The house of representatives overcame the objections of most
republicans and the White house to pass its version of mental health parity
The bill, sponsored by Rep. Patrick Kennedy (D-R.I.), would expand mental
health regulations and require insurance plans that offer mental health
benefits to make them "equal in cost and scope to any medical or
surgical benefits offered." The bill also mandates that insurers
consider coverage for all mental health conditions in DSM-IV.
The House passed the bill by a vote of 268-148 on March 5.
A less-comprehensive Senate parity bill, sponsored by Sens. Edward Kennedy
(D-Mass.) and Pete Domenici (R-N.M.), has the support of business and
insurance groups; it easily passed the Senate last September.
The White House and most House Republicans blasted the House version as an
overly broad mandate that ultimately would undermine access to care.
The House bill "would effectively mandate coverage of a broad range
of diseases and conditions and would have a negative effect on the
accessibility and affordability of employer-provided health benefits and would
undermine the uniform administration of employee benefit plans,"
according to a March 5 White House statement.
The House action comes after informal negotiations that had been ongoing
over the last several months deadlocked between members of the Senate and
House over differences between the House and Senate (S 558) version of broad
mental health insurance parity (Psychiatric News, January 18).
The two bills have engendered different levels of support among mental
health advocates because the House measure is considered stronger, while the
Senate version is thought more likely to become law. APA has endorsed both
measures, arguing that the differences between the two are not great and that
either bill would be a vast improvement over the current, limited federal
One of the main differences over which negotiators are deadlocked is that
the House bill would direct any plan that provides mental health parity
coverage to consider—but would not mandate—coverage of all
illnesses in the Diagnostic and Statistical Manual of Mental Disorders
(DSM). The Senate version would leave it up to insurance plans to
determine the psychiatric conditions they would cover, without having to
conclude whether treatment for a given mental disorder is medically
Both bills are designed to maintain any existing state parity protections,
including requirements for coverage of a given condition.
The House bill's approach to state parity laws also drew the fire of the
Bush administration for including "confusing preemption provisions
[that] could be read to add a patchwork of remedies that vary from State to
The White House also opposed several provisions in the House bill unrelated
to parity, including an effective ban on new physician-owned hospitals and an
increase in the rebate that drug companies are required to give state Medicaid
Congressional negotiations over a parity bill also have stalled over
differences between the bills in out-of-network benefits. The House bill would
require plans that include an out-of-network benefit for physical health care
to also offer out-of-network parity mental health coverage.
The Senate version would allow plans to offer a medical/surgical
out-of-network benefit without offering a corresponding mental health benefit.
If the plans did offer an out-of-network mental health benefit, they would
have to do so at parity.
Some supporters of the Senate version, including Kennedy, its cosponor,
raised doubts in comments to the media about whether a compromise is possible
in light of what they see as significant differences between the two
Mental health advocates remain optimistic that common ground can be
"Clearly there is going to have to be some kind of consensus building
between the House and Senate," said Nicholas Meyers, director of APA's
Department of Government Relations.
In a separate action, on February 7 the House easily passed a
noncontroversial one-year extension (Hr 4848) of the existing limited mental
health parity law. The measure would extend until the end of this year a law
(PL 104-204) that bans health plans that offer medical and surgical benefits
from using different lifetime or annual limits on coverage for mental health
care. The law does not require coverage for any mental health conditions. Its
mandate only applies to policies that already offer some type of mental health
The text of the insurance parity bills can be accessed at<http://thomas.loc.gov>
by searching on the bill numbers, HR 4848, HR 1424, and S 558.▪