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Hill Negotiating Insurance Bill Details
By Dana Milbank
Washington Post Staff Writer
Thursday, April 25, 2002
President Bush is close to agreement on legislation forcing employers to
expand insurance coverage for psychiatric illnesses, a position urged by
mental health advocates but one that has been opposed by business groups
and several key Republicans.
Bush plans to give the idea a strong endorsement Monday, when he is
scheduled to speak in Albuquerque at a job training facility for people
recovering from mental illnesses, congressional officials said. Those
familiar with the status of negotiations, which continued yesterday,
cautioned that there may not be agreement by Monday on all details of
the legislation, known as "mental health parity." But they
said Bush supports the idea and is likely to sign legislation this year.
An announcement of expanded mental health coverage in the home
state of Sen. Pete V. Domenici (R-N.M.) would be a triumph for the
lawmaker, who has a child suffering from schizophrenia and who has
championed the cause for years. In a broad sense, it would require
employers' health insurance plans to treat mental illness the same as
other illnesses for the purposes of reimbursements and caps on payouts.
"Talks have been going on," Domenici spokesman Chris Gallegos
confirmed. "At this point there is no agreement."
A weaker version of the mental parity legislation expired last fall, and
Congress has been debating plans to renew and strengthen the law.
Supporters said White House backing would likely provide a
sufficient push to get the proposal enacted. Moreover, they added, a
gesture of support for the mentally ill by the Republican president
could reduce the stigma and shame of mental disorders and could boost
his "compassionate conservative" credentials.
The main opposition has come from key GOP lawmakers in the House, who
object to the higher cost the requirement would impose on employers. The
White House would need to persuade House conservatives to endorse the
idea, which has long had strong backing from Democrats. As wife of the
vice president, Tipper Gore made it her signature issue, and Senate
Majority Leader Thomas A. Daschle (D-S.D.) has said he hopes to have a
vote on the legislation soon. Efforts
by the White House to involve itself in mental health parity legislation
could head off an election-year battle with Democrats on the subject.
Last week, Daschle said he would proceed with the legislation even in
the absence of an agreement with the White House. "Mental health
parity, I think, is something that's going to pass," he said.
An earlier version of the legislation, enacted in 1996, required
employers not to set higher annual or lifetime limits on mental health
services than on other health services. But it allowed them to charge
patients higher premiums and co-payments and offered them exemptions if
compliance increased their health care costs by more than 1 percent.
Domenici and Sen. Paul D. Wellstone (D-Minn.) passed legislation in the
Senate last year requiring group health plans at businesses with more
than 50 employees to provide mental health coverage without higher
premiums and co-payments than those for other illnesses. But the
provision was opposed by House Republicans and removed in a conference
between the House and Senate over a spending bill.
The issues still in dispute are whether the legislation will cover more
than 200 disorders listed in the Diagnostic and Statistical Manual of
Mental Disorders, as Domenici and Wellstone have proposed, or major
diseases such as schizophrenia and bipolar disorder, which the White
House is believed to favor. Also under consideration is whether
employers could be exempted if the costs proved excessive. The
Domenici-Wellstone legislation had no exemption. Past discussions have
focused on exemptions if health care
costs increase in the vicinity of 1 to 3 percent.
Negotiators are looking for ways to hold down the overall cost of the
legislation, possibly without specific exemptions and limitations on
diseases covered. The legislation is likely to be broader than one Bush
signed into law as Texas governor in 1997. Texas, one of 26 states with
mental health parity laws, includes only major mental illnesses in its
law.
Congressional estimates indicate the Domenici-Wellstone legislation
would boost health care premiums by 1 percent. Opponents of that bill,
who have included House Speaker J. Dennis Hastert (R-Ill.), House Whip
Tom DeLay (R-Tex.) and key GOP committee leaders, argue it would
increase costs on employers and workers.
Wellstone, who faces a difficult reelection battle, has not been
involved in the negotiations between Domenici and the White House.
"We continue to be very optimistic," said Wellstone
spokeswoman Allison Dobson. Domenici updated Wellstone of his
conversations in a phone call last night and said there was still no
deal.
Staff writer Amy Goldstein contributed to this
report.
© 2002 The Washington Post Company
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