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Volume 12 Number 200 News: Mental Health In a 32-13 vote, the House Energy and Commerce Committee Oct. 16 approved legislation (H.R. 1424) requiring employer-sponsored health plans to offer mental health care and addiction disorders benefits on par with medical and surgical services. Three House committees have now approved the legislation, and it could be on the House floor by late October or early November, its chief Democratic sponsor, Rep. Patrick J. Kennedy (D-R.I.), told BNA. The committee approved H.R. 1424 after defeating an attempt by Republican opponents of the bill to pass a substitute mirroring the Senate mental health parity bill (S. 558) and several other amendments. Democrats said the amendments would have weakened the bill, making it easier for employers to sidestep parity in their health coverage. H.R. 1424, the proposed 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 mental health and substance-related disorders, compared to other health benefits. The bill, sponsored by Kennedy and Rep. Jim Ramstad (R-Minn.), now has more than 270 cosponsors. Paying for It Before the bill can go to the floor, Democrats must resolve a pay-go issue. The bill, as scored by the Congressional Budget Office, would increase federal spending by $820 million over 10 years and reduce federal tax revenues by $3.1 billion over the same time period. Under rules adopted by Democrats, bills that increase spending must be paid for by cutting other federal programs or increasing taxes. Kennedy said the House Budget Committee would meet within the next week to determine how to pay for the bill. Energy and Commerce Committee member and former House Speaker J. Dennis Hastert (R-Ill.) said lawmakers should be concerned that Medicare could be used to fund the measure. Some committee Republicans, who said they supported the Senate version, 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. 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. The Senate approved S. 558 on Sept. 18. If the measure is passed by the House, a stalemate with the Senate "could easily happen" due to differences between the two bills, and as a result, a parity bill might not become law this year, said Rep. Heather Wilson (R-N.M.). But committee Democrats said the Senate bill is weaker than the House measure, and would not guarantee mental health parity. If S. 558 were adopted by the House, "we will have a watered-down bill that is almost like having no bill at all," said Commerce health subcommittee chairman Frank Pallone Jr. (D-N.J.). Illnesses in DSM-IV As in the subcommittee markup Oct. 11, much of the debate in the full committee 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. The American Psychiatric Association publishes DSM-IV, and it 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 and caffeine addiction. By Steve Teske
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