National Alliance on Mental Illness
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Bridging the Gap Between S 558 and HR 1424
March 6, 2008
Despite the consensus on the need for parity, the path toward final agreement between the House and Senate – and the President – will not be easy. There is likely to be stiff resistance in the Senate to any effort to require health plans to cover every diagnosis and condition in the DSM in order to maintain coverage for mental illness. Among the differences that the House and Senate will have to resolve to get a bill that can be enacted this year are:
It is important to note that BOTH bills:
The bills contain major differences with respect to the budget "pay-fors" that are required under House rules. These provisions are required to "offset" revenue lost to the Treasury as a result of enactment of parity. Under recently revived budget rules Congress must "pay for" any change in federal law that results in higher entitlement spending or lost revenue with an "offsetting" cut in another program. In the case of parity tax revenue will be lost to the government as health spending that is now made by families with after tax dollars shifts to before tax dollars. For example, spendingnow excluded from health plan coverage (e.g. because of arbitrary limits on inpatient psychiatric care that would not be allowed under parity) would be covered by health plans with pre-tax dollars.
The House bill is projected to result in nearly $3.8 billion in lost revenue and additional spending over the next decade. Under the congressional "pay-go" rules, all of this $3.8 billion must be offset. The House bill contains 2 provisions to make up for this lost revenue to the Treasury:
The Senate bill does not contain budget offsets. However, any final bill will require offsets before it can be offered for final passage.
Finally, immediately upon passage of HR 1424, the House added a separate piece of legislation to the parity bill, the Genetic Information Nondiscrimination Act (GINA, HR 493). This bill is designed to address the misuse of personal genetic information. Like mental illness insurance parity, GINA has been pending before Congress for years. It passed the House in April 2007 and is still awaiting action in the Senate.
What is the President’s Position on the House and Senate Bills?
Click here to view the "Statement of Administration Position on HR 1424."