d

Volume 12 Number 218
ISSN 1091-4021
Tuesday, November 13, 2007

News: Mental Health

Negotiations between House and Senate lawmakers over mental health parity legislation (H.R. 1424, S. 558) continue with the aim of bringing a bill to the House floor in December, the bill's Republican co-sponsor, Rep. Jim Ramstad (R-Minn.), said Nov. 9.

Ramstad told reporters House and Senate lawmakers have reached "a delicate point in the negotiations" over the two measures, focusing on 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); medical management issues; and how to pay for the bills, which cost the federal government about $4.1 billion over 10 years.

Under rules adopted by Democrats, bills that increase spending must be paid for by cutting other federal programs or increasing taxes. Despite other priorities for which funding must be found, such as to provide physicians a pay increase under Medicare, Ramstad was confident funding would be found for parity legislation.

"Those funds are there, we are going to be able to find them," he said.

The Senate approved S. 558 in September. H.R. 1424 has been approved by three House committees, the last of which, the Energy and Commerce Committee, approved it Oct. 16. The measures would require employer-sponsored health plans to offer mental health care and addiction disorders benefits on par with medical and surgical services. The House bill's other cosponsor is Rep. Patrick J. Kennedy (D-R.I.).

Any changes needed in H.R. 1424 as a result of talks with the Senate could be incorporated via the process of melding the three versions of the House bill passed by the Energy and Commerce, Education and Labor, and Ways and Means Committees, Ramstad said.

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.

"Whether or not the House actually passes Patrick Kennedy's bill, the real action will be to negotiate something outside of a conference that is at least 98.5 percent of the Senate bill, perhaps even more purely Senate than that," E. Neil Trautwein, vice president at the National Retail Federation, told BNA Nov. 7.

A Senate aide told BNA Nov. 9 that "substantive negotiations are ongoing" over the measures, adding, "From our vantage point, it seems unlikely that the House bill could pass in the Senate."

Supporters of H.R. 1424 have said their bill is more substantive, and have argued that it would ensure true parity for mental health treatment is achieved. Supporters of S. 558 say the House bill in its current form would never pass the Senate and likely would be vetoed by President Bush.

The biggest difference between the two measures is the House provision on DSM-IV. 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. The issue has been a nonstarter in the Senate, and opponents have said it could cause employers to drop mental health coverage altogether.

Ramstad acknowledge the issue is looming large over the talks, but said the DSM-IV provision could survive talks with the Senate with some changes.

"There's a middle ground there," he said. "It eliminates some of the lesser disorders that are really red herrings like caffeine addiction and air sickness disorders." He refused to elaborate.

But a mental health parity advocate told BNA Nov. 9 that such a change would not go over well with stakeholders. "I think it's a dangerous road to start picking and choosing DSM diagnoses and I can't see the business and managed care community agreeing to any sort of mandated list," the advocate said.