Mental Health Debate: Congress Considers Coverage

Is mental health as important as physical health? Do emotional issues deserve the same treatment as physical ones? What’s considered a legitimate mental health issue?

Congress is grappling with these important questions through its debate on a mental health equity bill. The House version of the bill, which passed March 5, 2008, requires insurers to provide equal levels of coverage for physical and mental illnesses. It would bar insurers from requiring larger co-payments or imposing lower reimbursement ceilings for mental health conditions. 

The Senate version puts no such restrictions on insurers; it lets them choose which mental health conditions to cover. The Senate bill, which passed in September 2007, is much preferred by insurance companies.

Because of this wide difference between the House and Senate bills, they will not be reconciled through negotiations called a conference committee. The Senate wants the House to pass another version that’s closer to its own, but House advocates are standing strong.

Kennedy vs. Kennedy

The debate is even more interesting because it’s being cast as a father-son battle. Edward M. Kennedy (D-Mass.) cosponsored the Senate bill while his son, Patrick J. Kennedy (D-R.I.) sponsored the House bill. The elder Kennedy said his son’s House bill was too different to be reconciled with his Senate version.

By blocking the House bill, Edward Kennedy, known for his socially-liberal policies, has found himself in an unlikely alliance with a socially-conservative advocacy group, The Family Research Council. The Council opposes the Jr. Kennedy’s bill for “moral” reasons. The group argues that the House bill would require insurance companies and therefore employers to pay for alcohol and drug addiction and for psycho-sexual disorders like pedophilia.

Morality and mental health

The Family Research Council argues that addiction and sexual disorders should not be covered, or the bill should give employers the right to deny coverage for conditions they find “immoral.”

Specifically, the Council argues that the House bill should provide a provision that permits denial of medical services for reasons of religion or conscience – known as a conscience clause. But this clause is reserved for health care providers like doctors and pharmacists, not employers. For example, doctors can refuse to prescribe the morning after pill if they have a moral objection to it, and pharmacists can refuse to fill a prescription.

Allowing for an employer conscience clause could open up a Pandora’s box in which employers could define “morality” – an inherently subjective concept - and deny mental health coverage to employees accordingly.

The younger Kennedy and his allies argue that their bill requires mental health coverage based on the Diagnostic and Statistical Manual of Mental Disorders, developed by the American Psychiatric Association. The manual is the standard required of insurers participating in the Federal Employees Health Benefits Plan, which covers members of Congress and their aides.

Advocates of the mental health equity argue further that behavioral health problems have a large yearly cost to employers and the nation. The American Psychological Association lists the yearly costs of common disorders on their website:

• Anxiety: Total cost $42.3 billion; 88% of the cost-per-worker is attributable to decreased productivity.

• Depression: Total cost $83.1 billion; $26.1 billion (31%) in direct medical costs, $5.4 billion (7%) in suicide related mortality costs, and $51.5 billion (62%) in workplace costs.

• Substance Abuse: Total cost $246 billion; $148 billion for alcohol, $98 billion for drugs. Lost productivity accounts for $162 billion of the total cost.

Other opponents

The Bush administration opposes the House version of the bill. The president worries that the bill would mandate coverage for too-broad a range of diseases and conditions and would have a negative impact on the accessibility and affordability of employer-provided health benefits. However, President Bush did not threaten to veto the legislation.

What do you think?

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