NPR

Mental Health Parity Approved With Bailout Bill

The huge financial bailout President Bush signed Friday actually began its legislative life as a bill to require health insurers to provide the same benefits for mental health care as for all other ailments. After passing the House earlier this year, the mental health parity bill sat waiting in the Senate — until last week, when it gained rapid forward momentum as the vehicle for the $700 billion Wall Street rescue plan.

The bill's sudden passage marks the end of an often painful 12-year odyssey for bipartisan advocates supporting equal insurance for mental health issues.

Sadly, most people don't find out they have less health insurance for mental illness than they do for physical ailments until they really need it, says Peter Newbould, director of congressional and political affairs for the American Psychological Association.

In most cases, it is much more costly to use one's mental health benefits than to seek health care for other illnesses, says Newbould. Typically, a 50 percent co-payment is required to see a mental health provider as an outpatient; to see a dermatologist or a heart specialist as an outpatient, the co-payment is normally 20 percent.

"This is what economists call demand-side restraints," Newbould says. "We call it discrimination."

The Fight For Equal Coverage

Newbould has been working to pass a federal law to end that discrimination for more than a decade.

In 1996, Republican Sen. Pete Domenici of New Mexico and Democratic Sen. Paul Wellstone of Minnesota managed to get the Senate to vote to require parity for mental and physical health benefits as an amendment to a bigger health bill. But insurers hated it, and the House forced it out of the final bill.

Instead, the senators got what Newbould calls a "partial parity" law that stopped insurance plans from being allowed to pay less to treat mental ailments as opposed to physical ones. For example, the bill banned insurers from having a $5,000 limit for mental health illness when the medical surgical limit was $50,000.

But insurance companies quickly skirted that law by limiting the number of mental health visits or days in the hospital. So Wellstone and Domenici came back to try for full mental health parity in 2001, joined in the House by Rhode Island Democrat Patrick Kennedy and Minnesota Republican Jim Ramstad, both of whom had struggled with addiction issues.

The bill was just starting to pick up momentum when Wellstone was killed in a plane crash in 2002. His son David has been lobbying for the measure ever since. After a recent rally on Capitol Hill, he said that he never doubted the bill would pass — eventually.

More Advocates Rally Behind Bill

"Everybody's affected by either some mental health issue or addiction. Everybody has it in their family. So I have just always had faith that since it's just the right thing to do, that it will pass," David Wellstone said.

Just before the start of the current Congress, several mental health groups won the support of employers and health insurers — in part, by showing that similar parity laws at the state level didn't break the bank. But other mental health groups were wary about the effect of that compromise on those very state laws. That ended up pitting the Senate version of the bill — led by Sen. Ted Kennedy — against the House version — led by his son, Rep. Patrick Kennedy.

That standoff was resolved just weeks ago, while the elder Kennedy has been home in Massachusetts being treated for a brain tumor.

There was still more urgency to get the bill passed before the end of this Congress. Both Domenici and Ramstad are retiring. But Ramstad, who's given several heartfelt speeches on the House floor about his fight with alcoholism, says it's not personal credit he's looking for.

"This is not about me. This is about the 80 million Americans suffering the ravages of mental illness and chemical addiction. And so many Americans are counting on this legislation to gain access to treatment," Ramstad says.

The terms of the new law apply to businesses that employ 50 or more people and that offer health insurance with mental health coverage. Now, these businesses must offer mental health coverage to the same extent as all other benefits. Most of the requirements take effect a year from now.

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Transcript

MELISSA BLOCK, host:

The huge financial bailout will have ramifications beyond Wall Street and the proverbial Main Street. That's because the bill began its legislative life as a measure to require health insurers to provide the same benefits for mental health as for all other ailments. As NPR's Julie Rovner reports, the bill's enactment marks the end of a painful 12-year odyssey for its backers.

JULIE ROVNER: Peter Newbould says it's a sad irony that most people don't find out they have less health insurance for mental illness than they do for physical ailments until they need mental health care.

Mr. PETER NEWBOULD (Director, Congressional and Political Affairs, American Psychological Association): And typically they find that it is more costly for one to use one's mental health benefits, a 50 percent co-payment to see an outpatient mental health provider, as opposed to typically 20 percent co-payment in order to see a dermatologist or a heart specialist. This is what economists call demand-side restraints, and we call it discrimination.

ROVNER: Newbould is director of congressional and political affairs for the American Psychological Association. He's been working to pass a federal law to end that discrimination for more than a decade.

Ms. NEWBOULD: I had more hair, and it was browner when I started.

ROVNER: In 1996, New Mexico Republican Senator Pete Domenici and Minnesota Democrat Paul Wellstone managed to get the Senate to vote to require parity for mental and physical health benefits as an amendment to a bigger health bill. But insurers hated it, and the House forced it out of the final bill. Instead, the senators got what Newbould calls a partial parity law that stopped plans from having lower dollar limits to treat mental ailments as opposed to physical ones. But insurance companies found ways to get around that.

So Wellstone and Domenici came back to try again for full parity in 2001, joined in the House by Rhode Island Democrat Patrick Kennedy and Minnesota Republican Jim Ramstad, both of whom had struggled with addictions. The bill was just starting to pick up momentum when, in 2002, Senator Wellstone was killed in a plane crash. His son David has been lobbying for the measure ever since. He said after a recent rally on Capitol Hill that he never doubted the bill would pass, eventually.

Mr. DAVID WELLSTONE (Co-Founder, Wellstone Action): Everybody's affected by either some mental health issue or addiction. Everybody has it in their family. So I have just always had faith that, yes, since it's just the right thing to do, that it will pass.

ROVNER: Just before the start of the current Congress, several mental health groups won the support of employers and health insurers, in part by showing that similar state parity laws didn't break the bank. But other mental health groups were wary about the effect of that compromise on those very state laws. That ended up pitting the Senate version of the bill led by Senator Ted Kennedy against the House version led by his son, Congressman Patrick Kennedy. That standoff was resolved just weeks ago, while the elder Kennedy has been home in Massachusetts being treated for a brain tumor.

(Soundbite of interview)

Unidentified Reporter: Has your dad been involved in some of these negotiations from?

Representative PATRICK KENNEDY (Democrat, Rhode Island): Oh, absolutely.

Unidentified Reporter: That's one of the things he's been working on?

Representative KENNEDY: Definitely.

ROVNER: There was still more urgency to get the bill passed before the end of this Congress. Senator Domenici is retiring, as is Congressman Ramstad. But Ramstad, who's given several heartfelt speeches on the House floor about his fight with alcoholism, says it's not personal credit he's looking for.

Representative JIM RAMSTAD (Republican, Minnesota): This is not about me. This is about the 80 million Americans suffering the ravages of mental illness and chemical addiction. And so many Americans are counting on this legislation to gain access to treatment.

ROVNER: Under the terms of the new law, health insurance plans serving 50 or more people will no longer be able to apply different levels of benefits to mental health than they do to any other type of treatment. Most of the requirements take effect a year from now. Julie Rovner, NPR News, Washington. Transcript provided by NPR, Copyright NPR.

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