House bill to level the field for mental health coverage
The House version of the bill includes a provision that prohibits discrimination against U.S. residents by health insurers and employers based on the results of genetic tests, unlike the Senate version, reported CQ Today.
Many insurers discriminate by setting higher co-payments or placing stricter limits on mental health benefits; actions that are well-within federal laws, reported The NY Times.
The House bill, which includes provisions to offset the cost of about $4.3 billion over 10 years, would increase the rebates that pharmaceutical companies must provide state Medicaid programs and would place new restrictions on physician-owned specialty hospitals to raise $2 billion over 10 years, according to the Wall Street Journal (WSJ).
Under the provision, physicians could not refer patients to hospitals in which they have a financial interest. Critics maintain that physicians' ownership interest gives them an incentive to refer patients to the facility and to increase volume unnecessarily and that a ban on referrals to new specialty hospitals would reduce the number of medical procedures being performed, which would result in savings, CQ Today reported.
According to The NY Times, the House bill does not apply to health plans sponsored by an employer with 50 or fewer employees. Nor does it apply to coverage in the individual insurance market. However, both bills would outlaw health insurance practices that set lower limits on treatment or higher co-payments for mental health services than for other medical care.
Typical annual limits, which include 30 visits to a doctor or 30 days of hospital care for treatment of a mental disorder, would no longer be allowed if the insurer had no limits on treatment of conditions like cancer, heart disease and diabetes, reported The NY Times.
Three factors contributed to support for the legislation. One factor is that researchers have found biological causes and effective treatments for numerous mental illnesses. The second factor is that a number of companies now specialize in managing mental health benefits, making the costs to insurers and employers more affordable. The third factor is that some doctors say that the stigma of mental illness has faded as people see members of the armed forces returning from Iraq and Afghanistan with mental disorders, according to The NY Times.
Under the bill, if an insurer chooses to provide mental health coverage, it must “include benefits” for any mental health condition listed in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association.
President George W. Bush’s administration opposes the House version of the bill but the president did not threaten to veto the legislation, according to The NY Times. In a statement, the administration said it “has concerns with H.R. 1424, which would effectively mandate coverage of a broad range of diseases and conditions and would have a negative effect on the accessibility and affordability of employer-provider health benefits,” according to CongressDaily.
Other officials and industry representatives have also weighed in on the passage of the bill in the House.
"We are spending in our emergency rooms too much money on taking care of all of the acute cases as a result of mental illnesses. Why not take care of people before they end up getting into the emergency rooms?" said Rep. Patrick Kennedy, D-R.I., who sponsored the House version of the bill.
"Health insurance plans support the bipartisan mental health parity legislation that passed the Senate by unanimous consent because it is a balanced approach that would preserve access to health plans' medical management and quality improvement programs,” said Karen Ignagni, president and CEO of America's Health Insurance Plans. "Unfortunately, the House legislation would turn back the clock on advances in the quality of care and impose excessive costs on patients and employers. Though well-intentioned, this legislation would undermine the progress that has been achieved in improving behavioral health benefits through coordinated-care strategies.”
Insurers could still deny coverage if they found that a service was not medically necessary, according to The NY Times.