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Democrats' Win Increases Chance For Parity Law

The Democratic takeover of Congress appears likely to help advance several issues important to psychiatrists, but they may not be happy about some proposals.

Some form of comprehensive mental health parity legislation is likely to advance in the 110^th Congress, along with several other initiatives long advocated by psychiatrists.

Mental health parity is "priority" legislation for the incoming Democratic leaders of the House and Senate, according to congressional staff, and opposition from the business community will not prevent votes on such a measure, they believe.

"Sen. Reid has a personal interest in this legislation," said Kate Leone, health policy advisor to incoming Senate Majority Leader Harry Reid (D-Nev.), in an interview with Psychiatric News.

Leone said negotiations among Senate supporters of parity, the insurance industry, and business groups that were undertaken in the previous Congress will continue, but if the negotiations are not successful, parity supporters will push ahead with a bill. She did not have a timetable for congressional action on the bill.

"We have the votes to push it through," she said. The Senate approved a nonbinding resolution (SRES 619) in November commemorating the late Sen. Paul Well-stone and urging Congress to "end discrimination against citizens of the United States who live with mental illness by making legislation relating to mental health parity a priority for the 110th Congress."

Efforts to advance a parity measure in the last Congress stalled in the House, where a bill (HR 1402) with 231 cosponsors—enough to pass it—was never allowed a vote by Republican leaders. Many of the new Democratic leaders of the House were co-sponsors of that parity bill, called the Paul Wellstone Mental Health Equitable Treatment Act of 2005, including incoming Speaker Nancy Pelosi (D-Calif).

The measure is not on Pelosi's "first 100 hours" agenda of items upon which Democrats have pledged quick action, but APA plans to push for a bill as soon as possible.

"We think this legislation would be a quick way to achieve something that would be a tangible benefit to the American public," said Nicholas Meyers, director of APA's Department of Government Relations.

The House measure would have prohibited insurers that offer some form of mental health coverage from imposing treatment limitations or financial requirements not placed on "medical and surgical benefits."

Democrats in both chambers have backed the use of so-called pay-as-you-go budget rules, which require that new expenditures be offset by either tax increases or spending reductions.

A parity law may be among the more achievable goals of Democrats, according to some mental health advocates, because unlike other health care initiatives it would not require fiscal offsets—in the form of tax increases or program cuts—to pay for it. The cost of insurance parity in the private sector would not be financed through the federal budget but by private companies issuing or purchasing insurance coverage.

Parity supporters have cited studies that found parity mandates in states increased cost per insurance policy between 0 percent and 3.5 percent a year, depending on the benefit level and whether the benefits are managed. Other research estimates that the lack of adequate mental health care costs $79 billion annually nationwide in lost productivity and increased absenteeism.

Drug-Cost Proposal Expected

Another key Democratic priority is to allow Medicare administrators to negotiate directly with drug manufacturers for lower prescription drug prices in the Part D program. Democrats plan to push forward with that pledge despite polls showing that seniors overwhelmingly approve of the drug program and the fact that private health insurance plans have negotiated savings that have made the program less costly than expected (see page 4).

"People definitely still want to pursue that," said Leone, who noted a bipartisan majority of the Senate supported such a price-negotiation measure in the last Congress.

Republican opposition is expected to be fierce, with Sen. Mitch McConnell (R-Ky.), the incoming Senate minority leader, pledging to oppose it, and President George Bush promising to veto such legislation. Opponents of federal price negotiations worry that with lower prices meaning less income for drug companies, the companies would offer fewer of their drugs in Medicare Part D plans and have less income to invest in research on new medications.

Physician Reimbursement to Return

The decision by Congress to defer a scheduled 5 percent cut in physician reimbursements in the waning hours of the 109^th Congress only delayed a detailed examination of the issue by Congress (see page 1). Both Democratic and Republican congressional staff believe that a mandatory pay-for-performance (P4P) program will eventually have to be included in any long-term "fix" to Medicare reimbursement policies and skyrocketing costs.

"This is what drives increased costs in Part B," said Mark Hayes, Republican health policy director for the Senate Finance Committee, in December comments to reporters about the current physician reimbursement system.

Another controversial proposal for which congressional leaders are expected to push is a comprehensive health information technology (HIT) measure.

"That's ripe for bipartisan action," Hayes said about HIT legislation that stalled in the 109^th Congress.

The House and Senate passed competing HIT measures in the last Congress. A House Democratic leadership aide said the new leaders in that chamber were more favorable to the bipartisan Senate bill, which included stronger privacy mandates and more funds to help physicians implement HIT programs (Psychiatric News, September 1, 2006).

Physicians have raised concerns about HIT for many reasons, including their concerns that patient privacy would be threatened and the cost of adopting the technology would fall on them.

"People are concerned about whether there are adequate protections in the law today," said Bridgett Taylor, a Democratic staff member of the House Energy and Commerce Committee. Democrats don't think there are enough patient-privacy protections, she said.

Related Articles:

Congress Rejects Big Cut In Medicare Payment

Mark Moran
Psychiatr News 2007 42: 1-28. [Full Text]

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