Insurance Reform Bill Threatens Mental Health Parity Laws

Federal legislation that would endanger state mental health parity laws advanced in the Senate after its supporters narrowly defeated an effort to amend the bill and protect states' parity measures.

The Senate Health, Education, Labor and Pensions (HELP) Committee narrowly defeated a mental health parity amendment to the Health Insurance Marketplace Modernization and Affordability Act (HIMMA, S 1955).

The amendment, offered by Sen. Edward Kennedy (D-Mass.), the committee's highest ranking Democrat, was defeated by a 10-10 tie vote, with Sen. Mike DeWine (R-Ohio), Sen. Jim Jeffords (I-Vt.), and all Democrats on the panel voting for it. The language of the amendment was essentially the same as the Paul Wellstone Mental Health Equitable Treatment Act of 2004, which would require full equality in health insurance coverage for beneficiaries who are treated for mental illness.

The HIMMA bill would provide small employers and associations with low-cost ways of purchasing insurance, something that is cost prohibitive for many small businesses. It would allow them to establish association health plans and preempt many state health insurance mandates, including state mental health parity laws, to achieve a nationwide “harmonization” of insurance regulations.

The preemption of state mandates would apply to individual and group insurance plans, as well as to the new association health plans, according to the APA Department of Government Relations.

APA lobbied committee members to support the amendment that would prevent discrimination in insurance coverage of mental illness treatment. Without the amendment, HIMMA provisions would effectively void the 39 state parity laws that protect insurance beneficiaries from this type of discrimination and the laws in 32 states that require insurers to provide mental health benefits.

The day after the committee vote, APA sent members an alert asking them to contact their two U.S. senators and to urge them to vote against the bill unless it restores protections for state mental health parity laws or mandates that health plans must include coverage for mental health care at the same level as for other illlnesses.

Supporters of the legislation said it would encourage small-business owners to pick the most comprehensive plans for themselves and their employees.

The bill has drawn the ire of patient-advocacy groups, state insurance commissioners, and Democrats, who say that bypassing state laws would harm patients and ignores the wishes of state legislatures, to which Republicans traditionally give deference.

Opponents offered a variety of amendments, most aiming to preserve specific state laws, but all were defeated. Among these were measures to retain state mandates regarding autism treatments and obesity screenings.

Democrats, who have prepared 68 amendments to the legislation, pledged to bring up more amendments if the bill comes to the floor for a vote.

A separate parity bill is expected in the Senate in the coming weeks.

Mental health advocates, including Sen. Pete Domenici (R-N.M.), have held closed-door discussions with Senate leaders and business opponents in an attempt to narrow differences over the legislation, according to mental health advocates.

The National Mental Health Association condemned the proposed legislation as “harmful” and said it has been “misrepresented as a solution” to the problem that more than 40 million Americans have no health insurance. The group said that the proposal eviscerates state parity laws “by permitting insurers to ignore the laws and providing beneficiaries and states no recourse.”

A copy of S 1955 is posted at<http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=109_cong_bills&docid=f:s1955is.txt.pdf>.▪