WASHINGTON, D.C. — As he waves goodbye to his congressional career, Jim Ramstad is also hoping to say farewell to a nearly 12-year battle to improve health insurance coverage for people with mental illnesses.
“There’s no question this bill would positively impact more people than any other bill I’ve co-sponsored,” said the retiring nine-term lawmaker.
Even though the House and Senate both passed Ramstad’s so-called mental health parity bill last week, the two chambers are still squabbling over how to pay for the program. House members want to subsidize the $3.9 billion measure, which would require health insurers to cover treatment for mental health disorders just as they do physical ailments, by a change to the tax code.
The Senate, however, has passed the parity measure as part of a bill to extend tax revenue, some of which would cover the cost of the new requirements.
Ramstad says he’s still hoping the Senate will ultimately take up the language passed in his chamber, which would effectively end the battle over funding. But on the eve of a long Congressional recess, it’s unclear if the two chambers can come to a consensus or will choose to punt the measure to a post-election lame duck session.
For Ramstad, the battle for mental health parity is highly personal. When Minnesotan Paul Wellstone introduced Ramstad to the concept of mental health parity in 1996, Ramstad had been a recovered alcoholic for 15 years. (The bill considered last week by the House is named after Wellstone.)
Likewise, Ramstad’s Democratic co-sponsor, Patrick Kennedy of Rhode Island, has long battled addiction. After crashing his car on Capitol Hill in 2006, Kennedy entered a rehab at the Mayo Clinic in Rochester, Minn.
A year ago, the duo set off on nation-wide voyage to conduct field hearings on the issue.
“We heard from literally hundreds of people who have been discriminated against by their health insurers,” he said.
Ramstad remembers one man from Arizona whose mother shot him in a fit of rage after her insurance coverage plan stopped paying for her medication and her schizophrenia kicked back in.
“He told me, ‘It wasn’t the gun that shot me, it was her coverage.’ There’s such a stigma attached,” Ramstad said.
For all his effort, Ramstad is still baffled as to why it’s taken so long for his measure to get any attention, saying the new coverage would likely cost companies as little as a cup of coffee per person, per month.
A key change
In part, he attributes the delay to his own leadership.
“When Republicans controlled Congress, we couldn’t get a hearing, let alone a vote,” he said.
When Democrats took over both chambers at the beginning of 2006, all that changed — but the bill still faced some hurdles.
Companies still held long-standing concerns that the new requirements would cost too much; the bill’s sponsors wanted employers to cover every disability listed in the fourth edition of Diagnostic and Statistical Manual of Mental Disorders, a standard text book used by mental health professionals when it comes to diagnosing mental disorders. In the industry, the book is known simply as DSM4.
“It really would have been precedent setting,” said Kathryn Wilber, who is senior counsel for the American Benefits Council, a trade group that represents companies that offer health care plans to employees. “Take the whole manual and say, ‘Cover this?’ “
Ultimately, it was Ramstad’s counterparts in the Senate, including Republican Pete Domenici and Patrick Kennedy’s father, Edward, who brought together mental health advocates, business and the insurance industry to hammer out a deal.
This summer, the group finally announced a compromise that does not include the DSM4 requirement and instead allows employers to determine coverage.
For Ramstad, letting go of that provision was a big concession, but the survival of his bill was worth more to him in the end, he says.
“I’d certainly rather defer to the psychiatric community,” he said. “But I think we still got a strong bill.”
Catharine Richert reports on developments in Congress, agriculture issues and other topics. She can be reached at crichert [at] minnpost [dot] com.