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WASHINGTONDifferent approaches taken in House and Senate versions of federal mental health care benefits parity legislation could erode the broad support the parity drive initially enjoyed.
When a Senate panel in February overwhelmingly approved legislation to expand a federal mental health care benefits parity law, the path to congressional approval seemed clear.
For the first time since the drive began several years ago to expand the 1996 parity law, federal legislators brought in employer and insurer groups to try to build support for a compromise bill.
That effort was successful, with several business groups that had staunchly opposed prior measures--including the American Benefits Council and the National Retail Federation--lining up to support and help shape the measure proposed by Senate Health, Education, Labor and Pensions Committee Chairman Edward Kennedy, D-Mass.
But the path to final approval no longer is as clear. Standing in the way is a new House bill, which on a key point takes a very different approach than the Senate measure.
That difference: the House bill, introduced last month by Sen. Patrick Kennedy, D-R.I., would require group plans to cover any diagnosis listed in the psychiatric community's compendium of mental health disorders on the same basis as any other medical condition. By contrast, the Senate bill leaves it to employers to decide which mental health disorders they will cover, though that coverage would have to be equal to coverage for other medical conditions.
Employer groups say that difference alone renders the House bill unacceptable and pledge to fight against its passage.
"The Senate HELP bill is absolutely as far as we can go. Indeed, we have bent over backwards to go that far," said Neil Trautwein, vp and employee benefits policy counsel with the National Retail Federation in Washington.
"The House bill would set a terrible precedent by saying a plan has to cover any condition for which there is a name or a code. The employer loses control in deciding what services its plan will cover," said Paul Dennett, vp-health policy at the American Benefits Council in Washington.
No one knows whether either chamber would be prepared to compromise and accept the other branch's position on the issue. But all agree that compromise will be difficult.
"It is difficult to see how this issue will get resolved," Mr. Dennett said, adding, though, it is still very early in the legislative process.
"There are some very fundamental differences," said Katie Strong, director of congressional and public affairs for the U.S. Chamber of Commerce in Washington.
Complicating matters is that the House measure has massive support among House members--more than 260 representatives are co-sponsors--while the Senate bill also enjoys broad support in that chamber. Additionally, neither side has reached out to the other to work out this and other differences, lobbyists say.
Whichever approach prevails, most employers will have to expand their coverage of mental health disorders.
Both bills, for example, would require employers to provide the same financial cost-sharing requirements for mental health coverage as they do for other medical conditions. For example, if a group health care plan covered 80% of medical treatment expenses, it would have to do the same for mental health care expenses.
In addition, discriminatory treatment limitations would be banned. That would mean an end to common plan designs in which a maximum of 20 or 30 annual visits to mental health care therapists are covered, with no limits imposed on the number of visits to physicians treating other medical conditions.
Similarly, health care plans could not impose a limit on the number of inpatient days for treatment of mental disorders if they did not impose the same limit for other medical conditions.
That would be a big change from the 1996 law that bans discriminatory annual and lifetime dollar limits, which were common before Congress banned them, for coverage of mental health care expenses, but permits other discriminatory cost designs.
Forced by the 1996 law to do so, employers scrapped those dollar limits and imposed new limits, such as covering 50% of a claim for mental health care services but paying 80% of other medical claims' costs.
While parity advocates have been lobbying for years to expand the 1996 law, this year was viewed as a breakthrough year, with Sen. Kennedy defusing employer opposition by bringing employers into the negotiating process. At the same time, with the Democrats regaining control of the House, House Republican leaders who had blocked parity bills previously no longer are in a position to do so.
Some say eventually legislators--if a compromise between the two bills can't be reached--just might walk away from the issue. "When an issue comes up year after year, legislators get worn down" and get tired of it, said Mark Ugoretz, president of the ERISA Industry Committee in Washington.