House and Senate Parity Bills: Differences Complicate Passage Prospects

The introduction of a House mental health parity bill in March has scrambled prospects for congressional passage of a bill that President Bush could sign. The introduction of the Paul Wellstone Mental Health and Addiction Equity Act (HR 1424) by Reps Patrick J. Kennedy (D, RI) and Jim Ramstad (R, Minn) threatens to split both the mental health community and the House and Senate. A Senate committee had previously passed a separate parity bill called the Mental Health Parity Act of 2007 (S 558), which is more limited in scope and was the product of compromises offered by mental health, employer, and insurance groups.

The Coalition for Fairness in Mental Illness Coverage, for example, supports the Senate bill cosponsored by Patrick Kennedy's uncle, Sen Edward M. Kennedy (D, Mass). But the Coalition has not and will not take a position on Patrick Kennedy's bill, according to Pamela Greenberg, chairperson of the Coalition, who is also the CEO of the Association for Behavioral Health and Wellness (ABHW).

Two members of the Coalition-the American Psychiatric Association and Mental Health America-support both the House and Senate bills. The ABHW opposes the House bill.

Business groups almost uniformly oppose the House bill. "The House bill is everything that we did not like in previous mental health parity bills," said E. Neil Trautwein, vice president of the National Retail Federation, a trade group that supports the Senate bill.

Both bills attempt to extend mental health parity in employer health plans by improving on a 1996 law that requires companies with more than 50 employees to offer the same annual and lifetime dollar limits for mental health expenses as for other medical expenses. The 2007 bills would expand that parity dictate by applying it to deductibles, copayments, out-of-pocket expenses, coinsurance, covered hospital days, and covered outpatient visits.

The House bill goes further, mandating coverage of a very broad range of conditions that would be subject to parity, unlike the Senate bill, which would leave that determination to the states. The House sponsors want to ensure that parity extends to treatment for things like substance abuse and eating disorders, conditions that might not qualify under the Senate bill. In addition, the House bill would allow states with stronger parity laws to ignore the federal law. The Senate bill preempts state laws on parity.

Sens Kennedy and Mike Enzi (R, Wyo), the other cosponsor, have been trying to hold together the groups who agreed to their bill, and have therefore refused to consider Senate floor amendments that would bring the Senate bill closer to the House bill.

"There is a whole lot of positioning going on," said one lobbyist for a key mental health group, who did not want to be identified. "Anyone who tells you they know what will happen is full of it."