April 30, 1999—Two bills introduced last week would end discrimination between mental health and medical/surgical care in health insurance policies. Both build on the 1996 Mental Health Parity Act, which bans different lifetime and annual spending caps for mental and general health care. The bills apply only to plans that already provide mental health benefits, and would not require plans to offer such benefits.
The House bill has strong support from mental health advocacy groups. The Senate's approach, while welcome, has elicited concern.
Comprehensive legislation introduced by Representatives Marge Roukema (R-NJ), Peter DeFazio (D-OR) and Bob Wise (D-WV) would provide full parity for insurance coverage of mental health and addiction services. H.R. 1515, The Mental Health and Substance Abuse Parity Amendments of 1999, would prohibit health insurance plans from imposing inpatient hospital day and outpatient-visit limits or applying different deductibles, co-payments, out-of-network charges and other financial requirements for mental health treatment. Its provisions apply to individuals diagnosed with any mental illness or substance abuse disorder. The bill would essentially close the gaps in current federal law and create a nondiscrimination policy for people with private health insurance.
The bill would also amend the 1996 Parity Act to eliminate the sunset provision, under which the 1996 parity law would terminate September 30, 2001 and end the current exemption for employers who show that their health insurance premiums rose more than 1% as a result of complying with the 1996 Parity Act.
Co-sponsors of H.R. 1515 include Representatives Lois Capps (D-CA), Brian Baird (D-WA), Constance Morella (R-MD) and Ted Strickland (D-OH).
The bill introduced by Senators Pete Domenici (R-NM) and Paul Wellstone (D-MN), the Mental Health Equitable Treatment Act of 1999 (S. 796), would take a critical step toward removing discriminatory barriers to health care for many people with mental illnesses. It does not address parity for addictive disorders.
The Senate bill would prohibit group health plans from setting arbitrary day and visit limits on services for all mental disorders, putting insurers on notice that mental health care should not be treated differently than general health care. It would provide full parity, including equal co-payments, deductibles and other out-of-pocket costs, but only for specified severe "biologically based" mental illnesses.
As does the House bill, S. 796 would amend the 1996 Parity Act to remove the 2001 sunset provision and the 1% cost exemption. It would also expand current law by increasing the scope of coverage to include small businesses with 25 or more employees (the 1996 Act applies only to businesses with 50 or more employees).
S. 796 makes a fundamental distinction between mental illnesses demonstrated to be "biologically based" and those seen as having other causes. It would exclude many childhood disorders, anxiety disorders and mild to moderate depressive disorders, as well as Tourette Syndrome and bulimia.
The illnesses outlined as eligible for full parity are:
The Bazelon Center objects to this distinction. Federal endorsement of a higher standard for coverage of some mental illnesses is a step backward. No other condition must meet such a test concerning its causes before insurance will pay for its treatment. Highly effective treatments are available for mild to moderate depression (caused, for example, by grief) or anxiety disorders (such as that caused by extreme stress or childhood trauma). The Senate's proposed approach would provide less coverage for these conditions than for major depression or panic disorder.
The Bazelon Center and more than 20 other national mental health groups were concerned enough about setting this precedent in insurance regulation to write the sponsors urging changes. S. 796 could lead to policies in other contexts that require higher standards for mental health services than for physical health care.
S. 796 has been co-sponsored by Edward Kennedy (D-MA), Arlen Specter (R-PA), Harry Reid (D-MN), Paul Sarbanes (D-MD) and John Chafee (R-RI). It will be offered on the Senate floor, probably as an amendment to another measure. The bill has a significant chance of passage.
House bill: Call or write your Representative and urge him or her to sign on as a co-sponsor of H.R. 1515, The Mental Health and Substance Abuse Parity Amendments of 1999.
Senate bill: Call or write both of your Senators to
Write:
The Honorable _____________________
United States House of Representatives
Washington, D.C. 20515
The Honorable _____________________
United States Senate
Washington, D.C. 20510
Phone or Fax
Call the U.S. Capitol switchboard,
202-224-3121, and ask for your Representative's or Senator's office.
Email: (use only as a last resort, it gets much less attention) forms at http://congress.org/elecmail.html.
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Bazelon Center for Mental Health Law - chrisk@bazelon.org