity for annual and lifetime limits between mental health coverage and medical-surgical coverage. The new bill would expand parity to include deductibles, copayments, out-of-pocket expenses, coinsurance, covered hospital days, and covered outpatient visits.

Finding Keys to Compromise

Mental health advocates and congressional staff said the legislation is not perfect, but its broad support and strong chance of passage are the result of a series of carefully crafted compromises.

Among the compromises is a provision that limits the bill's scope to employers with more than 50 employees, a change that made it palatable to small-business advocates and brought it in line with many state parity laws.

The bill also would allow employers to drop their parity coverage for a year if the cost adds more than 2 percent to the company's overall health insurance costs in the first year. The same clause would apply to increases in insurance costs over 1 percent in subsequent years. Employers could, however, opt to continue mental health coverage despite such increases.

The cost-containment provisions were crafted to overcome reservations by businesses that mental health parity would greatly increase already burgeoning employee health care costs. The amendments made this the first congressional parity bill that was unopposed by major business groups such as the U.S. Chamber of Commerce and the American Benefits Council.

“It truly is a day to celebrate when these organizations with diverse representation all express support for the same parity bill,” said Pamela Greenberg, chair of the Coalition for Fairness in Mental Illness Coverage, a group that has long pushed for parity and of which APA is a member.

Domenici, long a parity advocate, said expanded access to mental health services is needed to ensure care for the millions of Americans who are diagnosed with a mental illness each year. The bill also may help reduce the nation's more than 30,000 suicide deaths each year.

“We need to reduce these numbers, and I believe expanding access to mental health services will allow us to do so,” Domenici said.

Obstacles Mean Passage Not Assured

A potential stumbling block for the compromise arose shortly before the Senate HELP Committee approved the bill by 18-3 on February 14. Sen. Christopher Dodd (D-conn.) said the measure needed an amendment to clarify its intent not to usurp state laws that already offer more comprehensive parity mandates. The bill would limit its preemption of state parity laws to financial requirements—for example, mandating lower deductibles for mental health benefits—and treatment limitations, such as requiring coverage of a greater annual number of drug addiction treatment visits. Some states mandate mental health care coverage beyond what insurers offer for other medical conditions.

The bill's backers were unable to meet before the committee vote to agree on the additional language, so supporters plan to insert the clarifying language as an amendment when the full Senate considers it.

At least one parity supporter, Sen. Michael Enzi (R-Wyo.), cautioned, however, that amending the bill could upset the delicate balance it sought to achieve between business and mental health interests and open it to wider opposition. Some business groups said they supported the bill because it would overrule state mandates on financial requirements and treatment limitations for mental health services.

If the full Senate passes the measure, supporters will still need to reconcile it with an as-yet-unintroduced House version, which supporters expect will take a different approach. If based on previous House parity bills, that measure will require plans that offer mental health benefits to provide comparable coverage to medical and surgical benefits, while avoiding any preemption of stronger state laws.

Should both chambers agree on a parity bill, it has a good chance of becoming law since President Bush has expressed his support for such legislation in past years.

A copy of the Mental Health Parity Act of 2007 is posted at<http://thomas.loc.gov/cgi-bin/query/z?c110:S.558:>.▪