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Wellstone Bill Faces Hurdles

Domenici and Hastert at Odds

When Sen. Paul Wellstone died last October, Sen. Pete Domenici

(R-N.M.) vowed to honor the Minnesota Democrat by finally shepherding through the mental health parity bill they had worked on together for several years.

But even with the influential support of President Bush and Senate Majority Leader Bill Frist (R-Tenn.), the Paul Wellstone Mental Health Equitable Treatment Act of 2003 is currently stopped in its tracks.

Insiders say Domenici may have inadvertently imperiled the bill’s chances in the House by using tactics that irked Speaker Dennis Hastert (R-Ill.).

Hastert, who was already a skeptic of the bill, didn’t take kindly to Domenici’s recent plea to the White House that Bush use his influence to force Hastert to act on the bill.

“If [Domenici] wants to negotiate, he should negotiate with Hastert,” said a senior House GOP leadership aide. “The Speaker’s belief is that just because [the White House] made a commitment doesn’t mean he’s committed.”

Though the White House has made good on its promise to talk to Hastert, the tactic appears to have backfired and made the Speaker even less likely to bring the measure to the floor.

“The White House may be talking to other Members, but they didn’t have much success with [Hastert],” said the House GOP aide. “He really wonders why the White House went along with this in the first place.”

Domenici’s office said the Senator was not aware of Hastert’s displeasure. But a Senate GOP aide acknowledged that Domenici’s maneuvering “has caused some serious friction.”

Rep. Patrick Kennedy (D-R.I.), the lead sponsor in the House, said supporters will push to memorialize Wellstone regardless of the obstacles. He suggested that coming up short — by failing to pass the bill or watering it down — would cause deep disappointment.

“It’s not going to be honoring Paul Wellstone’s memory nor will it acknowledge the time we are in where [mental health] is a big factor in many people’s lives,” said Kennedy. “To do anything less, we’d have to change the name of the bill.”

Hastert is not alone in his skepticism of the measure, which would require health insurers to institute the same co-payments, deductibles and access for mental health care that is currently afforded for physical maladies. The mandate would apply only to insurers that already cover mental illness and psychotherapy.

Critics of the bill — including Senate Health, Education, Labor and Pensions Chairman Judd Gregg (R-N.H.) — say it would require insurers to increase health insurance premiums as well as force them to cover what many consider fringe mental illnesses, such as transvestitism and fetishism.

The Congressional Budget Office estimated that the bill would raise health insurance premiums by 0.9 percent and cost the federal government about $5 billion over 10 years.

Domenici, however, used his clout on the Budget Committee to have those costs factored into the federal budget. The House Budget Committee’s resolution does not include those costs, and aides predicted a vigorous fight in conference on the fiscal 2004 budget resolution.

Even if Domenici wins the battle on the budget front, he still has to convince Gregg to bring the bill up in the HELP panel. The chairman said he’s looking for some concessions from Domenici before that could happen.

“We had a bill last year that we thought was reasonable,” said Gregg. “But now they’ve gone back to the original bill, which is unfortunate.”

Gregg said he would prefer a measure allowing health insurers who would see more than a 1 percent increase in premium costs to opt out. He also said the bill should only mandate parity for severe mental illnesses, such as schizophrenia, bipolar disorder and major depression.

Gregg would not say when or if he would schedule the bill for markup. And Senate aides said Gregg’s concerns are just the tip of the iceberg.

“Gregg is just the public face of the many Members who are questioning the cost and long-term consequences,” said one Senate GOP leadership aide.

Still, Domenici said he’s counting on Frist to use his influence with Gregg to get a markup.

“[Gregg’s] going to report it out,” said Domenici. “I’ll ask him to, and the leader will ask him.”

Even Frist said he preferred Gregg’s approach, though he promised to work on a compromise that Domenici would accept.

“There are two issues I would want to look at again,” said Frist. “The breadth of the diagnoses that are covered and the overall effect on the cost of health care delivery.”

Despite the chorus of criticism from some colleagues, Domenici believes he has the support of the majority of the Senate for his original bill, which would cover all mental illnesses. Indeed, Domenici’s bill last year attracted 65 co-sponsors and so far this year the measure has 43. An identical House bill has 181 co-sponsors.

“If on the floor of the Senate some people want to argue, they’ll have a shot at changing it,” said Domenici. “I’m not going to change it though.”

Domenici and other supporters are especially inflexible on the question of what mental illnesses to cover, saying every psychological malady listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders should be included.

But critics contend it would expose insurers to potential abuse.

“We have to be clear that we’re not covering in an indiscriminate way anything that people try to move in through the back door of mental health,” said Frist. “We’ll have to draw the line somewhere.”

House Energy and Commerce Chairman Billy Tauzin (R-La.) and House Education and the Workforce Chairman John Boehner (R-Ohio) also said limiting the kind of mental illnesses insurers would have to cover is a prerequisite for any action in committee.

“We’re not going to put it on the committee schedule until we know what we’re working with,” Tauzin said of his efforts.

Though Bush also appears to favor a limited approach, the bill’s backers view any support from the president as a boon to their cause.

“I think the president holds the key, and his support is crucial,” said Rep. Jim Ramstad (R-Minn.), a co-sponsor in the House.

Democrats agree that the president needs to weigh in and blame him for not stepping up the pressure on Hastert and Frist.

“The White House expressed public support for this, but the White House has failed to act, despite the personal pleas of Senator Domenici, which the last time I checked was a senior Republican,” said one Senate aide.

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