A bill that would prohibit insurers from placing limits on mental health coverage sailed through a House committee on Wednesday, July 18, but is heading for a collision with a Senate version that is backed by the business community.
Supporters stress that the bill, which has 268 co-sponsors, does not mandate that employer-sponsored health plans provide mental health coverage. But when they do, the legislation requires equity between mental health and medical/surgical benefits on treatment limitations, financial requirements and out-of-network coverage.
“A key part of the problem is that private health insurers generally provide less coverage for mental illnesses than for other medical conditions,” said Rep. George Miller, D-California and chairman of the House Education and Labor Committee.
The panel approved the bill, 33-9, after defeating an alternative measure offered by Rep. John Kline, R-Minnesota.
Kline’s proposal included provisions that are in Senate legislation, which was the product of negotiations between lawmakers, business lobbyists and mental health advocates. The Senate bill has been approved by the Senate Health Education Labor and Pensions Committee and is awaiting floor action.
Kline said the House version would limit the ability of employers to design and manage their health plans. He also criticized it for allowing states to enact higher standards than those in federal law.
“The House bill is an unbalanced effort that goes beyond providing parity—it gives mental health benefits preferential treatment,” Kline said.
His substitute, and the Senate bill, would not mandate coverage of specific benefits and would explicitly state that medical management of mental health benefits is not prohibited. It also ensures that federal law would trump state law.
These arguments will continue after the full House and Senate have approved their own bills and negotiations begin to meld the measures—a process that might not start until this fall and could drag into 2008.
E. Neil Trautwein, vice president and employee benefits counsel at the National Retail Federation, hopes the Senate provisions prevail.
“We have great confidence in the negotiating skills of the senior senator from
The conference committee likely will feature two Kennedys. Rep. Patrick Kennedy, D-Rhode Island, is the author of the House bill.
In order to produce final legislation that President Bush will sign, “the conference will have to tilt in the direction of the Senate bill,” Trautwein says.
The negotiations may be spirited. Another person who may be involved, Rep. Robert Andrews, D-New Jersey, disputed the Republican assertion that the House bill would curtail managed care. During the July 18 House meeting, he highlighted language in the measure that would protect “management practices.”
Proponents of the House approach argue that federal law should not pre-empt stronger state measures and that the range of diseases covered should reflect diagnoses included in the Diagnostic and Statistical Manual (DSM).
But some Republicans countered that a broad approach to coverage would force companies to pay for caffeine-addiction treatments and other questionable claims.
Advocates say that using the DSM would “end discrimination by diagnosis,” as Rep. Kennedy wrote in a July 17 letter to colleagues.
Andrews and others dismissed arguments that the bill would impose substantial financial burdens on employers. They cited a recent study by the actuarial firm Milliman Inc. that showed that the measure would increase annual costs by 0.6 percent or less.
“We do not see a huge surge in increased utilization under this bill,” said Steve Melek, a Milliman actuary, prior to a House hearing last week.
In fact, mental health coverage bolsters business performance by reducing absenteeism and presenteeism, former first lady Rosalynn Carter testified at the same hearing.
Carter, who chairs the
The results are good for the bottom line, according to Carter. “Over three to five years, the total cost of health care goes down,” she said.
More important, she argued, people are suffering needlessly. “The brain is so important, yet we don’t insure it,” she said. “This is a tragedy for our country.”
—Mark Schoeff Jr.