The Senate approved the mental health parity measure as part of larger tax package that would extend several tax breaks that are about to expire. The House passed it as a stand-alone bill, 376-47.

The core policy of the two pieces of legislation is identical. The difference involves how each chamber pays for the $3.4 billion, 10-year proposal.

Before the bill can head to President Bush, either the House has to pass the Senate version or the Senate has to approve the House measure. In a September 23 statement, the White House indicated that Bush would sign the bill.

Time is rapidly dwindling for the House and Senate to sort things out, as Congress tries to wrap up the legislative year during the next week.

“The question is whether our bill with the offset or their bill with a different offset becomes law,” said Sen. Pete Domenici, R-New Mexico and one of the authors of the Senate version, in a floor speech. “But there should be no doubt we will now get parity of treatment for huge numbers of Americans suffering from mental illness.”

The bill does not mandate that insurers offer mental health coverage. But if they do, it cannot be more restrictive than coverage for medical and surgical benefits. Under current law, lifetime annual benefits for each category must be equal.

The new measure goes further, requiring parity for deductibles, co-payments, out-of-pocket expenses, coinsurance, covered hospital days and covered outpatient visits. The rules would affect about 113 million in group health policies.

The legislative journey for mental health parity was long, treacherous and unique. It featured father-and-son champions. Rep. Patrick Kennedy, D-Rhode Island, led the charge for the bill in the House. His father, Sen. Edward Kennedy, D-Massachusetts, was one of the Senate leaders.

During the past three years, business groups, insurance companies and mental health advocates fought through contentious issues and forged a compromise. Corporate advocates acknowledge that the expanded coverage will add costs for employer-sponsored health plans.

In negotiations over the final bill, the piece that business resisted the hardest—coverage of every mental health ailment in a psychiatric diagnostic manual—was taken out. The final bill allows employers to determine coverage and to use medical management techniques.

Mental health proponents point to their own victories. The bill requires that insurers who deny coverage explain why. It also extends coverage to out-of-network providers and protects tougher state mental health parity laws.

“We got the best bill we could get,” said David Wellstone, son of the late Sen. Paul Wellstone, D-Minnesota, for whom the bill is named. “This is a bill that can pass.”

Even though neither side got everything it wanted, the process of producing a consensus bill drew wide praise.

“The bipartisan collective effort that brought together diverse interest groups should be a model emulated by Congress next year as it tackles the much more difficult challenges of comprehensive health system reform,” said James Klein, president of the American Benefits Council.

For now, a targeted accomplishment—putting depression on the same plane as cancer and diabetes—is being celebrated.

“Millions of Americans have been born and died with mental illnesses, never covered by health insurance,” Domenici said. “This is a really red-letter day for fairness.”

After a September 17 rally for the bill, Kennedy emphasized the urgency of passing the bill now rather than having to reintroduce it next year.

“It wasn’t put together overnight and it can’t be reworked in the next Congress,” he said. “Who knows what the environment will be.”

—Mark Schoeff Jr.

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