Update on federal parity law- NAMI position

MEMORANDUM

TO: NAMI State Presidents

NAMI State Executive Directors

NAMI Consumer Council Representatives

FROM: Mike Fitzpatrick, Executive Director

Andrew Sperling, Director of Legislative Advocacy

RE: Status of Federal Parity Legislation

DATE: November 2, 2007

As you know, 2007 has presented NAMI with the most promising opportunity
to date to pass federal legislation requiring equitable coverage for
mental illness treatment in group health plans. An insurance parity bill
(S 558) passed the Senate by unanimous vote on September 18. The House
is expected to act on a companion parity bill (HR 1424) within the next
few weeks.

For more than 15 years, enactment of federal parity legislation has been
a top policy priority for NAMI. The absence of equitable insurance
coverage has forced too many individuals and families living with
serious mental illness to exhaust their limited coverage and be forced
on to public sector programs. Parity will not address every shortcoming
in our health care system, but it will place mental illness on par with
all other diseases and establish a durable precedent in federal law that
mental illness should be covered on the same terms and conditions as all
other medical conditions.

In the few remaining days and weeks of this year's congressional
session, the sponsors of the separate House and Senate bills have a
major challenge ahead of them in resolving the differences between S 558
and HR 1424. NAMI is hopeful that this can happen quickly and that a
bill acceptable to the President can emerge from this process so that
parity can be signed into law this year.

* *

*/What is NAMI's Position on the Separate House and Senate Parity Bills?/*//

NAMI is currently supporting the Senate bill (S 558) that passed the
Senate unanimously on September 18. It is viewed as the quickest and
most reliable path to getting a federal parity bill signed by the end of
the year, having already gotten past all 100 Senators - each of whom has
the ability to block any single piece of legislation.

NAMI is currently neutral on the House companion (HR 1424). This
position of neutrality is based on concerns regarding both process and
substance:

*Process *- There is growing concern that any effort to push the Senate
to pass an alternative mental illness parity bill is likely to result in
Senators blocking the bill, or at least blocking a motion to appoint
Senators to a "conference committee." S 558 has already cleared this
most difficult hurdle in the legislative process - agreement among all
100 Senators. House passage of the Senate bill would allow parity
legislation to go quickly to the President to be signed into law and
bypass a long drawn out process of reconciling the separate House and
Senate bills.

If parity legislation were to be pushed off until 2008, the obstacles
posed by election year politics are certain to intensify. The few
remaining weeks of the current 2007 congressional session offer the best
opportunity ever to achieve the dream of federal action to end insurance
discrimination - it is critical that parity legislation pass this year.

*Substance *- Both S 558 and HR 1424 contain requirements for group
health plans to cover mental illness treatment at parity when it is
offered (i.e., equal treatment limits and financial limitations).
However, the House bill goes further in mandating coverage of the
broadest list of conditions if mental health benefits are offered.

NAMI is concerned that this "triggered" coverage mandate (separate from
the underlying equitable coverage requirement) has the potential to
place mental health benefits at risk as the bill forces employers and
health plans to make an "all or nothing" choice between covering all
mental health disorders in the APA Diagnostic Statistical Manual (DSM)
and completely eliminating all mental health benefits. In addition, the
coverage mandate in HR 1424 would likely result in preemption of state
laws requiring offering or coverage of serious mental illness (including
minimum coverage requirements). These substantive concerns with the DSM
mandate in HR 1424 are discussed in greater detail in the following
analysis that is posted to the NAMI website.

http://www.nami.org/Template.cfm?Section=Parity1&Template=/MembersOnly.cfm&C
ontentID=53500
<http://www.nami.org/Template.cfm?Section=Parity1&Template=/MembersOnly.cfm&
ContentID=53500>

NAMI has raised these substantive concerns privately with the sponsors
of the House bill (Representatives Patrick Kennedy of Rhode Island and
Jim Ramstad of Minnesota) and will continue to work with them - as well
as the Senate sponsors (Senators Pete Domenici of New Mexico, Edward M.
Kennedy of Massachusetts and Mike Enzi of Wyoming) to press for a strong
bill that can pass Congress and be signed into law before the end of the
year.

*//*

*/S 558 - Comprehensive Parity Protections That Build on Existing Coverage/*

It is important to note that this "triggered" coverage mandate for the
entire DSM is NOT included in the Senate bill. As a result, S 558 does
not preempt any state law that requires offering or coverage of serious
mental illness, or any state law that limits a parity requirement to
serious mental illness. Further, it should be noted that NAMI views the
Senate bill as strong legislation that would end all forms of insurance
discrimination including limits on inpatient days and outpatient visits,
as well as financial limitations such as higher cost sharing,
deductibles and out-of-pocket limits.

By avoiding any new coverage mandates, the Senate bill keeps coverage
affordable. Attempts to characterize S 558 as "weaker" or "watered down"
are simply false. The Senate bill provides comprehensive protections
against unfair or arbitrary limits in coverage for mental illness, while
avoiding new requirements that could result in loss of mental health
coverage.

If you have any questions regarding the current status of federal parity
legislation, the details of the House and Senate bills, or NAMI's
position going forward, please do not hesitate to call us. Andrew
Sperling can be reached at either andrew@nami.org
<mailto:andrew@nami.org> or toll-free at 888-999-6264, ext. 7940.

Thank you for your continued support for federal parity legislation.
Your efforts are critical to achieving enactment of legislation to end
insurance discrimination this year.

cc: NAMI National Board of Directors