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APA Medical Director Steven M. Mirin, M.D., joined Senators Paul Wellstone (D-Minn.), Pete Domenici (R-N.M.), and other mental health care advocates on Capitol Hill October 21 to denounce a reported deal between the White House and business leaders that could let many businesses opt out of a limited mental health parity law.
A provision of the Mental Health Parity Act signed by President Clinton in September 1996 permits businesses to opt out if providing mental health benefits raises their plan costs by 1 percent or more. Supporters of the legislation, which becomes effective in January 1998, had reluctantly accepted the 1 percent exemption, an amendment offered by Senator Phil Gramm (R-Tex.), in order to assure the bill’s passage. But they had envisioned the exemption being based on a plan’s retrospective experience after the first year of implementing the parity act provisions. According to a front-page story by Robert Pear in the October 21 edition of the New York Times, however, the White House acceded to pressure from business lobbyists to permit exemptions based on prospective estimates using 1997 cost data.
At press time, APA lobbyists working with Domenici and Senator Harry Reid (D-Nev.) succeeded in getting the Senate to accept a provision that would have directed the Secretary of Health and Human Services and the Secretary of Labor to identify and disclose, on a quarterly basis, all employers and health plans that had opted out based on the 1 percent exemption. But the language was rejected by the House, and with only a week remaining in the first session of the 105th Congress, it was highly unlikely that any further action would occur on the exemption, according to APA’s deputy director for federal relations, Shelley Stewart.
APA’s concerns are not limited to the "special interests’ inventive interpretation of the law’s ostensibly clear language stating that the employer needs to first provide the benefit before requesting a waiver," remarked APA Director of Government Relations Jay Cutler, J.D. APA is also concerned with the "need for public accountability," he added. Otherwise, there would have been no provision in the law requiring enforcement with respect to waiver requests, he noted.
Millions of Americans are depending on implementation of the parity act to "ensure fairness and needed health care," remarked Mirin. Allowing use of a prospective exemption is "a travesty, and we need to stand up and say that it is," Mirin added.
Thirteen states have parity laws, and another 33 states have such laws pending, observed Mirin. Their experience shows that "parity for mental health care saves money rather than costs money."
The Administration should consider the potential impact on those 33 states "if we can’t set an example here in Washington," Mirin said. "So I urge you all to advocate on behalf of our patients, on behalf of their family members, to roll back this unwarranted attack on the parity" law.
The parity act was "an enormous step forward for the country" because it ended some of the discrimination that people with mental illness have faced for years, said Wellstone. "We don’t intend to raise the hopes of people and finally get to the point where people can get some decent care to now, all of a sudden, have a rule come out that will give the big insurance companies and large businesses a huge loophole."
The 1 percent provision was "very clear," Wellstone added. "I went back through the Congressional Record today to check on this. I remember the debate we had. And what we said was that first we implement this legislation, and then we evaluate it. We never said that it was prospective, and that companies could, on their own, contract out to somebody to do a kind of projection about what the cost would be and then, also on their own, opt out of this."
Domenici remarked that he has gotten more thanks from people for pushing the parity act than for "any other issue." People are "looking forward to this with a kind of exhilaration that you just can’t imagine," he added. "Because there’s huge fear in the community of people out there that have relatives, friends, children, neighbors who have serious mental illness, about whether the insurance companies are going to continue to get by doing lip service to mental illness coverage."
The Administration’s reading of the exemption rule would make it "so easy for companies to deny coverage that we may just as well not have passed the bill," Domenici said.
He urged the Administration to establish a procedure that "requires that companies prove that, in fact, it’s too expensive."
One way would be to require companies to purchase insurance and at the end of 1998 determine its impact on plan expenses.
While chiding the Administration for its interpretation, Domenici departed from his customary pro-business stance to admonish business and insurance executives to be good corporate citizens.
Businesses should understand that they will eventually have to comply with the parity law, Domenici said. If there are problems, "we’re going to go back and fix it," he added. We are "going to make sure that coverage is extended" because we know that it is not too expensive to do so, he said.
The Clinton Administration’s interpretation of the 1 percent provision is an example of government regulation at its worst, said Reid. Many people throughout the country "had a celebration when this law passed," but the mood has since turned to sadness as people have learned that "through government fiat, government regulation they’re going to undo what we did in the Congress. We cannot allow this to happen."
New Jersey Representative Marge Roukema (R) expressed shock at what she characterized as the Administration’s creation of a loophole to sidestep the intent of Congress.
Allowing a prospective exemption would perpetuate discrimination against mental illness, Roukema added. "I’ll tell you we just cannot stand for this; we’ve got to fight back. . . . However that loophole was opened, it’s got to be closed."
An angry Representative Vic Fazio (D-Calif.) lashed out at the "less enlightened employers and insurance companies in America," which, he said, were "twisting arms at the Administration" to negate the intent of the parity act.
Studies show that "ultimately there will be savings both to taxpayers and to employers if we enact reasonable mental health parity legislation," said Fazio. If "those special interests who are pushing this perversion of our legislation are successful," they may "rue that day," he added. "Because I don’t think we’ll come back simply with what we did last year. I believe we will come back with full parity legislation. The people of America are behind us on this issue, and we will not be denied."
National Alliance on Mental Illness (NAMI) Executive Director Laurie Flynn blasted the Administration’s interpretation of the 1 percent exemption as continued discrimination against the mentally ill. "Discrimination should be a thing of the past," said Flynn. "It is rooted in outmoded stigma."
Flynn said she wanted to have "an answer for my daughter, who spoke to me this morning after hearing about this and asked me this question: ‘How long will I be a second-class citizen?’ Today we should resolve that issue. We should move forward as this nation has always done to protect those people who need our help and provide access to health care that works."