While Sen. Edward Kennedy (D-Mass.) and his son, Rep. Patrick Kennedy (D-R.I.), have similar goals — parity of insurance coverage for mental health ailments with physical ones — they have taken different approaches, based as much on the political realities of the two chambers as on differences in their own philosophies.
Sen. Kennedy is an old hand at the political
game, renowned as a deal maker and advocate on health care issues.
Rep. Kennedy has far less experience, but observers say he has been tenacious in his push for a bill.
The younger Kennedy, says his former chief of staff, Sean Richardson, believes in connecting “policy with people” by holding numerous field hearings on mental health coverage issues.
He “believes that his narrative will make the difference” in getting enough support to move the bill, says Richardson.
Rep. Kennedy’s bill, the Paul Wellstone Mental Health and Addiction Equity Act of 2007, requires that insurance companies consider, but not necessarily cover, all mental ailments listed in the Diagnostic and Statistical Manual of Mental Disorders, the standard reference work for psychology and psychiatry.
The House bill also would require that if out-of-coverage providers are permitted for the treatment of physical ailments, the same should apply to mental health treatments.
Sen. Kennedy’s bill, the Mental Health Parity Act of 2007, does not require that DSM standards be considered or that out-of- network coverage be required.
The Senate bill is currently in the House, having passed by unanimous consent last September.
The House bill will go to the floor this week.
Both Kennedys said they respect each other’s efforts and what they brought to negotiations.
“Patrick … brings deep commitment, knowledge and leadership to mental health — an issue that has been neglected far too long,” Sen. Kennedy said.
According to Rep. Kennedy, his father is “the Lion of the Senate, and whether you’re his son or not, there is a great thrill to move something of this magnitude together with him.”
However, many observers say that Sen. Kennedy’s bill does not go far enough — in part because of his desire to have a workable proposal that not only Congressional Republicans, but also the administration, can sign on to. The administration says that forcing insurers to consider DSM standards, even if they don’t necessarily have to cover them, would be too onerous a burden, and possibly result in higher premiums.
And that doesn’t necessarily sit well with the House side.
Sen. Kennedy “would rather move product than make a point,” noted an aide to Rep. Jim Ramstad (Minn.), the Republican co-sponsor of the House bill. “We come at it from the patient perspective; the Senate came at it from an industry perspective.”
Republicans and industry groups, however, say that the House bill’s requirements are too onerous, potentially leading employers to drop health care coverage altogether.
The proposal will likely lead to a “stalemate” between the chambers, which will hold up necessary mental health parity law, Rep. Heather Wilson (R-N.M.) said earlier when the bill was being marked up. The Senate bill is the “only bill that has a chance of passing and becoming law,” she added.
Supporters of the House bill, however, counter that the bill merely requires doctors to assess those ailments, not that plans cover the treatments.
Critics, including America’s Health Insurance Plans and the American Benefits Council, which represents employer-sponsored benefit programs, also argue that Rep. Kennedy did not take an inclusive approach to developing his bill, failing to give the health care industry sufficient input.
That lack of input has led to a House bill that “sets back the progress that’s been made over the past decade” in getting mental health parity, said Karen Ignagni, AHIP’s president and CEO, referring to years of negotiations needed to bring certain industry groups on board.
Critics on both sides alternatively have argued that the Senator was too pragmatic or his son was too idealistic. But both men strongly disagreed with such characterizations.
“The fact of the matter is my bill has the support of a strong bipartisan majority — 274 cosponsors,” Rep. Kennedy said. “I don’t call that idealistic. I call it pragmatic and I call it progress.”
Instead, both Kennedys argued that it was the differences between the chambers that drove the content of their bills. “The real difference is in the rules and procedures of the House and Senate,” Sen. Kennedy said.
Added Rep. Kennedy, referring to the possibility of a Senate filibuster: “There are a divergent set of political circumstances in each chamber and that demands different approaches to reach final passage in our respective chambers.”
There are other differences as well.
While the House requires that before passage there must be legislation to include a specific “pay for” to offset its costs, the Senate does not have such a requirement, Rep. Kennedy noted.
A mental health parity law would likely result in higher health care premiums, which in turn could mean less taxable income.
“There are different dynamics in each chamber, such as the political nature of these offsets.” The offset remains an “unknown quantity that needs to be resolved,” he added.
Under current budgetary rules, any increases in spending must be offset by cuts elsewhere.
A former Democratic aide took this a step further. “Some will argue that the Senate has only passed half a bill” because no offset has been provided. Instead, the Senate has “laid this issue at the feet of the House.”
Both sides are likely to reach agreement on the substance of the bill.
Reaching an agreement on the offset is a different story, the aide said.
Experts on the issue, like Barbara Kennelly, who runs the National Committee to Preserve Social Security and Medicare, say the bill is too pricey to pass in a year where even health care entitlement programs such as Medicare and Medicaid face cuts. “I don’t have much hope for it,” she said.
The Congressional Budget Office estimates the Senate bill would reduce federal tax revenues by $1 billion from 2009 to 2012 and by $3 billion from 2009 to 2017.
CBO also estimates that the House bill would reduce federal tax revenues by $1.1 billion from 2008 to 2012 and by $3.1 billion from 2008 to 2017.
Both Kennedys, however, were optimistic that a deal could get done this year, even while they declined to specify how that would happen.
“One thing I learned many years ago is never reveal what compromises are possible,” Sen. Kennedy said. “And legislation is always the art of the possible.”