On the heels of an 82-15 victory in the United States Senate September 5, supporters of legislation equalizing payment limits for mental illness and physical illness raced to get the measure through the House of Representatives before the planned September 27 end of the second session of the 104th Congress.

At press time House-Senate conferees were considering the measure as part of a spending bill for the departments of Veterans Affairs and Housing and Urban Development (V.A.-HUD). Representative Marge Roukema (R-N.J.), sponsor of a companion measure in the House, scheduled a press conference at 1 p.m. September 11 to ask colleagues for support. Later that day the House voted 392-17 to approve "a motion to instruct" House conferees to accept the mental health measure passed by the Senate a week earlier.

Also at press time APA President Harold Eist, M.D., issued a statement urging support of the Roukema measure.

"The Roukema bill will help ensure that insurance companies do what they are supposed to do--insure people against the risk of illness, rather than what they are doing--avoiding risk by discriminating against one type of illness. . . .The Roukema bill says that whatever lifetime and annual caps are in a policy on physical illness, the same caps apply to mental illness," Eist said.

As passed by the Senate, the measure mandates that health insurers who offer any mental health coverage must apply the same aggregate annual and lifetime limits to that coverage as for all other health insurance coverage. In winning passage of the measure, sponsor Senator Pete Domenici (R-N.M.) cited Congressional Budget Office (CBO) estimates that the mandate would cause only a 1/16 of 1 percent increase in health insurance costs.

Domenici and cosponsor Senator Paul Wellstone (D-Minn.) had fought an uphill battle after Senate passage of a comprehensive parity measure earlier this year. The business community had rallied in opposition based on CBO figures projecting a substantial increase in health insurance costs under comprehensive parity. Supporters of that measure, including Domenici, had argued that it would ultimately save money by providing people with access to appropriate treatment, helping them to be healthier and more productive.

Unlike the earlier provision, which would have required insurers with mental health plans to apply the same rules to deductibles, copayments, and visit limits for mental health care as all other health care, the compromise leaves insurers free to manage the benefit as they see fit, subject only to equal aggregate caps.

The compromise measure keeps costs down further by exempting small businesses with 25 or fewer employees. Based on Domenici's pledge that the compromise measure would not increase health care costs by more than 1/16 of 1 percent, he voted for an amendment by Senator Phil Gramm (R-Tex.) that would exempt plans that experienced premium increases of 1 percent or more as a result of the mandate.

The compromise excludes substance abuse treatment from the mandate and permits separate insurance products (carve-outs) for mental and medical health coverage.

The Senate version specifies that the mandate would apply to federal employees' health benefits starting October 1, 1997, and would sunset September 30, 2001.

The CBO assumed the effective date for private plans would be January 1, 1997, according to a September 10 CBO memo. Over the six years between 1997 and 2002, the proposal would increase the federal deficit by about $590 million, according to a combined CBO and Joint Committee on Taxation estimate. It assumes that the 1/16 of 1 percent cost would be passed on to employees in lower wages, which, in turn, would reduce federal income and payroll tax revenues.

The APA-backed Coalition for Fairness in Mental Illness Coverage wrote Domenici on September 10 urging him to "help us in the fight to end insurance discrimination and support the mental illness parity provision in the final V.A.-HUD appropriations bill." In addition to APA, the coalition is composed of the National Alliance on Mental Illness, Mental Health America, American Managed Behavioral Healthcare Association, American Medical Association, American Psychological Association, Federation of American Health Systems, and National Association of Private Psychiatric Health Systems.

In a related matter, Eist testified before the House Government Reform and Oversight Subcommittee on Civil Service September 5 on mental health coverage parity under the Federal Employees Health Benefits Program (FEHBP). The federal Office of Personnel Management eliminated the lifetime coverage maximum on mental health benefits in FEHBP plans in 1995.

(Psychiatric News, September 20, 1996)