By Lyndsey Layton
Washington Post Staff Writer
Wednesday, September 24, 2008
Congress approved legislation yesterday that would require private insurers to provide the same level of benefits for mental illness as they do for physical maladies, a change lauded by advocates as a great shift in the nation's understanding of mental health.
"We've always had a stigma, sort of like mental illness is a character flaw," said Rep. Patrick J. Kennedy (D-R.I.), who has struggled with drug and alcohol addiction and co-sponsored the House version with Rep. Jim Ramstad (R-Minn.), a recovering alcoholic. "But now science has moved forward, and we can see the complexities in the brain that lead to eating disorders, compulsive disorders. All these connections are being made, the science is just becoming so firm. And it destroys the myth that this stuff is a choice."
The measure has received strong bipartisan support in the House and Senate and has the backing of business, insurance companies, health advocates, the medical community and the White House. But its passage into law was not ensured last night.
The remaining obstacle appeared to be ironing out differences in how to pay the cost to the federal government -- estimated at $3.4 billion over 10 years, in the form of forgone tax revenue. Lawmakers also needed to resolve whether the final bill should be a standalone measure or part of a larger package of legislation.
The House approved the language in a standalone bill, while the Senate wrapped it into a $150 billion package of popular tax cuts, including a one-year patch for the alternative minimum tax, and extensions of expiring tax provisions including tuition credits and state and local sales tax deductions (for states that do not have an income tax), as well as research and development tax credits.
It is unclear whether a joint agreement can be reached in the few days remaining before Congress recesses.
"The Senate has devolved to the point where almost nothing is moving now," one senior Senate staff member said. "The issue is whether this gets caught up in the bigger inertia of the Senate."
Lobbyists for health care and industry and Hill staff members say now is the best moment for the bill to be passed.
"We've come so very, very far," said Andrew Sperling, legislative affairs director for the National Alliance on Mental Illness. "We are in a whole world of trouble if we don't get this done. We just can't pick up the pieces and start where we left off this year if it doesn't pass."
Federal law now allows insurers to set higher co-payments or stricter limits on mental health benefits than they do for medical or surgical coverage.
"You go in there with a broken arm, you have a $200 deductible and your insurance kicks in," Kennedy said. "You have depression, schizophrenia, substance abuse, and you find out you have a $2,000 deductible, you've got limitations on your treatment and all kinds of co-pay."
Typical annual limits include 30 visits to a doctor or 30 days of hospital care for treatment of a mental disorder. Under the legislation passed yesterday, those limits would no longer be allowed if the insurer had no limits on treatment for medical conditions such as cancer, heart disease and diabetes. Small businesses with fewer than 50 employees would be exempt.
Currently, 42 states require insurance companies to cover mental and physical illnesses equally, as does the federal employees' health benefit program. But 82 million people work for employers who self-insure, which means they are exempt from state parity laws. An additional 31 million are in other plans that do not have to offer equal coverage.
The legislation is the culmination of more than a decade of lobbying by mental health advocates and several members of Congress.