In a momentous development for anyone who cares about the state of mental health care, the United States House of Representatives has approved the Paul Wellstone Mental Health and Addiction Equity Act of 2007 by a considerable margin. Named after a late Senator and longtime advocate whose brother suffered from severe mental health issues, the Act is an extension and redefinition of a 1996 law requiring insurance providers to cover mental health treatments in much the same way that they cover physical conditions and disabilities. Despite congressional quibbles over policy details, the act's passage is a strong step forward that has received the formal blessings of virtually all mental health organizations. The Senate passed its own very similar bill six months ago, and now the two houses of Congress need to work together to devise a single plan that both satisfies industry concerns and, more importantly, serves the American people.
This issue is perhaps the best recent example of open bipartisanship, that very rare state of near-unanimous agreement between the United States' government's two dominant parties. Despite the existence of competing bills, nearly all representatives agree that mental illness is a very real health concern that should be covered by all group insurance plans. Sponsored by ideologically opposed representatives and fellow reformed substance abusers Jim Ramstad and Patrick Kennedy (Ramstad is, perhaps appropriately, Kennedy's Alcoholics Anonymous sponsor), the new bill is only the latest piece of legislation in an extended campaign to ensure mental health coverage for insured workers. The legal battle compelling insurance providers to revise their tendency to process mental health treatments as unneccessary or "elective" is more than a decade old. The original act, passed and signed into law by then-President Clinton in 1997, pushed for parity in eliminating the practice of placing far more restrictive caps on treatment expenses related to mental health conditions. But its policies only applied to the employers who already offered such health coverage, and it failed to include chemical addiction and dependence treatments in its larger equation.
The updated, bipartisan-sponsored Senate extension of this bill passed by unanimous consent in September 2007. It improved the existing act in several ways, most notably creating the mandate that all employer and group health plans offer equal coverage and copays for mental health treatment and expanding the definition of such to include drug and alcohol addiction therapies. The last development is too long in coming. It may seem unreasonable to some that employer plans pay for the treatment of workers' drug problems, but yearly caps will prevent businesses from being forced to subsidize lengthy stays in residential rehab centers. The Senate act was also developed in consultation with representatives from the insurance and pharmaceutical industries while the House act was not, and the fact that the two are entirely independent bills may unnecessarily complicate the legislative process.
The most significant difference between the two plans is the all-or-nothing House requirement that group plans provide coverage for every single condition listed in the diagnostic manual. That detail would override several pre-existing state policies that do not necessarily include the entirety of the DSM. This aspect of the bill has fostered somewhat understandable concerns among insurance industry representatives, and the White House has responded in turn by endorsing the Senate plan and asserting that the House plan would raise overall healthcare costs to a greater degree (though we must mention that both plans allow employers to waive the requirement for one year if it causes their overall health care premiums to rise more than 2%). Overall spending will obviously go up, and representatives must figure out how to offset these increases, but that issue will not be resolved until the final bill becomes law.
The act now passes to the Senate and we hope that the two bodies can reach an agreement on a single piece of legislation that will not result in unproductive objections on the part of the insurance industry and the current administration. The first bill, already an act of compromise, best balances the interests of all involved, and the final product would ideally most resemble its Senate predecessor. The greatest tragedy would be a failure to advance and pass the initiative because of the chronic infighting so common to the U.S. Congress. No act of legislation is perfect, and we can almost guarantee that every concerned party will find some small point of dissent. But all involved should remember that their primary concern lies with the group most affected: the millions of Americans who need their health care plans to cover absolutely crucial mental health treatments.
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