| After more
than a decade of struggle, the House on Wednesday passed a bill
requiring most group health plans to provide more generous coverage
for treatment of mental illnesses, comparable to what they provide
for physical illnesses. The vote was 268 to
148, with 47 Republicans joining 221 Democrats in support of the
measure.
The Senate has passed a similar bill requiring
equivalence, or parity, in coverage of mental and physical ailments.
Federal law now allows insurers to discriminate, and most do so, by
setting higher co-payments or stricter limits on mental health
benefits.
“Illness of the brain must be treated just like
illness anywhere else in the body,” said Speaker
Nancy Pelosi, Democrat of California. Supporters of the House
bill, including consumer groups and the
American Psychiatric Association, said it would be a boon to
many of the 35 million Americans who experience disabling symptoms
of mental disorders each year.
Insurers and employers supported the Senate bill.
Many opposed the House version, saying it would drive up costs.
President Bush endorsed the principle of mental
health parity in 2002. But on Wednesday, the White House opposed the
House bill, saying it “would effectively mandate coverage of a broad
range of diseases.”
Both bills would outlaw health insurance practices
that set lower limits on treatment or higher co-payments for mental
health services than for other medical care.
Typical annual limits include 30 visits to a
doctor or 30 days of hospital care for treatment of a mental
disorder. Such limits would no longer be allowed if the insurer had
no limits on treatment of conditions like cancer, heart disease and
diabetes.
The
Congressional Budget Office estimated that an earlier version of
the House bill would increase premiums for group health insurance by
an average of four-tenths of 1 percent. Some of the cost could be
passed on to workers.
The House bill does not apply to health plans
sponsored by an employer with 50 or fewer employees. Nor does it
apply to coverage in the individual insurance market.
Three factors contributed to support for the
legislation. First, researchers have found biological causes and
effective treatments for numerous mental illnesses. Second, a number
of companies now specialize in managing mental health benefits,
making the costs to insurers and employers more affordable.
Finally, some doctors say that the stigma of
mental illness has faded as people see members of the armed forces
returning from Iraq and Afghanistan with mental disorders.
Supporters of mental health parity see it as a
civil rights issue, and the debate Wednesday was filled with
poignant moments.
“I have a mental illness, and I am fortunately
getting the best care this country has to offer because I am a
member of Congress,” said Representative
Patrick J. Kennedy, Democrat of Rhode Island and chief sponsor
of the House bill. Mr. Kennedy has been treated for depression and
drug dependence.
The main Republican sponsor, Representative Jim
Ramstad of Minnesota, a recovering alcoholic, said, “I am living
proof that treatment works and recovery is real.”
The House bill is named for Senator
Paul Wellstone, the Minnesota Democrat killed in a plane crash
in 2002. He had a brother with severe mental illness. The main
sponsor of the Senate bill,
Pete V. Domenici, Republican of New Mexico, has a daughter with
schizophrenia.
Under a 1996 law, health plans are forbidden to
set annual or lifetime dollar limits on mental health care that are
lower than the limits for other services. But insurers have gotten
around the law by setting different limits on the number of
outpatient visits or hospital days, and by charging different
co-payments.
The protections of the House bill apply to people
who need treatment for alcohol and drug abuse, as well as mental
illness.
Under the bill, if an insurer chooses to provide
mental health coverage, it must “include benefits” for any mental
health condition listed in the latest edition of the Diagnostic and
Statistical Manual of Mental Disorders, published by the American
Psychiatric Association.
E. Neil Trautwein, a vice president of the
National Retail Federation, a trade group, said: “Businesses will be
faced with the choice of covering every single mental or substance
abuse disorder listed in the diagnostic manual, or nothing at all.
Neither choice is appealing.”
Among the conditions listed in the manual, critics
noted, are caffeine intoxication and sleep disorders resulting from
jet lag.
Nicholas M. Meyers, director of government
relations at the American Psychiatric Association, said: “This is
nonsense. Simply because a diagnosis is made does not obligate
insurers to pay for treatment.”
Insurers could still deny coverage if they found
that a service was not medically necessary. |
