Mental health advocates and congressional parity backers are gathering
their strength to push for passage of a mental health insurance parity
compromise before the current Congress ends. Their chief obstacle: money.
Senate and House negotiators finished the major work on a compromise parity
measure in June, although bill writers have continued to tweak some of the
Both parity measures would require insurance plans that offer mental health
benefits to make them equal in the cost of copayments and deductibles as well
as the number of covered doctor visits or days in the hospital to the
plans' other medical benefits.
The final compromise measure includes much of the language from the
less-comprehensive Senate version but also "surprising" acceptance
of some provisions of the more-generous House bill, according to lobbyists who
asked not to be named because of their involvement in crafting the bills.
The compromise legislation was considered briefly by the Senate after it
was folded into a large tax package (S 3335) before Congress adjourned for its
August recess, but it failed to pass due to a partisan fight over whether to
bring unrelated energy legislation up for a vote. Senate supporters are
expected to repeat their push for the measure after funding offsets for the
bill's $3.8 billion, 10-year cost are identified.
"We remain hopeful that this most important part of APA's
legislative agenda will be signed into law before Congress adjourns,"
said Nicholas Meyers, director of APA's Department of Government
The final compromise addresses areas of contention that had initially
resulted in the House and Senate passing bills (HR 1424 and S 558) that
greatly expanded federal parity mandates but differed on important
The compromise dropped some provisions of the House bill, which was
described by parity advocates as the more generous version, including a
provision barring the federal law's preemption of stronger parity laws.
Instead, the compromise defers to the state preemption standard used by the
Health Insurance Portability and Accountability Act (HIPAA), which preempts
only state laws that "prevent the application" of the federal
The compromise also dropped the House bill's requirement that all
insurance plans provide parity coverage for all conditions in DSM-IV.
However, it did include a definition of mental health benefits that
specifically recognizes that benefits must be in accordance with state law.
The language will allow state parity provisions that are based on all
DSM-identified conditions to remain in effect, according to mental
health policy experts who have followed the bill.
Among the "surprising" components of the parity compromise was
Senate negotiators' acceptance of House language requiring plans to cover
out-of-network mental and substance use disorder services under the same terms
and conditions that plans provide for out-of-network medical/surgical
benefits. Prior to the compromise, the Senate bill allowed insurance plans to
offer out-of-network medical/surgical benefits without offering any
corresponding out-of-network mental health and addiction treatment
The acceptance of the House's out-of-network language was unexpected
because mental health advocates and insurance industry lobbyists who had
worked on negotiations for the Senate bill had adamantly stated they would not
consider any changes to the bill because that might endanger compromises that
had been carefully crafted over several years to satisfy competing
Another feature of the compromise that aims to prevent insurance plans from
circumventing mental health parity mandates requires the Government
Accountability Office to study insurance industry practices relating to mental
health care after the measure is enacted. Federal researchers would report on"
specific rates, patterns, and trends in coverage and exclusion of
specific mental health and substance use disorder diagnoses by health plans
and health insurance," according to the compromise bill.
Supporters of parity in the Senate have told supporters that they plan to
push for enactment of the bill in the fall before Congress adjourns. House
parity supporters also are anxious to enact a new parity law quickly, as some
of the most influential parity supporters are retiring at the end of this
"Mental illness is a disease like any other. We should treat it that
way," stated Sen. Max Baucus (D-Mont.) during Senate floor comments
shortly before that chamber failed to overcome procedural hurdles and bring
the compromise up for a vote at the end of July.
To boost chances that the bill will pass, Senate supporters are searching
for the fiscal offsets for the $3.8 billion that the Congressional Budget
Office (CBO) estimated the measure will cost the federal government over 10
years. The costs stem from the CBO's conclusion that the measure will
result in slightly higher insurance premiums, which will then result in the
diversion of more workers' pay into employer-paid premiums, which are tax
exempt, thus leaving less wages on which the government can collect taxes.
About 35 percent of the lost federal revenue will come from reduced Social
Security payroll tax withholding, according to CBO estimates.
Fear that parity will carry a large cost to private insurance companies and
their policyholders stymied progress of a strong federal parity measure for
many years, even as the majority of states enacted their own parity
requirements. The concern about increased costs to private insurance were
eventually mollified by research showing only modest additional cost when
mental health parity was added to programs such as the Federal Employees
Health Benefits Program.
During Senate floor comments shortly before Congress recessed in July, Sen.
Amy Klobuchar (D-Minn.) urged her colleagues to pass a strong parity measure
because it was the leading goal of one of her predecessors, Sen. Paul
Wellstone (D-Minn.), who died in a 2002 plane crash while campaigning for
reelection. Wellstone saw how crucial a strong national parity law was after
the emotional and financial toll that his brother's mental illness took
on his family while he was growing up.
"There was a horrible financial situation for his family,"
Klobuchar said. "He didn't want that to happen to someone else. He
felt that if you can cover physical illnesses, you should also cover mental
The mental health parity compromise legislation can be accessed at<http://thomas.loc.gov>
by searching on the bill number, S 3335. ▪