Washington Post: Congress Approves mental health bill

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Congress Approves Mental Health Bill

Private Insurers Would Provide More Benefits

By Lyndsey Layton

Washington Post Staff Writer

Wednesday, September 24, 2008; A02

http://www.washingtonpost.com/wp-

dyn/content/article/2008/09/23/AR2008092302882.html?wpisrc=newsletter

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. 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 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.