Legislation that would require insurers to treat mental health care the same as medical or surgical care was approved by the Senate Health, Education, Labor and Pensions Committee on Feb. 14.
The committee vote was 18-3 in favor of the legislation, known as S. 558 or the “Mental Health Parity Act.”
Specifically, noted Sen. Edward Kennedy, D-Mass., the chairman of the committee, the bill bars health insurers from putting any restrictions on mental care that are not also in place for physical treatments.
“That means no limits on days or treatment visits, and no exorbitant co-payments or deductibles,” he said. “The bill was negotiated by and has the support of the mental health community, the business community and the insurance industry.”
The parity in care also applies to substance abuse under the legislation, and it does not affect state laws requiring coverage for mental care. For insurers, the legislation would exempt medical management strategies designed to ensure access to care, rather than limiting it.
The issue is an important one, Kennedy said, because mental illness costs the U.S. economy roughly $300 billion annually in treatment costs, lost worker productivity and crime. Additionally he noted, a study of more 46,000 workers at major companies found that employees who reported being depressed had healthcare costs that were 70% higher than other employees, and those reporting feeling stressed had 46% higher costs.
Additionally, he said that ensuring parity for mental health care would not significantly increase costs. The Office of Personnel Management, he noted, has said that parity would not significantly increase premiums for the 8.5 million federal employees, and he also said that McDonnell Douglas found a 4 to 1 return on investment for parity after accounting for lower medical claims, reduced absenteeism and smaller turnover.
“This country can afford mental health parity,” he said. “What we can’t afford is to continue denying persons with mental disorders the care they need.”
The committee’s ranking minority member, Sen. Mike Enzi, R-Wyo., also praised the bill, noting work by lawmakers to ensure that the costs of mental health care “will not be a burden on employers that are struggling with health care costs.”Some members of the panel took issue with the bill, however, either on substance or on the proceedings being used to move it through committee.
Sen. Tom Coburn, R-Okla., said that while he agreed with the principle of parity for mental health care, he felt the bill would not properly address the issue and could, in fact, come with unintended negative consequences. “I believe we’re going to see an adverse effect,” he said.
The problem with mental care, he said, is more connected to a lack of available, trained psychiatrists, “and I don’t see that this bill is going to be solving that problem.”
Effectively, Coburn argued, the legislation would impose mandates on mental care. The only effective federal health care legislation, he said, has been the Employee Retirement Income Security Act, or ERISA, which does not impose mandates on the states.
“We’re taking all the market forces away,” he said. “We’re taking the competition away.”
Kennedy disputed that argument, saying the committee is not imposing “uniform standards for around the country.”
Sen. Richard Burr, R-N.C., said during the markup that he also supported the principle behind the bill, but was opposed to how it has been moved through the Senate. Burr claimed he had raised technical questions about the bill a week before and had only heard back on his questions the previous day. Despite being assured by the chairman that work would continue on the bill as it moved to the full Senate floor, he maintained his opposition.
“Perfecting a bill, especially on the technical side, is not something you do on the floor,” he said. “You do it in committee.”