As the first session of the 107th Congress prepares to adjourn, the exciting progress of the mental health parity bill has begun to falter, its final outcome very uncertain. This situation has become all too familiar to those who follow federal public policy. Legislative advocates for mental health successfully cultivate and nurture a piece of necessary legislation to the very moment of fruition, and then run into the toxic blockade erected by those who have become our greatest nemeses, of late, members of the Republican House Leadership. You may recall that a similar chain of events occurred several months ago after the patient protection bill sailed out of the Senate with flying colors. The corresponding House bill was then significantly weakened, its teeth removed, and passed by a slim House majority dictated to by a Leadership unfriendly to patient protection interests.
Psychology’s advocacy team has repeatedly run into this stone wall erected by the current House Leadership who have demonstrated that they prefer protecting the policies of their cronies in the business and corporate world to protecting the rights of Americans with mental disorders. The details of the current situation regarding mental health parity follow, along with a discussion of possible resolution of the matter.
As of today (12/10), negotiations over the Senatepassed mental health parity measure are continuing in Conference Committee, but senior House Republicans and business groups remain staunchly opposed to a compromise that would expand the 1996 mental health parity law but allow some businesses an exemption. Under a compromise deal first offered last week by Rep. Nancy Johnson (R- CT), the chair of the House Ways and Means Subcommittee on Health, employers that demonstrate to the government that their health care costs would rise by 1% or more would be exempted from the parity requirements of the Senatepassed measure, which, as it stands, would require insurers that provide mental health coverage to offer benefits at the same level as the benefits provided for physical health coverage. The Senate bill also would exempt businesses with fewer than 50 employees.
Neither side was satisfied with Johnson’s proposal. Backers of the Senate bill, including its sponsors, Senators Paul Wellstone (D-MN) and Pete Domenici (R-NM), say the cost exemption should be higher. Rep. Patrick Kennedy (D-RI), a sponsor of a similar bill in the House feels the exemption should be in the area of 2%. A December 5th Los Angeles Times Editorial supported an even higher exemption, 2.5%.
But many employers are opposed to the parity measure, even with an exemption. The American Benefits Council, a trade group composed mainly of Fortune 500 companies believes that the underlying problem with the bill is that it does not allow employers greater flexibility in designing health benefits. This is the old message about the destructive impact of government mandates on the business community, a mantra that resonates well in some quarters of Congress. What it really reflects is that the combined pressure from the business community and the insurance industry who oppose the bill has caused the House Leadership to jump on the same band wagon as their buddies.
House Speaker Dennis Hastert (RIL) rationalizes his opposition to parity by claiming that the Labor-HHS spending bill is not a proper vehicle for new insurance requirements. Meanwhile, the chairs of the House Ways and Means Committee, the House Energy and Commerce Committee and the House Committee on Education and the Workforce — Bill Thomas (R-CA), Billy Tauzin (R-LA) and John Boehner (ROH), respectively — have also all stated their opposition to the Senate measure. Their often heard refrain is, “at a time when hundreds of thousands of Americans are losing their jobs, we should not be placing additional strains on the employer-based health care system.” An aide to Rep. Ralph Regula (R-OH), who is chairing the conference committee, said Regula was “somewhat sympathetic” to the parity measure but was not “pushing” it because of the opposition of a “formidable lineup” of senior House Republicans. On the Senate side, however, Senators Arlen Specter (R-PA) and Tom Harkin (D-IA), the leading Senate negotiators on the committee, continue to advocate for the measure.
It is unfortunate that the fate of this bill will rest on the views of only a handful of elected officials in Leadership positions in the House. The solution to this impasse between the Senate and the House, of course, requires a reversal of the House Leadership’s opposition. There are at least three ways to accomplish this goal: 1) By persuasive argument to convince the House Leadership that their concerns are baseless (doubtful given their attachment to their business/insurance industry cronies), 2) By enlisting the support of enough House Republicans who are willing to go against their Leadership on this issue, similar to what occurred with the original Norwood patient protection bill in 2000 when 21 Republicans voted against the wishes of their Leadership (a possibility), or 3) By creating a shift in House Leadership as a result of the 2002 election process (a change in the majority party would flip control of the House to the Democrats who are and would likely continue to be very supportive of parity if they were to occupy the Leadership role in the House).
Historically, a large number of psychologists lean more toward traditional Democratic Party policy. They would, no doubt, heartily endorse efforts to assist in changing control of the House back to the Ds. What is the likelihood of this occurring, keeping in mind that pinning our hopes for passage of parity on the 2002 election is a risky proposition, at best? It is never easy to predict the outcome of elections one year down the road. Viewed through the clouded lens of a post-September 11 camera, much of the political landscape is even murkier than normally would be the case. However, a couple of important elements are clear at this juncture when evaluating what may transpire next November. In all federal elections, conventional wisdom dictates that there are Five Rs which represent the fundamental critical factors affecting the outcome of elections. The 5 Rs are a useful tool for appraising next year’s electoral possibilities. They are: Retention, Resources, Redistricting, Recruiting, and Records.
Eleven months from election day 2002, Democrats are winning the game of incumbent Retention (these are seats where an incumbent is running. Incumbents are reelected over 90% of the time and so it is desirable for a given party to have greater numbers of these). Republicans are ahead in Resources. (this refers to money the candidates and the parties have collected to provide the fuel for successful political campaigns). Neither party can claim the high ground in the remaining Rs – Redistricting, Recruiting, and Records. Redistricting is the highly partisan attempt by state legislatures to alter congressional district lines every 10 years in accordance with Census results. The process is aimed at producing more seats for their party. Recruiting refers to the success a party has in enlisting high quality candidates to either challenge weak incumbents or run for an open seat. Records refer to the documented effectiveness of an office holder in either bringing home the bacon to the district and/or sponsoring visible and popular legislation for constituents.
AAP operates a bipartisan PAC which does not support either party. Clearly, AAP has and continues to support political candidates of both stripes. The common denominator distinguishing candidates who receive the support of AAP is that they must be sympathetic to the concerns of psychology. Democrats and Republicans alike have historically been strong supporters of psychology legislation. And while it is true that the House Republican Leadership is, in the case of parity, unsympathetic to our concerns, many individual Republicans have been our champions. To name just a few, Marge Roukema (R-NJ) is currently the author of a solid House parity bill, and as mentioned above, Senator Arlen Spector has done yeoman’s work for parity. It would be hard to find anyone more dedicated to mental health issues than Senator Pete Domenici (R-NM). Charlie Norwood (R-GA) worked tirelessly to support our positions on the patients’ bill of rights.
A stark reality remains however. The current leadership in the House is strongly opposed to creating public policy to elevate mental health services to the level they deserve and ultimately end the history of discrimination against the mentally ill in the private health insurance system. The individual leaders are well entrenched and it would be virtually impossible to replace them by election. They are senior members of the House. All represent safe districts in which they are unassailable. It is safe to say, they will leave office only when they choose to retire, not by defeat at the polls. Thus the only way to change the individuals who currently occupy the Leadership positions is when and if a Democratic majority is elected to the House. That could happen next November 5th. The voters in a relatively small number of congressional districts where there is no candidate who dominates will ultimately decide whether the 108th Congress will change back to Democratic control or remain under Republican leadership.
In the meantime, AAP along with APAPO will be working diligently to try to encourage a small handful of courageous Republicans to oppose their Leadership’s position and take a stand to end the discrimination against those with mental disorders. We achieved success with this strategy in 2000 with what came to be known as the Norwood 21, as mentioned above. We are not quite there yet, but we are continuing to work toward achieving a similar kind of victory with parity.
You can help by continuing your support of AAP and AAP/PLAN. One of the 5 Rs cited above is what AAP is all about, providing resources to candidates to assist their elections. You can also inform your colleagues and friends about the importance of voting for candidates sympathetic to psychology’s concerns. This ought to be top priority for every psychologist given that the profession provides the means for putting bread on the table of every psychologist. Happy New Year to all of you.