Parity in peril
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| Topics: Congress, insurance, parity, politics
Despite overwhelming support for ending insurance discrimination in physician and hospital fees for a mental illness or a substance abuse disorder, passage of the parity bill is no longer a sure thing. The Senate voted unanimously more than one year ago, and the House overwhelming approved its measure in March. With one week to go for the 110th Congress, it's hard to believe this has not become law for the 113 million people affected.
Lengthy negotiations to reconcile differences between the bills bowed to the Senate's demands that insurance companies and employers -- the law affects only those with 50 or more workers -- protect the system of pre-certification and network providers. To cover the projected $3.9 billion loss of tax revenues over the next decade, restrictions were imposed on physician-owned specialty hospitals.
This is where the bill might go down, having nothing to do with the merits of parity, or the fact that it has bipartisan support in both chambers. It has everything to so with the way Congress operates. Efforts to fold the bill into the Senate's Renewable Energy and Job Creation Act of 2008 (HR 6049) - a humongus bill with dozens of deductions, called "tax extenders," for increasing rehab tax credits for builders in the Gulf, to domestic corporations operating in American Samoa, to deferring taxes for foreign subsidiaries. All cost taxpayers billions over the next decade. Yet Sen. Tom Coburn threatens to hold up mental health parity unless the restriction on physician-owned specialty hospitals, known to be more costly, is lifted. And in the meanwhile, there is talk of reintroducing it in the House where it also needs a a fiscal off-set.
Mental health parity has been called the legacy of Sen. Pete Dominici and Rep. Jim Ramstad, neither of whom will be seeking re-election. It has gained attention and curiosity because father and son, Sen. Ted Kennedy and Rep. Patrick Kennedy, each authored bills containing strong, differing provisions. The response of lawmakers in both houses make it clear this is a disparity needing correction. Yet with one week to go, it is hostage to the inefficiencies of political caprice.
When the Senate passed the mental health parity bill one year ago, long time champion Sen. Ted Kennedy said the
discrepancy is simply unacceptable -- it makes no sense for health insurance to charge patients more for mental health services than they do for physical health services. . .The stigma against the mentally ill is a blatant form of discrimination and one that is clear in the higher rates some insurance plans charge for mental health treatments.
Former first ladies Rosalyn Carter and Betty Ford repeated similar sentiments when they wrote in the Washington Post "We cannot wait any longer to make this crucial investment in our nation's health and help people in need."
