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Volume 12 Number 196 News: Mental Health The House Energy and Commerce Health Subcommittee Oct. 10 approved legislation (H.R. 1424) by voice vote requiring employer-sponsored health plans to offer mental health care and addiction disorders benefits as they do for medical and surgical services. The full committee is expected to consider the measure the week of Oct. 15, and then it will go to the House floor. Two House committees--Education and Labor, and Ways and Means--have approved the measure. The Senate approved mental health parity legislation (S. 558) Sept. 18. The House subcommittee approved H.R. 1424 after defeating an attempt by Republican opponents of the bill to pass a substitute mirroring S. 558 and several other amendments. Democrats said the amendments would weaken the bill, making it easier for employers to sidestep parity in their health coverage. H.R. 1424, the Paul Wellstone Mental Health and Addiction Equity Act of 2007, would require that group health plans offering coverage to employers with more than 50 workers provide parity in coverage for mental health and substance-related disorders as for physical illnesses. H.R. 1424, sponsored by Reps. Patrick J. Kennedy (D-R.I.) and Jim Ramstad (R-Minn.), now has 272 cosponsors. Senate Bill Supporters Business groups have rallied behind the Senate bill, saying it would be less costly than H.R. 1424. Supporters of the Senate bill also say it is the result of extensive negotiations among parity advocates, businesses, insurers, lawmakers, and other stakeholders. Supporters of the Senate bill said the House measure has no chance of passing the Senate, but Kennedy told reporters the Senate already had changed its bill to accommodate the House by removing a provision in S. 558 allowing it to preempt stronger state laws. Rep. Kennedy also said the vote of three House committees for the bill will improve the standing of the House in negotiations with the Senate. "Everytime we stick to our guns ... it strengthens our hand with the Senate, because, frankly, it shows the resolve of the chamber for a real bill that is not going away," he said. Kennedy said negotiations with the Senate on the two bills likely would produce an "amalgamation" of the measures. "It will look like a conference bill," he predicted. Measure Seen Ending Discrimination Energy and Commerce subcommittee Democrats and Republicans supporting the measure said it would end decades of discrimination against those with mental disorders by leveling the playing field between coverage for mental and physical illnesses. "By putting mental heath on a par with medical and surgical benefits, we will be improving the availability and affordability of health care for those with mental health and substance abuse conditions," subcommittee Chairman Frank Pallone Jr. (D-N.J.) said in his opening statement. "This will not only reduce pain and anguish of many of our constituents and their families who suffer from mental health and addition diseases, but will also benefit our nation as a whole," Pallone said. Financial Burdens Some subcommittee Republicans, who said they supported the Senate bill, said H.R. 1424 would impose financial burdens on employers and could cause some to drop mental health coverage rather than increase its scope. The bill does not require employers to offer coverage, but if they do, the measure stipulates it must be on par with coverage for physical illnesses. The Congressional Budget Office has found both the Senate and House bill would increase premiums for employer-sponsored health insurance by 0.4 percent. Subcommittee ranking minority member Nathan Deal (R-Ga.) said that, while that may be a small increase, the bill represents another federal mandate that will make it more difficult for employers to offer health benefits to their workers. H.R. 1424 is an attempt "to force a specific policy down the throat of the marketplace," full committee ranking minority member Joe Barton (R-Texas) said. DSM Provision Much of the debate in the markup stemmed from a provision in the House bill requiring employers to cover all illnesses listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). The provision is not in the Senate bill. DSM-IV is published by the American Psychiatric Association and covers what in the association's view are all mental health disorders for both children and adults. It also lists causes of disorders, statistics in terms of gender, age at onset, and prognosis, as well as treatment research. H.R 1424 supporters said the provision would ensure true parity is achieved in health coverage, while opponents said the DSM-IV language would allow coverage for illnesses such as jet lag, caffeine addiction, and sibling rivalries. Barton said the provision could be abused by treatment professionals to increase their income by providing more therapy. But Rep. Tim Murphy (R-Pa.), a child psychologist, dismissed those charges, saying increased availability of mental health treatment likely would save employers money by addressing issues that may harm worker productivity. He said using the DSM-IV could help workers get the treatment they need more quickly, be it mental or physical health care. More information is available.
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