President Bush Offers General Endorsement of Mental Health Parity Legislation
President Bush called on Congress yesterday to approve a mental health parity bill this year but did not offer specifics on what type of measure he would support, the Los Angeles Times reports (Gerstenzang/Kemper, Los Angeles Times, 4/30). "Our country must make a commitment: Americans with mental illness deserve our understanding, and they deserve excellent care. They deserve a health care system that treats their illness with the same urgency as a physical illness," Bush said at a speech at the University of New Mexico (AP/Las Vegas Sun, 4/29). But Bush did not directly address whether he favors a bill that covers all mental illnesses or only the most serious disorders -- an issue that appears likely to be the main dividing point as negotiations over parity legislation proceed (Kornblut, Boston Globe, 4/30). Bush was joined by Sen. Pete Domenici (R-N.M.), who along with Sen. Paul Wellstone (D-Minn.) is co-sponsoring the leading parity bill (S 543) on Capitol Hill (Roth, Houston Chronicle, 4/30). Their proposal builds on the original 1996 mental health parity law, which prohibited health plans that cover mental illness from setting different annual and lifetime benefits than they do for physical illnesses. The law was reauthorized for one year in December after Wellstone's and Domenici's proposal, which was attached as an amendment to the fiscal year 2002 Labor-HHS appropriations bill, failed to pass a House-Senate conference committee. It does not prevent insurers from establishing higher deductibles or copayments for mental health benefits than for other medical conditions, a loophole that the new proposal seeks to eliminate. The Domenici-Wellstone bill, which has 64 cosponsors, would require all health plans that provide mental health benefits to offer full parity with respect to both costs and access to services (Goldreich, CQ Monitor News, 4/30). Businesses with fewer than 50 employees would be exempt from the mandate (Hotakainen, Minneapolis Star Tribune, 4/30).
The measure faces a "fierce fight on Capitol Hill," where many House Republicans, including the leadership, are opposed, saying it would greatly increase health costs (Curl, Washington Times, 4/30). In addition, some lawmakers who support parity in concept want equal coverage limited to the most severe mental disorders, such as schizophrenia. The Domenici-Wellstone bill, on the other hand, would mandate parity for every disorder -- more than 250 -- listed in the American Psychiatric Association's Diagnostic and Statistical Manual (Boston Globe, 4/30). As governor of Texas, Bush signed a bill requiring parity for eight serious mental disorders, including schizophrenia and depression (Keen, USA Today, 4/30). The Washington Post reports that Bush yesterday "alternated between references to covering 'all' people with mental illness and treating 'serious mental illness.'" While stating that it is "critical" to "provide full mental health parity," Bush said it must be done without "significantly" raising health costs (Milbank, Washington Post, 4/30). White House Press Secretary Ari Fleischer said that the administration's goal was to achieve "maximum parity ... without driving up the costs so high that people lose insurance in the end" (Los Angeles Times, 4/30). An aide to Wellstone said he and Domenici are continuing to negotiate with Bush over the bill's scope. According to one health care lobbyist, the bill would have to be "narrowed significantly to give Bush the middle ground he needs to win House Republican support" -- a move that could divide mental health advocates (CQ Monitor News, 4/30). The Boston Globe reports that Senate Majority Leader Tom Daschle (D-S.D.) is "reportedly ready to bring the bill to a vote again -- perhaps as early as next month -- if a compromise with the White House fails to materialize" (Boston Globe, 4/30).
Mental health advocates generally backed Bush's endorsement of parity, while insurer and business groups reiterated their opposition to a "costly new mandat[e]" (Webb, St. Paul Pioneer Press, 4/30). The American Psychiatric Association released a statement praising Bush for "his commitment to ending discrimination ... against patients seeking treatment for mental illness by supporting mental health parity legislation" (Los Angeles Times, 4/30). But Kate Sullivan, director of health policy at the U.S. Chamber of Commerce, part of a coalition that has run newspaper advertisements urging Congress not to pass the Domenici-Wellstone bill, said, "It's not the benefit, it's the cost. Employers know the value of having good mental health coverage, but they are struggling just to hang on to the benefit programs they already are offering, and many are already at the brink" (Rovner, "All Things Considered," NPR, 4/29). The Congressional Budget Office has estimated that the Domenici-Wellstone bill would increase insurance costs by about 1% a year, or a total of $23 billion, although opponents of the measure call that figure "far too low" (Los Angeles Times, 4/30). Under one possible legislative compromise, employers could receive an exemption from the law if costs were found to be too great. The Wellstone-Domenici proposal offers no exemption, but past discussions have considered offering exemptions if the parity requirement were to increase an employer's health care costs by more than 1% (California Healthline, 4/25).
In his speech, Bush also announced the formation of a 15-member commission to study the "cracks" in the nation's mental health care system and to offer recommendations for improvement. The commission will be headed by Michael Hogan, director of the Ohio Department of Mental Health (Boston Globe, 4/30). A 1999 surgeon general's report found that 50 million Americans have a mental illness each year, but fewer than 50% of them seek treatment (Los Angeles Times, 4/30). The full text of Bush's speech is available online. A report on the speech from NPR's "All Things Considered" is available online in RealPlayer. There will also be a discussion of mental health insurance parity in the second hour of NPR's "Talk of the Nation" today. Check local listings for show times. The audio for the program will be available online in RealPlayer after 6 p.m. ET.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.