Advocates Renew Push for Mental Health 'Parity' Bill

A bill has long lingered in Congress that would require health insurers to provide equal benefits for mental and physical ailments. President Bush has vowed to sign such a mental health "parity" bill on several occasions, but a Republican-controlled House repeatedly blocked it. Now with Democrats in control of Congress, mental-health advocates are quietly planning a quick campaign for the bill's passage.

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Americans with mental illness have been waiting a long time for what they consider equality. Advocates for mental health have spent 15 years now pushing for legislation that would require insurance companies to provide the same coverage for mental as well as physical ailments. Two presidents and broad majorities in Congress have supported the measure, but it has yet to make it into law.

NPR's Julie Rovner reports on the long, strange journey of the mental health parity bill.

JULIE ROVNER: Most people with private health insurance don't find out until it's too late that their policies don't cover mental health problems very thoroughly. Andrew Sperling is chief lobbyist for the National Alliance on Mental Illness.

Mr. ANDREW SPERLING (Lobbyist): Many families that have mental illness strike their family didn't know they needed this before their child was diagnosed with bipolar disorder or schizophrenia or major depression. And they didn't even know what was in their benefit. And they would quickly find out when they sought treatment that they only had 10 inpatient days for the entire lifetime of that individual enrolled person, and they would exhaust that coverage very, very quickly.

ROVNER: The result is often financial catastrophe. Sperling has seen the problem close-up, so he's spent the better part of the past 15 years trying to get Congress to solve it by passing a law requiring health insurers to cover treatment for mental illnesses on the same terms and condition as all other ailments. The so-called mental health parity bill has long had the backing of majorities of members in both Houses of Congress. Sperling says the first big breakthrough came in 1996.

Mr. SPERLING: It was actually April 18th, and I remember it very well cause it didn't come until well around midnight that night. And we actually did know it was coming.

ROVNER: It was a surprise of sorts, engineered by Republican Senator Pete Domenici of New Mexico and Democrat Paul Wellstone of Minnesota. The two unexpectedly offered it as an amendment to an unrelated health insurance bill. It passed 68 to 30. Joy turned to disappointment, however, when the mental health language was dropped in the final negotiations on the health insurance bill. Sperling and his allies decided to make a fuss when the bill got signed into law by then-President Clinton.

Mr. SPERLING: We had about 150 NAME members in Lafayette Park across the street from the White House protesting. And we didn't make any friends in the Clinton White House that day, ‘cause this was a great triumph for the president during his reelection year in 1996, and they were none to happy to see protestors in Lafayette Park.

ROVNER: But the protest served its purpose. Congress later that fall passed a scaled-back mental health parity bill, one that only required parity in dollar amounts for mental health and physical coverage. That meant insurers could still limit the number of mental health doctor visits or hospital days. So Sperling and his allies continued to push for the broader parity bill. But then they ran up against business lobbyists, people like Neil Trautwein, who is a vice president with the National Retail Federation.

Mr. NEIL TRAUTWEIN (National Retail Federation): Back in those days, as now, we're concerned about the cost of coverage, and for better or worse the mental health care benefit became a proxy for all the other mandate fights.

ROVNER: During the late 1990s, Trautwein says, Congress was debating the so-called patients bill of rights. It would have required health insurers to provide a long list of benefits, of which mental health coverage was only one.

Mr. TRAUTWEIN: It wasn't that employers had anything against mental healthcare coverage. Nearly every employer around will have mental healthcare coverage, but it became part of the power struggle.

ROVNER: In 2001, when the Democrats took over the Senate, the bill again seemed headed for easy passage. But this time it was derailed by the September 11th attacks. Things looked up again in the spring of 2002, when President Bush, who had signed a state mental health parity bill as governor of Texas, endorsed a federal version during a trip to New Mexico with Republican Senate sponsor Pete Domenici.

President GEORGE W. BUSH: Senator Domenici and I share this commitment. Health plans should not be allowed to apply unfair treatment limitations or financial requirements on mental health benefits.

ROVNER: But again, says Sperling, hopes got dashed, this time with the death of the bill's Democratic champion. Minnesota Senator Paul Wellstone died in a plane crash just before election day in 2002.

Mr. SPERLING: And that was a devastating blow for us, to have such a really outspoken advocate who was - really had pursued this legislation very aggressively, die.

ROVNER: Republicans took back the Senate and maintained the House in those 2002 elections, and despite Domenici's efforts, the bill seemed to languish for the next four years. But in fact, says Trautwein, of the National Retail Federation, negotiations between business and mental health lobbyists continued pretty much the whole time, and a compromise was emerging.

Mr. TRAUTWEIN: Hopefully it's going to be a good model for future healthcare policy. Instead of I win/you lose, it's how can we operate in the real world?

ROVNER: Now with Democrats ready to put the bill back on the fast track, both Sperling and Trautwein say they are optimistic a measure will pass early this year and be signed by President Bush.

Julie Rovner, NPR News, Washington.

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