"I'd like to see substance abuse included," Rep. Kennedy said, "but in order to not give the opposition any excuse for not passing parity, we've decided to go with the bill that's passed already in the full Senate and has bipartisan co-sponsorship on both sides. It's better to stay on safe ground so the pressure is maximized. It will be like a wall tumbling down. If we get this victory under our belts, the blow that this is going to make to stigma is so profound that the battle for parity in substance abuse will soon follow."
But the challenge appears to be greater this year, as a host of other issues, including war, terrorism and prescription coverage for Medicare recipients, vie for the attention of lawmakers.
"This is a bill that has won support on both sides of the aisles," Ralph Ibson, vice president for government affairs at NMHA, told PT. "In the right circumstances, it should not be difficult to pass. Unfortunately, this year it competes for attention with many other things. The advocates are hopeful that the president would at some point engage the Congress with letters and renew a call that they deliver a bill to him."
In addition, the bill's sponsors can expect stiff opposition from the insurance industry, which succeeded in scuttling last year's measure. "We have a great number of organizations that have endorsed parity," Ibson said. "There is a group of eight of us that have been working together for some time as a coalition for parity, and that includes a number of provider organizations, such as the American Psychiatric Association, the American Medical Association, the American Psychological Association and even the Managed Behavioral Healthcare Organization. But the rest of the insurance industry certainly has not embraced this legislation. Far from it."
"We will do what we can to defeat it," Larry Akey, director of communications for the Health Insurance Association of America, told PT. "We believe that the best place for benefit design decisions to be taken is between employers, employees and their health plan, not in the emotionally charged atmosphere of Congress or the state legislatures."
Health Insurance Association of America President Donald Young issued a statement that called the parity measure "a misguided effort to provide additional treatment resources for a wide variety of ill-defined and difficult-to-diagnose mental disorders" that will "drive up the cost of health insurance for everyone, and å will cause hundreds of thousands of Americans to lose their health coverage altogether."
Mohit Ghose, a spokesperson for the American Association of Health Plans, is concerned about the cost of a legislated mandate. "We believe in this environment of rising health care costs, any type of benefit mandate bill will put a tremendous amount of pressure not only on employers but on employees," he told PT.
"We believe that people need access to the right care in the right setting at the right time, including mental health services," Ghose said. "We also believe it is imperative that we permit employers a level of flexibility in designing their benefits that allows us to bring more people into the system rather than losing their benefits. This bill is almost like giving the employer a disincentive, taking away the flexibility to design a plan that meets his employees' needs, telling him that you provide this or you provide nothing. And that's the danger."