A House Energy and Commerce Subcommittee gave its approval to mental health parity legislation despite concerns from some republicans that the bill is inferior to a Senate proposal and would ultimately raise premiums.
The legislation, HR 1424 or the Paul Wellstone Mental Health and Addiction Equity Act of 2007, would require insurers to give equal treatment to mental conditions as they do to physical ailments. The bill was passed by a voice vote and is slated for a full committee markup next week.
“By putting mental health on a par with medical and surgical benefits, we will be improving the availability and affordability of healthcare for those with mental health and substance abuse conditions,” said subcommittee chairman Frank Pallone, D-N.J. “This will not only reduce the pain and anguish of many of our constituents and their families who suffer from mental health and addiction diseases, but will also benefit our nation as a whole.”
Critics expressed concern, however, over language that would require health plans to cover all diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition put out by the American Psychiatric Association if they provide coverage for any mental diseases.
Rep. Joe Barton, R-Texas, the ranking minority member of the full committee, noted that the DSM includes such diagnoses as jetlag or caffeine related disorders, and he argued the bill would require these conditions “to be treated the same as a heart attack” by health insurers.
“I can tell you I’ve had jetlag and I’ve had a heart attack,” he added. “It’s not the same.”
The ranking Republican member of the subcommittee, Nathan Deal, R-Ga., also expressed concerns that by requiring insurers to provide coverage for every disorder, the law would lead to higher premiums. According to estimates by the Congressional Budget Office, he said, HR 1424 would increase premiums for businesses by .4%. That figure may seem low, he added, until it is combined with any number of other mandates imposed on health coverage.
“The aggregate effects of mandates like this can be significant in the health insurance market,” he said.
Rep. Heather Wilson, R-N.M., a critic of the approach being taken by the House, said that the requirement that plans provide coverage for all conditions would potentially have the unintended effect of forcing employers to drop their coverage altogether rather than accept the higher costs. Instead, she called upon committee members to adopt language from the Senate version of the bill, which contains a provision that would permit plans to contract with mental health providers and use procedures such as utilization review to manage use of care and is generally viewed more favorably by the health insurance industry.
Adding to the problem, she said, is the real possibility that the Senate will not accept the House version, setting the stage for a legislative stalemate. The Senate version has been championed by Sens. Mike Enzi, R-Wyo., and Edward Kennedy, D-Mass.
“The Senate bill is better public policy,” Rep. Wilson said, and likely the only bill the chamber would accept. “We should focus on passing legislation that has a reasonable chance of becoming law and helping people,” she added.
Supporters of the bill countered that the use of the entire DSM is important to ensure that care providers are making their decisions without being guided by health plan rules and regulations. “It’s critical that we let the physician, not the insurance companies, make the decision,” said Rep. Gene Green, D-Texas.
Rep. Tim Murphy, R-Penn., who is himself a psychologist, also argued in favor of the bill, noting that “the diagnoses and treatment of mental illness saves money” for patients and businesses alike. Additionally, he argued that just because the DSM includes diagnoses for conditions like jetlag or caffeine withdrawal, does not mean that they come with expensive treatments. It would be important for a company to know if their top salesman were suffering from narcolepsy or a brain tumor, he said, or if the symptoms only indicated jet lag. “If you have caffeine withdrawal, the treatment is to cut back on the caffeine,” he added, rather than seeing a psychologist or psychiatrist.
An amendment offered by Rep. Wilson to incorporate the language of the Senate bill into the House version was rejected by a vote of 19 to 9.
H.R. 1424 was named for former Sen. Paul Wellstone, D-Minn., who died in a plane crash in 2002. The current bill has 272 co-sponsors in the house and has been championed by Reps. Jim Ramstad, R-Minn., and Patrick Kennedy, D-R.I., son of Sen. Kennedy. In fact, Rep. Kennedy, who is not a member of the subcommittee, was at the markup “working the room” in the words of Rep. Darlene Hooley, D-Ore., speaking privately with members on both sides of the aisle as the proceedings took place.