Advocates laud president’s statement but don’t see victory yet
Mental health advocates cheered President Bush’s recent public support for health insurers extending the same level of coverage to treat mental illnesses as they do for medical ailments. But despite the president’s high-profile backing, advocates cautioned that legislation now pending in Congress is no slam dunk.
Rhode Islander James McNulty, president of the National Alliance for the Mentally Ill (NAMI) in Arlington, Va., stressed that the President stopped short of proclaiming support for federally mandated parity.
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"He hasn’t backed the Domenici-Wellstone bill yet, and it’s not clear to me that he will," McNulty said, referring to the Senate bill sponsored by Republican Sen. Pete Domenici (N.M.) and Sen. Democrat Paul Wellstone (Minn.). "But I’d say the chances are really good for an improvement to the previous mental-health parity bill (passed in the mid-1990s). And it’s time for an update."
The chances for a mental health parity bill now reside in the machinations of an "inside political game," McNulty acknowledged. Though the Senate passed a parity bill last year – and the House has enough votes to pass it – Republican House leaders are staunchly opposed and could thwart its chances this year, McNulty said.
"It will come down to whether the leadership lets it (go to a vote)," he said.
U.S. Rep. Patrick J. Kennedy has led the House minority’s effort to pass the parity bill. "Untreated mental illness costs businesses money in a big way," from lost productivity and absenteeism, Kennedy said in an interview last year.
Many House Republicans, though, have sided with business groups, who argue that the bill amounts to a federal mandate that will ultimately add to the problem of runaway health-care costs.
A recent statement from the employer-backed American Benefits Council in Washington, D.C. read: "Employers are strongly concerned that in today’s environment of rising health care costs, legislation imposing additional mental health coverage mandates will increase costs even more."
The American Association of Health Plans said a federal mandate for mental-health parity would add "billions of dollars to health care costs."
Last year, Rhode Island passed its own mental-health parity law, requiring health plans to provide equal coverage for mental and physical illnesses.
But neither that law nor parity laws in other states affect large employers with self-insured health plans. They are exempt from the law under the Employee Retirement Income Security Act (ERISA), which regulates how companies provide employee benefits.
Many of Rhode Island’s largest employers, including hospitals, manufacturers and financial-services firms, are exempt from the state’s parity law because of ERISA, and could be affected if Congress passes parity legislation.
Though some employers nationally offer roughly equal coverage of mental and physical illnesses, many do not, according to advocacy groups. The National Depressive and Manic Depressive Association says 87 percent of employer-based health plans in the United States include at least one restriction on mental-health coverage, such as limits on the number of outpatient visits.
McNulty said mental-health parity laws in individual states have not led to increases in health-care costs. But the Congressional Budget Office estimates that a national parity law could add slightly less than 1 percent in U.S. health-care costs – or as much as $23 billion.
In his support for mental-health parity, Bush is breaking ranks with most other Republicans and his strong business constituency – a likely reason that Bush didn’t endorse the legislation outright.
"You feel a little bit like an ungrateful slob, saying ‘But you didn’t give us the whole thing, Mr. President,’" McNulty said. "But our job is to keep the pressure on in hopes that he’ll up the ante."
Still, the president’s public backing of the cause can be seen as nothing else but a big step forward, McNulty said.
"Overall, when you get the president of the United States backing your cause, it’s certainly a huge step forward," he said.
