Insurance Legislation Dead?

If you suffer from depression, perhaps you know that a visit to a
therapist can cost more than an appointment with your general
practitioner. Many group insurance plans attach higher out-of-pocket
costs to psychiatric treatment--hiking copays and deductibles or capping
the amount of treatment one can receive.

Nearly two years ago, President Bush acknowledged this. He visited
New Mexico, home of Republican Senator Pete Domenici, a longtime champion
of mental health coverage, to press for parity, the insurance equivalent
of coverage for physical ailments.

"Americans with mental illness deserve our understanding, and they
deserve excellent care," Bush told an applauding crowd. "They deserve a
health care system that treats their illness with the same urgency as a
physical illness."

The president named a commission to study gaps in the mental health
care system and pledged to work with Congress to pass a bill in 2002.
Since then the parity bill--now named after Domenici's fellow proponent,
the deceased Minnesota senator Paul Wellstone, a champion of mental
health rights--has apparently dropped off the White House agenda.

It has languished in congressional backwaters as well, despite
majority support. The bill passed in the Senate but never came up for a
vote in the House. Domenici's biggest foe is said to be House Speaker
Dennis Hastert, who sides with insurance companies and is staunchly
opposed to letting the bill onto the House floor.

Health insurance organizations are quick to point out that their
intent is not to discriminate against the mentally ill but to ensure that
changes to health care coverage are not imposed on the industry in a
one-size-fits-all fashion. As the stalemate continues, insurance
organizations argue reform is an issue for employers and employees, not
legislators.

"Every mandated benefit comes with a price tag," says Larry Akey,
spokesman of the Health Insurance Association of America, a group that
opposes the current bill. "There are no free benefits." The cost
ultimately comes back to employers and employees, says Akey. With health
insurance costs climbing 10 to 15 percent annually in the last few years,
Akey argues that further increases could cause employers to drop
insurance benefits altogether.

The Congressional Budget Office estimates parity legislation would
increase premiums by about 1 percent. Other estimates go as high as 5
percent. (In the meantime, dozens of states have passed various laws of
their own, with effects not widely assessed. But some have seen premiums
go down.)

"All the empirical evidence shows parity will save money in the
long run," says one Capitol Hill aide whose office supports the
legislation. Treatment of mental illness would reduce hospitalization and
incarceration and bump up worker productivity well in excess of premium
increases, he says.

For now the bill's future seems to lie at the feet of the
president, who will have to push House leadership if it is to
pass.

"This is a civil rights bill," says Ralph Ibsen, a lobbyist for the
National Mental Health Association, a group that has been campaigning for
the legislation. "It's disturbing that we haven't passed it. It's a
modest piece of legislation that basically says, 'Treat us the
same.'"