The House Energy and Commerce Subcommittee on Health held a July 23 hearing to discuss mental health coverage. Witnesses focused their remarks on legislation (H.R. 4066), sponsored by Reps. Marge Roukema (R-NJ) and Patrick Kennedy (D-RI), that would prohibit group health plans from imposing limits on mental health benefits unless similar limits are placed on medical and surgical benefits.
Noting that Congress has “been grappling for some time about what the federal government’s role should be in mandating health benefits,” Subcommittee Chair Michael Bilirakis (R-FL) opened the hearing, saying, “I think serious mental illnesses are problems that deserve serious attention, but I also think we have to be mindful of costs,” adding that he had “no desire to add to mandates and increased costs.”
Rep. Charlie Norwood (R-GA) disagreed, saying, “This is an issue about equality….Are we going to continue to treat people with mental health illness as second-class citizens?”
Ranking Member Sherrod Brown (D-OH) called the current health care system “discriminatory, short-sighted, and morally wrong.” Adding that “this nation will bear the cost of mental health illness whether this parity bill passes or whether it doesn’t pass….Delaying treatment merely increases the costs.”
In speaking to the costs of such coverage, Rep. Lois Capps (D-CA) said that the Congressional Budget Office estimates that “true mental health parity would increase costs by less than 1 percent.” She added that insurance companies are “discriminating against people who are struggling with a disease.”
Dr. Charles Cutler of the American Association of Health Plans (AAHP) testified in opposition to the legislation. Saying that “health plans routinely cover mental health services,” Dr. Cutler cited a recent AAHP survey of health plans, which found that 96 percent of plans provided coverage for mental health/substance abuse services. Dr. Cutler also noted that a PricewaterhouseCoopers survey concluded that of the 13.7 percent increase in overall health care costs for employers, government mandates, increased litigation, and fraud and abuse accounted for over 25 percent of the increased cost.
Dr. Cutler criticized H.R. 4066 because he said it would require coverage for all conditions listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), some of which are not based on scientific evidence. “For example, jet lag…, caffeine intoxication,… and academic, occupational, and religious problems…are all conditions listed in the current version of the DSM that plans would be required to cover on par with medical and surgical benefits,” he said.
“These allegations are simply unfounded,” said Dr. Darrel Regier of the American Psychiatric Assocation (APA). “The truth is that DSM-IV criteria are included in virtually all state Medicaid legislation, the Federal Employees Health Benefits Program guidelines for parity, and in fact, the ‘medical necessity’ criteria of virtually all managed behavioral health companies employed by general health insurance companies to manage their benefits,” he said, suggesting that the “DSM issue is a canard that is intended to distract the Congress from the real issue: blatant discrimination against a single group of patients.”
Citing a U.S. Surgeon General’s report, Dr. Regier said “the lack of parity coverage of treatment for mental illness costs businesses over $70 billion every year in lost productivity, increased use of sick and disability leave, and higher use of non-psychiatric medical services.”
However, Neil Trautwein of the National Association of Manufacturers said that his organization “opposes mandated health benefits because of rising health care costs and the need for greater flexibility of benefit plan administration.” While acknowledging that mental health benefits are “important to the productivity of our members,” Mr. Trautwein added that “employers are increasingly less able and less willing to absorb health cost increases in the current economy.”
Expressing her concern with the scope of the coverage provided under the legislation, Kay Nystul, a psychiatric registered nurse who provides case management for Wausau Benefits, said, “A clear distinction needs to be drawn between biologically based mental illness and other conditions listed in the DSM-IV,” she said. “When people are able to function in activities of daily life, yet have a condition that is ‘diagnosable,’ the treatment sought should be considered optional or elective rather than necessary even though treatment could potentially increase quality of life,” she added.
The subcommittee also heard testimony from James Hackett, Chairman and CEO of Ocean Energy, Inc., who testified in support of mental health parity legislation. Detailing his family’s experience with mental health coverage after his daughter was diagnosed with posttraumatic stress disorder after being sexually assaulted, Mr. Hackett said, “If we had depended on our company-provided benefits for full payment, our daughter would not have been able to receive the needed inpatient treatment nor avail herself of the needed follow-up psychiatric treatment.” As a result of his experience, Ocean Energy, Inc. established full parity in insurance coverage for its employees.
