WASHINGTON, D.C. — Not long after the fifth anniversary of the death of Sen. Paul Wellstone, Congress is inching closer to enacting one of his signature legislative goals: Insurance parity for mental health problems like depression, schizophrenia and drug addiction. But the shrinking congressional calendar and impending retirement of several key players on the issue threaten to derail it once again.
In September, the Senate passed a compromise bill worked out among insurers, small business groups and mental health advocates. Soon after Congress returns from its two-week Thanksgiving recess, backers of a stronger measure named for Wellstone expect to get a floor vote in the House. The two sides are already in discussion on how to reconcile the bills.
“I’m confident that we’ll be able to pass a good strong bill in the House and work out some differences and get it to the president yet this year,” said Minnesota Republican Rep. Jim Ramstad, a longtime mental-health advocate who will retire at the end of 2008.
Backers of mental health parity pushed to enact a law in the wake of Wellstone’s death in a plane crash in October 2002. But Republicans, backed by businesses and an insurance industry that did not want to absorb the cost, blocked a vote. Now, with Democrats in control, supporters are hopeful.
“I certainly think that the change in leadership in Congress has made this bill possible,” said Elana Wolowitz of Wellstone Action, a progressive group. Wellstone’s son David has lobbied extensively and testified before Congress, and Wellstone Action is mounting a nationwide grassroots campaign to meet with key lawmakers.
But when Congress returns to Washington Dec. 3 for a three-week session, members’ packed agendas could include such big-ticket items as a farm bill, an Iraq war spending bill and the children’s health program known as SCHIP, as well as finishing 11 of 12 annual spending bills that have yet to be signed into law. That deadline may motivate Congress to reach a compromise on mental health, but some say there’s just not time.
“I don’t think you’d find many folks who are really optimistic about a vote in this year,” said Rich Buckley, the head of the Washington office of pharmaceutical company AstraZeneca. The company joined groups like the American Psychological Association and the National Alliance on Mental Illness to back the Senate bill after determining it would not impose excessive mandates or costs. (Sales of Seroquel, AstraZeneca’s antipsychotic, would also be likely to see a boost if the bill goes through.)
Once 2008 rolls around, much of the congressional agenda will be given over to issues designed to help or hurt the congressional and presidential candidates. And the pressure for immediate action will be off.
In addition to Ramstad, one of the key Senate champions of mental health parity, Republican Pete Domenici of New Mexico, also will retire at the end of next year. Wellstone joined forces with Domenici in 1996 to enact a law requiring parity between traditional and mental health coverage for annual and lifetime benefit limits. He’s continued to be a major force behind the effort in the Senate, but he was recently diagnosed with a degenerative brain disease.
Like father, like son
Like Ramstad, Wellstone and Domenici, other key backers came to support the bill through personal circumstances. Domenici’s daughter and Wellstone’s brother both suffered from schizophrenia. Ramstad says he’s been on the road to recovery from alcoholism since he awoke from a drinking-induced blackout in a South Dakota jail in 1981.
Two other champions, Sen. Edward Kennedy, D-Mass., and his son, Rep. Patrick Kennedy, D-R.I., also have a personal connection. The elder Kennedy’s sister Rosemary was disabled for life after a lobotomy in her 20s. And after crashing his car in the middle of the night on the Capitol grounds last spring, Patrick Kennedy announced he has bipolar disorder and is addicted to alcohol and painkillers. Ramstad became his Alcoholics Anonymous sponsor.
But father and son are now backing different approaches to the problem. In the largest difference, the stronger House bill would refer to psychiatry’s Diagnostic and Statistical Manual, known as DSM-IV, to determine coverage.
“Without this requirement, insurers and employers could decide, without the benefit of science or medical expertise, which mental illness or addiction diagnoses should be covered,” David Wellstone told a House subcommittee in July.
The Senate bill does not define what would be covered, an approach that could exclude diseases like alcoholism and anorexia but also lower its cost to businesses.
Twenty-seven states, including Minnesota, already have some form of mental health coverage. The Kennedys reached a key compromise when they agreed to loosen a restriction in the Senate bill that would have pre-empted state laws, even if they provided stronger coverage.
Minnesota’s law requires that if insurers offer mental health coverage, the benefits be on par with traditional coverage. Self-insured companies, which include many large companies, are exempt, however, and thus fall under federal law.
One remaining sticking point is paying for the program. Since higher premiums would reduce wages, income tax revenues also would fall — to the tune of $4.2 billion over 10 years. But an actuarial study from Milliman Inc. showed that even in a worst-case scenario the program would cost $2.40 per member per month.
Supporters say in the long run, the program will pay for itself. Ramstad says untreated mental illness cost the U.S. economy $550 billion last year. He says 150,000 Americans died from chemical addictions in 2006, and 34,000 committed suicide. Mental health parity would affect about 113 million people.
The bill still must be revenue-neutral to avoid procedural roadblocks in Congress. Patrick Kennedy suggests increasing taxes on pharmaceutical companies’ direct advertising, or establishing a sin tax on items like liquor that contribute to mental illness.
“Captain Morgan’s as well known as Cap’n Crunch,” he said.
Opponents like GOP Rep. John Kline, who represents Twin Cities suburbs, say the bill constitutes an employer mandate.
“It seems ironic that at the time many of my colleagues in the majority profess to offer solutions to decrease the number of uninsured … they’re proposing issuing coverage mandates that appear to do the exact opposite by making coverage more costly and leading to less availability,” he said at the July hearing.
“Would you say the same to someone with cancer?” Patrick Kennedy responded. “Are you going to play with someone’s life who has cancer that way?”
In 2002, President Bush backed mental health parity but cautioned that a plan must not “significantly run up the cost of health care.” In 2003, a presidential commission on mental health supported the idea but did not include it in a list of specific goals, and the president has not mentioned it since.
Given that Congress may have only to the end of the year to find a compromise, the broader support for the Senate bill may win out.
“If the House doesn’t accede to the Senate point of view then the opportunity to get this thing passed disappears for a long time,” said Buckley, who pointed out that the House bill could not get through the Senate.
“What do you want?” asked Domenici, who backs the Senate plan. “If you want every last drop then you’re not going to get a bill.”
Meanwhile, advocates say the anniversary of Wellstone’s death would mark a fitting time to enact legislation. In a speech on the Senate floor commemorating Wellstone, Republican Sen. Norm Coleman said: “I cannot imagine a better way to honor Paul’s legacy than sending a strong mental health parity bill to the president of the United States and have him sign it into law.”
Adam Graham-Silverman covers foreign policy and economics for Congressional Quarterly in Washington D.C. and is MinnPost’s Washington correspondent. He can be reached at agrahamsilverman [at] minnpost [dot] com.