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Recovery in the News
House passes Kennedy’s mental-health bill
John E. Mulligan
Providence Journal
March 6, 2008
WASHINGTON — The House last night handily passed Rep. Patrick J. Kennedy’s legislation to put medical insurance for the treatment of mental illness and addiction on a par with coverage of physical ailments.
The 268-to-148 vote sets up potentially difficult compromise talks with the Senate, which last fall passed a more restrictive version of mental-health insurance parity, under the sponsorship of the congressman’s father, Massachusetts Sen. Edward M. Kennedy, among others.
The House vote was a personal victory for Patrick Kennedy and the coauthor of the bill, Rep. Jim Ramstad, a Republican from Minnesota. For more than a year, the two have campaigned against the longstanding disparity in mental-health insurance coverage, telling their personal stories of addiction and alcoholism.
“My friends, I have a mental illness,” Kennedy said — noting that his government insurance policy covers his treatment of bipolar illness as well as drug addiction and alcoholism.
“If you have diabetes, no one holds it against you,” Kennedy said during the three-hour debate yesterday afternoon. But Kennedy said the mentally ill are still too often stigmatized, in part by insurance rules that often impose higher fees or tighter treatment limits on mental-health patients than on those suffering from physical maladies.
“It’s your fault if you wander around in the streets and you’re homeless” because of addiction or mental disease, declared Kennedy, who has framed the mental-health parity debate as a question of civil rights.
“I’m living proof that recovery works,” said Ramstad, who again recounted how he sought treatment for alcoholism more than 25 years ago after “I woke up in a jail cell in Sioux Falls, S.D.”
Former first lady Rosalynn Carter, a longtime advocate for the mentally ill, said at a rally in front of the Capitol before the vote, “Insurance parity is the most important thing we can do to end the stigma.”
But there were renewed warnings yesterday that the more expansive House bill would have the perverse effect of undermining mental-health coverage by raising its cost and regulatory burden on insurance companies.
“This whole thing could come unglued” if House members insist on their version of the bill in negotiations with the Senate, said Rep. Heather Wilson, a New Mexico Republican, after losing an effort to have the House consider the Senate version of the bill.
Wilson said that the best path to mental-health insurance parity is the Senate compromise worked out early last year among business, the managed-care industry and key mental-health advocacy groups.
Sen. Pete V. Domenici, a New Mexico Republican who has championed mental-health parity for many years, was even more emphatic. “To me this is an absolute disaster,” he said of the passage of the more generous House bill.
Domenici asserted that a straightforward House-Senate compromise conference will fail because even modest concessions to the House version will drive away enough Senate supporters to kill the bill. “We can’t pass anything close to that bill over here,” Domenici said in an interview.
“I don’t accept that,” Senator Kennedy said in an interview as he prepared to walk over to watch the House debate his son’s bill. The elder Kennedy, Domenici’s longtime partner in the parity campaign, conceded that the differences between the two bills are “something we’ll have to work on.”
Senator Kennedy declined to predict how negotiations would proceed, but said he has had much experience with fashioning compromise between sharply divergent versions of important legislation.
Kennedy also said the House vote constitutes “an extraordinary step forward” to fair treatment of the mentally ill. He has said in the past, moreover, that passage of a House version of the bill will help to spur negotiations.
To those who prefer the Senate bill, the biggest difference is that it gives the managed-care market much latitude in deciding which mental illnesses to cover. The House bill, by contrast, requires coverage of all conditions set out in the diagnostic code of the mental-health industry’s professional organization. Patrick Kennedy argues that this is the only fair approach.
Supporters of the Senate bill argue that the diagnostic list in the House bill will drive up costs by including a number of marginal conditions.
The House bill also has more stringent requirements than the Senate bill for coverage of mental illness by doctors and other caregivers who do not belong to the coverage “network” of the patient’s insurance plan.
The House bill, in addition, demands that managed-care companies disclose more about the criteria that they set for coverage of mental illness.
Supporters of the Senate and House parity bills have had informal discussions for months about possible grounds for compromise because it has long been clear that each version had strong support.
Both versions build on a limited mental-health parity law, enacted in 1996, that dealt largely with insurance for government employees. The bills under consideration do not force mental-health insurance upon private carriers. Rather, they require that insurers who offer any treatment for mental illness must use the basic same rules that they apply to the treatment of cancer or broken bones or other physical ailments.
For example, the managed-health-care company cannot impose higher copayments for a session with a clinical psychologist than it charges for a visit to the same customer’s cardiologist
If the two houses agree on a compromise version, it would go to President Bush’s desk for his signature. Mr. Bush is on record as supporting mental-health parity.