President Bush Signs $700B Financial Bailout Bill That Includes Mental Health Parity Provisions

President Bush on Friday signed into law a $700 billion bailout of Wall Street firms that included mental health parity legislation (HR 1424), the New York Times reports (Pear, New York Times, 10/6). Bush approved the bill soon after the House on Friday voted 263-171 to pass it. The Senate on Wednesday voted 74-25 to approve the measure (Hirschfield Davis, AP/Baltimore Sun, 10/3). The bill received the support of 172 House Democrats and 91 House Republicans (Lisi, New York Post, 10/4).

The legislation would require group health plans of 51 or more employees to cover mental illnesses at the same level as physical ailments. It does not require the plans to offer such coverage but it must be equivalent if they do. The mental health legislation was added to the larger bailout package as a means of enticing House members who voted against the previous bailout measure but supported a parity bill (Kaiser Daily Health Policy Report, 10/3). Under the new law, the U.S. Department of Labor must submit biannual reports to Congress on group health plan compliance (Bender, Boston Globe, 10/4). The law allows managed care companies to refuse to pay for care if they deem it not medically necessary or "clinically appropriate," but insurers must reveal their criteria for determining medical necessity and their reason for denying any mental health claim, according to the Times (New York Times, 10/6).

Lawmaker Comments
Sen. Pete Domenici (R-N.M.) co-sponsored the mental health parity legislation with the late Sen. Paul Wellstone (D-Minn.) as "the issue literally struck home" with both lawmakers, each of whom had family members with mental conditions and illness. Domenici said of the new law, "We are ushering in a new era of health care for those with mental illnesses." The measure also received broad support from other lawmakers, including Sens. Edward Kennedy (D-Mass.) and Mike Enzi (R-Wyo.) and Reps. Patrick Kennedy (D-R.I.) and Jim Ramstad (R-Minn.) (Reichard, CQ HealthBeat, 10/3).

Kennedy in a statement said, "The miracles of modern medicine make mental illness just as treatable today as physical illnesses," adding, "After 10 years of debate, Congress has finally agreed to end discrimination in health insurance coverage that plagues persons living with mental illness for so long." He continued, "It will now be the law of the land that people with such illnesses deserve the same access to affordable coverage as those with physical illnesses" (Boston Globe, 10/4).

Implications, Concerns
According to Congressional Budget Office estimates, the mental health parity law will raise premiums by about two-tenths of 1%. Physicians say by eliminating the restrictions of higher charges on treatments for mental illnesses and addictions, the new law will make it easier for patients with various conditions, such as depression, autism, schizophrenia, eating disorders and alcohol and drug addictions to seek treatment, the Times reports. About 113 million people in the U.S., including 82 million people who are enrolled in employer-sponsored health plans that are not affected by state regulation, will benefit from the new law, federal health officials say.

Andrew Sperling, a lobbyist for the National Alliance on Mental Illness, said, "Under the new law, we will probably see more aggressive management of mental health benefits because insurers can no longer impose arbitrary limits" (New York Times, 10/6).

Helen Darling, president of the National Business Group on Health, said, "We are especially gratified that this final product preserves large employers' flexibility in plan design and medical management." Darling added that "while striking the right balance, this legislation nonetheless remains a benefit mandate on large employers. At a time when large employers are working hard to maintain benefits, mandates have the potential over time to erode" the efforts of employers to provide health coverage (CQ HealthBeat, 10/3).

Wall Street Journal Profiles Domenici's Efforts
The Wall Street Journal on Saturday profiled Domenici, who in April 1996 with Wellstone sought to attach a mental health parity provision to a health insurance bill. The provision won Senate approval in 1996, but it "dropped out of the legislation after negotiations with the House, with opposition from health insurance companies and their allies in Congress blocking the effort," the Journal reports (Lueck, Wall Street Journal, 10/4).