Copyright 1999 The Washington Post
The Washington
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June 14, 1999, Monday, Final Edition
SECTION: EDITORIAL; Pg. A20
LENGTH: 609 words
HEADLINE:
'Parity' in Health Insurance
BODY:
LEGISLATION TO require that health insurance
contracts provide greater "parity" in coverage of mental and physical illness if
they cover mental illness at all may well pass in this Congress. A limited and
mostly hortatory version of the bill passed a couple of Congresses ago. The idea
has bipartisan support; Pete Domenici and Paul Wellstone are the leading
sponsors in the Senate. The president has climbed aboard the bandwagon, if wagon
it is. The opposition, while real, is somewhat muted, perhaps reflecting the
fact that this is a hard cause to which to say no.
So it could happen,
and the benefit is clear enough. Mental illness can be every bit as debilitating
as physical illness; many people, including, it would seem, many members of
Congress, are familiar with cases in which it has struck. It is susceptible to
treatment and can often be managed if not "cured." But
insurance policies, no doubt mirroring a view in the society at
large, traditionally have been written in such a way as to make them far less
hospitable to mental health claims than to claims for treatment of often
less-serious physical illnesses. The Domenici-Wellstone legislation, and the
executive order the president issued the other day, affecting coverage under the
federal employment health benefit program, seek in various ways to reverse that.
We are not disposed to argue, so much as to note that in this, as in all such
cases, the benefit is accompanied by costs. Both sides in this case seek to have
the cost issue both ways, and neither can. Proponents say the need is great --
great enough to require regulation, surely -- but that the cost would be all but
imperceptible -- an extra percentage point or two on premiums, perhaps. The
business groups that have led the opposition say the opposite -- that the cost
would be appreciable, while the need can safely be left to the market. Our own
sense is that the two go in tandem.
Opponents -- some, at least -- say
the cost increase would be enough to price some significant number of people out
of the insurance market, thereby reducing on balance the
coverage the proposal sets out to expand. The patchy data that exist suggest
that this is an exaggeration -- that by itself the mental health proposal would
not have that great an effect on costs (though as drafted the legislation could
induce some companies to free themselves from the constraint by dropping mental
health coverage entirely).
But the question is whether this will be the
only such benefit that, over time, Congress is tempted to confer through the
regulation of private health insurance, a relatively new field
for it, or whether there will be more. What about the convalescent and other
long-term care that many health insurance policies don't cover?
Should they be required in the name of parity to offer more? You can think of
all manner of sympathetic examples of your own.
The other day in
Congress some members introduced a bill to require that
contraceptives be covered by plans that cover prescription
drugs and devices. It too is presented as a question of unfair discrimination,
and perhaps it is; the sponsors note that women of child-bearing age end up
having to spend far more than men in out-of-pocket health care costs. By itself,
this worthy benefit wouldn't be that costly, either. But is Congress, acting as
a kind of national benefit commission, the right forum for deciding what private
health insurance contracts should be made to cover when
Congress doesn't have to bear the cost nor bear directly the blame for raising
cost? It seems to us that question has to be a part of the debate as well.
LOAD-DATE: June 14, 1999 
