Reacting to concerns that Congress may be considering a compromise they can't live with, groups opposing federally mandated mental health benefits are stepping up efforts to kill the provision.
Employers would be forced to provide the same level of mental health benefits as they do for other benefits under the provision. For example, if a plan allowed 100 days of inpatient hospital care it also would have to cover 100 days of mental healthcare.
Business and managed-care groups oppose the measure because they say it represents a federally mandated benefit that will increase the cost of insurance and cause many employers to drop mental health coverage. The Congressional Budget Office estimated that private insurance costs would increase by 4% if employers are forced to beef up their mental health coverage. Other estimates have been as high as 12%.
Small businesses argue that they would not have the option of dropping mental health coverage if it became prohibitively expensive because 32 states mandate some mental health benefits. Large employers that are self-insured are exempt from such state mandates under the Employee Retirement Income Security Act.
The measure was sponsored by Sens. Pete Domenici (R-N.M.) and Paul Wellstone (D-Minn.) and was added as an amendment to the Senate health insurance reform plan passed last month. However, the House-passed health insurance reform plan does not include a similar provision.
The mental health amendment is just one of several issues that need to be resolved when the House and Senate work out the differences between their bills. The House plan includes tax incentives to spur the private use of medical savings accounts, medical malpractice reforms and a controversial measure that would allow small employers that band together to purchase insurance to skirt some state laws.
Democrats, led by the White House, have come out in support of mental health parity as have a number of moderate Republicans. Democrats are bitterly opposed to the MSA provision and to the medical malpractice reforms.
A final compromise plan could include both the mental health and MSA provisions. Another possibility is a smaller pilot project for mental health parity, possibly dealing with the federal employees health plan and an MSA provision that would sunset after several years. Aides say an additional option is to limit the scope of the mental health amendment to only severe mental illness. But opponents say none of these deals is acceptable.
"That any compromise would open the door to an endless array of federally mandated benefits is so clear to us that we would oppose the bill in its entirety," said Neil Trautwein, manager of healthcare policy at the U.S. Chamber of Commerce.
The Chamber of Commerce and several other business groups are pushing Congress to remove all but the noncontroversial provisions of the bill. However, one of the bill's Senate sponsors, Sen. Nancy Kassebaum (R-Kan.), said that would be "unrealistic."