House Passes Mental Health Parity; Difficult Conference Looms

Legislation that would bolster mental health benefits gained strong House approval Wednesday night, March 5. It now heads for what could be difficult House-Senate negotiations to produce a final bill.

In a 268-148 vote, the House passed a measure that would prohibit companies that offer mental health and substance-abuse benefits from charging more for them than they do for medical and surgical benefits.

The bill expands current parity law, which requires equal annual and lifetime dollar limits. Under the House measure—and a Senate companion—co-payments, deductibles, and out-of-pocket expenses also would have to be equal.

Unlike the Senate bill, the House version would mandate coverage for all conditions listed in a diagnostic manual published by the American Psychiatric Association. 

Critics say that provision would force companies to finance treatment for disorders like jet lag and caffeine addiction. Advocates argue that broader coverage prevents “discrimination by diagnosis.”

The Senate bill, which passed that chamber unanimously last fall, has the strong backing of business groups. Their House allies criticized the Democratic majority for not allowing a House vote on the Senate bill. The Bush administration opposes the House bill and supports the Senate version.

Rep. Howard “Buck” McKeon, R-California and ranking member of the House Education and Labor Committee, faulted the House bill for providing “preferential treatment for mental health benefits.” He said it “has little chance of becoming law.”

The measure may put all benefits in jeopardy. “Some employers may choose to drop their mental health coverage rather than comply with burdensome mandates,” McKeon said. 

Rep. Robert Andrews, D-New Jersey, disputed McKeon’s assertion. “There is not one shred of empirical evidence” that employers have discontinued mental health coverage in states that have stronger parity laws than the one the House approved.

Rep. Patrick Kennedy, D-Rhode Island and one of the bill’s authors, also dismissed McKeon’s argument. “No one questions when you get a broken arm, but when you have a mental illness, it’s discriminated against,” he said. “[His bill] is not preferential treatment.”

Kennedy, who has had his own battles with substance abuse, characterized the measure as a “truly landmark piece of civil rights legislation.”

Whether it will survive a House-Senate conference is a different matter. Kennedy’s father, Sen. Edward Kennedy, D-Massachusetts and chairman of the Senate Health Education Labor and Pensions Committee, will be one of the negotiators. He and Sen. Pete Domenici, R-New Mexico, are the authors of the Senate measure.

Both lawmakers praised the March 5 House vote. But in a press conference following unanimous approval of the Senate measure last fall, Domenici emphasized that businesses, insurers and mental health advocates not only backed the bill but had spent years crafting it.

“We’ll go to conference carrying that with us, knowing that it makes the bill pretty passable,” Domenici said in September.

In contrast to accolades for the Senate bill, the House version drew opprobrium from business groups. They said it would negate medical management practices, mandate out-of-network coverage, subject businesses to different coverage rules in different states and raise insurance costs.

“One of our member companies has pre-existing contracts with more than 150 plans, all of which would require amendment or renegotiation, severely disrupting the entire spectrum of benefits offered,” wrote Edwina Rogers, vice president of health policy at the ERISA Industry Committee, in a letter to House members.

Another bill that has drawn less criticism from business, the Genetic Information Nondiscrimination Act, was added to the parity legislation. The measure, which was approved 420-3 by the House in April 2007, prohibits health insurers from canceling or denying coverage based on a person’s genetic information.

But a coalition of employers warns that the bill could subject companies to excessive punitive damages for paperwork mistakes when keeping health records.