#61
Bush Plans to Endorse Mental Health 'Parity'
Hill Negotiating Insurance Bill Details
04/25/02 Washington Post
President Bush is close to agreement on legislation forcing employers to expand insurance coverage for psychiatric illnesses, a position urged by mental health advocates but one that has been opposed by business groups and several key Republicans. Bush plans to give the idea a strong endorsement Monday, when he is scheduled to speak in Albuquerque at a job training facility for people recovering from mental illnesses, congressional officials said. Those familiar with the status of negotiations, which continued yesterday, cautioned that there may not be agreement by Monday on all details of the legislation, known as "mental health parity." But they said Bush supports the idea and is likely to sign legislation this year.
An announcement of expanded mental health coverage in the home state of Sen. Pete V. Domenici (R-N.M.) would be a triumph for the lawmaker, who has a child suffering from schizophrenia and who has championed the cause for years. In a broad sense, it would require employers' health insurance plans to treat mental illness the same as other illnesses for the purposes of reimbursements and caps on payouts. "Talks have been going on," Domenici spokesman Chris Gallegos confirmed. "At this point there is no agreement."
A weaker version of the mental parity legislation expired last fall, and Congress has been debating plans to renew and strengthen the law. Supporters said White House backing would likely provide a sufficient push to get the proposal enacted. Moreover, they added, a gesture of support for the mentally ill by the Republican president could reduce the stigma and shame of mental disorders and could boost his "compassionate conservative" credentials. The main opposition has come from key GOP lawmakers in the House, who object to the higher cost the requirement would impose on employers. The White House would need to persuade House conservatives to endorse the idea, which has long had strong backing from Democrats. As wife of the vice president, Tipper Gore made it her signature issue, and Senate Majority Leader Thomas A. Daschle (D-S.D.) has said he hopes to have a vote on the legislation soon. Efforts by the White House to involve itself in mental health parity legislation could head off an election-year battle with Democrats on the subject. Last week, Daschle said he would proceed with the legislation even in the absence of an agreement with the White House. "Mental health parity, I think, is something that's going to pass," he said. An earlier version of the legislation, enacted in 1996, required employers not to set higher annual or lifetime limits on mental health services than on other health services. But it allowed them to charge patients higher premiums and co-payments and offered them exemptions if compliance increased their health care costs by more than 1 percent. Domenici and Sen. Paul D. Wellstone (D-Minn.) passed legislation in the Senate last year requiring group health plans at
businesses with more than 50 employees to provide mental health coverage without higher premiums and co-payments than those for other illnesses. But the provision was opposed by House Republicans and removed in a conference between the House and Senate over a spending bill.
The issues still in dispute are whether the legislation will cover more than 200 disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, as Domenici and Wellstone have proposed, or major diseases such as schizophrenia and bipolar disorder, which the White House is believed to favor.
Also under consideration is whether employers could be exempted if the costs proved excessive. The Domenici-Wellstone legislation had no exemption. Past discussions have focused on exemptions if health care costs increase in the vicinity of 1 to 3 percent. Negotiators are looking for ways to hold down the overall cost of the legislation, possibly without specific exemptions and limitations on diseases covered. The legislation is likely to be broader than one Bush signed into law as Texas governor in 1997. Texas, one of 26 states with mental health parity laws, includes only major mental illnesses in its law.
Congressional estimates indicate the Domenici-Wellstone legislation would boost health care premiums by 1 percent. Opponents of that bill, who have included House Speaker J. Dennis Hastert (R-Ill.), House Whip Tom DeLay (R-Tex.) and key GOP committee leaders, argue it would increase costs on employers and workers. Wellstone, who faces a difficult reelection battle, has not been involved in the negotiations between Domenici and the White House. "We continue to be very optimistic," said Wellstone spokeswoman Allison Dobson. Domenici updated Wellstone of his conversations in a phone call last night and said there was still no deal.