Mental Health Parity Act

Lots of buzz about Patrick Kennedy's (D-RI) bill:

The House of Representatives passed a bill Wednesday that would require health insurers to cover treatments for addiction and mental conditions the same way they provide for physical illnesses.

The bill, which was approved 268-148, would broaden coverage to virtually every type of mental illness.

It also puts the Senate Kennedy on the opposite side of the negotiating table from the House Kennedy. Jacob Goldstein in the WSJ has a nice rundown:

Now that Congressman Patrick Kennedy (pictured, left) has won passage in the House for his mental health parity bill, he has to work out a compromise with the Senate, which has passed a much less restrictive version of the bill. Kennedy will be sitting across the negotiating table from one of the old lions of the Senate: his father, Ted Kennedy (pictured right), a driving force behind the Senate bill.

The Senate bill, backed by business and insurance groups, would give insurers that chose to cover mental health wide latitude in which conditions to cover. The House bill would require those that offered mental health coverage to cover all mental health and substance abuse disorders in the standard manual of mental illness, the WSJ reports. Both bills would forbid companies from charging higher copays or putting more stringent limits on mental health care than on other kinds of care.

Some Republican backers of the Senate bill have said the House version will never make it in the Senate. Kennedy the elder disagrees. "I don’t accept that," he told the Providence Journal yesterday, just before walking over to the House to watch the debate over the bill. But he did say the differences are "something we’ll have to work on."

Kennedy the younger, a Rhode Island Democrat, told the Boston Globe that he and his dad, a Massachusetts Dem, have been trying to figure out ways to bridge the legislation gap. "We’ve discussed strategies and ways we can try to move this," he said.

The SF Chronicle (first link above) points out problems for CA:

But some mental health advocates say the well-intentioned legislation could a have a negative impact by overriding laws in California, where health plans already are required to cover major mental illnesses.

Because the federal bill would not mandate plans to cover mental health as they are required to do in California, such a law could raise rates and cause some employers to drop mental health coverage altogether.

"If you are a family in California with a member, a son or daughter with mental health issues, you could end up with nothing," said Andrew Sperling, director of legislative advocacy for the National Alliance on Mental Illness.

Sperling's group supports a competing bill in the Senate, which was passed by that chamber in September and is now in the House.

The Senate bill, sponsored by Sen. Edward Kennedy, D-Mass., gives insurers more leeway in choosing which conditions to cover. But like the House version, it does not mandate mental health coverage and exempts group health plans with fewer than 50 employees. In a twist, the competing House bill is backed by Kennedy's son, Rep. Patrick Kennedy, D-R.I.

The passage of both bills sets the stage for the two chambers to try to reach some sort of compromise because the stakes are high. Wednesday's vote was significant because mental health parity laws have been introduced in Congress for many years, but routinely stalled in the Republican-dominated House.

And there's a cost side as well (SF Chronicle):

Insurers say expanding coverage to such conditions as kleptomania, sibling-relational problems, voyeurism and exhibitionism - diagnoses not covered under current California law - would drive up costs.

"Health plans provide what they need to by law. A mandate ends up taking flexibility away from employers and consumers in purchasing a plan that would meet their needs," said Nicole Kasabian Evans, spokeswoman for the California Association of Health Plans.

It's important to view all the players and all the aspects of this bill. Some will line up with the House version, some with the Senate, until a compromise bill can pass.

A reminder: "Wednesday's vote was significant because mental health parity laws have been introduced in Congress for many years, but routinely stalled in the Republican-dominated House". Congress matters, and a GOP-led Congress will not be health reform champions. At least now between the Senate and the House,  the issues can get a fair hearing in ways inconceivable prior to 2006. As Bush is fond of saying, elections matter, too. And if you don't want to see good legislation like SCHIP vetoed, work your butt off to put a Democrat in the White House.

Update [2008-3-6 13:23:36 by DemFromCT]: Here's some good House video from the Speaker's blog.

Update [2008-3-6 15:4:1 by DemFromCT]: link to Kaiser's Daily Health Report on HR 1424, including offset provisions.

The bill includes provisions to offset the cost of about $4.3 billion over 10 years. The legislation would increase the rebates that pharmaceutical companies must provide state Medicaid programs to raise $2 billion over 10 years.

In addition, the bill would place new restrictions on physician-owned specialty hospitals to raise $2.4 billion over 10 years (Wall Street Journal, 3/6). Under the provision, physicians could not refer patients to hospitals in which they have a financial interest. Critics maintain that "physicians' ownership interest gives them an incentive to refer patients to the facility and to increase volume unnecessarily" and that a "ban on referrals to new specialty hospitals would reduce the number of medical procedures being performed, which would result in savings," CQ Today reports.

The Bush administration opposes both provisions (Armstrong, CQ Today, 3/5).

For more links and discussion on health reform, see Health Care Discussion Links.