Debate Over Mental Health Parity Legislation May Shift Focus to Breadth of Coverage
While President Bush is expected to announce his support for mental health parity legislation today, it is unclear whether he will endorse equal coverage for all behavioral disorders or only the most serious illnesses, the Washington Post reports. In either case, Bush's stance will highlight a "shar[p] debate" among mental health providers and advocates over the breadth of parity legislation. Patients and doctors dealing with the most serious disorders, such as schizophrenia and bipolar illness, "say that if confronted with a choice between no parity and parity for the most serious illnesses, they would settle for the limited benefit," the Post reports. But many mental health advocates say that anything less than full parity for hundreds of mental conditions would be a defeat (Vedantam, Washington Post, 4/27). Last December, the Senate passed an extension of the 1996 mental parity law, which prohibited insurers from establishing annual lifetime limits on mental health benefits that differed from those applied to other medical care. The proposed expansion, which died in a House-Senate conference committee, would have required insurers that provide mental health coverage to offer those benefits at the same level as the benefits provided for physical health coverage with respect to both costs (such as deductibles) and access to services (California Healthline, 4/25). Sens. Pete Domenici (R-N.M.) and Paul Wellstone (D-Minn.), have reintroduced the proposed expansion, which would require equal coverage for all mental health disorders listed in the American Psychiatric Association's Diagnostic and Statistical Manual (DSM), a 941-page "compendium of the diseases, disorders and distress that affect the human psyche."
As the governor of Texas, Bush signed a parity law that was limited to a few disorders. Insurance companies, while opposed to parity in general because they say it would lead to higher health costs, would favor this approach if forced to choose. "The Senate bill will require coverage of a range of conditions, including caffeine addiction, jet lag, religious problems, occupation problems," Karen Ignagni, president of the American Association of Health Plans, said, adding, "When members of Congress think about mental health, they think about schizophrenia. I don't think they are aware of the generalities and terms used in the Senate legislation which could increase costs for conditions that are not supported by the scientific research." Likewise, in a research paper published by the Heritage Foundation last month, Timothy Kelly, a clinical psychologist in Virginia, said that parity should encompass only schizophrenia, bipolar disorder, major depression, severe panic disorder, obsessive compulsive disorder, post traumatic stress disorder, attention deficit disorder and anorexia nervosa. But most "major" mental health patient and doctor groups are opposed to compromising on parity, saying it would prevent people with legitimate disorders from getting needed care, the Post reports. "If it only covers schizophrenia and bipolar illness, as important as that is, it would not cover many of the needs that people have as a result of trauma, terrorism and many other mental health problems," Michael Faenza, president of the National Mental Health Association, said. And Allison Dobson, a spokesperson for Wellstone, said that limited parity could "start a new form of discrimination, pitting one form of mental illness against the other" (Washington Post, 4/27).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.