FIG1 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.
Sen. Edward Kennedy's mental health parity amendment is
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
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
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."