Senate Begins Debate on Patients' Bill of Rights
This week, the Senate began consideration of important patients' rights legislation, S 1052, the Bipartisan Patient Protection Act of 2001, sponsored by Senators John McCain (R-AZ), Edward M. Kennedy (D-MA) and John Edwards (D-NC).
As is being widely reported in the press, Congress has been debating a patients' bill of rights for nearly four years, but progress has been stymied by partisan stalemate, particularly over the contentious issue of allowing individuals to sue their health plans in state court for monetary damages.
On June 20, the White House threatened to veto the McCain, Kennedy, Edwards bill in its current form because of objections over health plan liability. President Bush is supporting an alternative measure drafted by Senators Bill Frist (R-TN), John Breaux (D-LA), and Jim Jeffords (I-VT) that does not allow for lawsuits against health plans in state court.
For the past four years, NAMI has pushed hard for enactment of patients' rights legislation that includes enforceable standards for all health plans to ensure access to mental illness treatment services. NAMI will continue to support all proposals before Congress that contain the following key provisions:
1) Limits on the use of restrictive prescription drug formularies that operate as barriers toward access to the newest and most effective medications,
2) enactment of mandatory third-party, independent, clinical review with prompt timelines for binding decisions and,
3) coverage of routine treatment associated with participation in clinical trials for new treatments for serious brain disorders.
S 1052 contains all of these key components. By contrast, the Frist, Breaux, Jeffords proposal would not allow psychiatrists to overrule a plan's restrictive formulary and excludes individuals with severe mental illnesses from its clinical trials provision. For more information on NAMI's position, please go to NAMI's Where We Stand paper on the Patient's Bill of Rights at www.nami.org/update/unitedbill.html
All NAMI members and advocates are encouraged to contact their Senators and urge them to support a strong, enforceable Patients' Bill of Rights that ensures access to needed treatments and services for persons with severe mental illnesses and their family members, and oppose all weakening amendments. All Senators can be reached by calling the Capitol Switchboard at 202-224-3121. Fax numbers, email and mail addresses can be obtained by clicking on "Write to Congress" on the Public Policy home page of the NAMI Web site, www.nami.org
Senator Richard Durbin (D-IL) is expected to offer an amendment to S 1052 that would severely limit the ability of health plans in the individual insurance market from denying health coverage to individuals with a pre-existing mental illness diagnosis. The amendment would also prohibit insurers from charging such individuals higher premiums based on a preexisting mental health condition.
Specifically, the Durbin Amendment would:
*Limit any preexisting condition exclusion relating to a mental health condition to no more that 12 months (18 months in the case of a late enrollee), and reduces this exclusion period by the aggregate of periods of credible coverage.
*Prohibit any health insurer that offers health coverage in the individual insurance market from imposing a preexisting condition exclusion relating to a mental health condition unless a diagnosis, medical advice or treatment was recommended or received within the 6 months prior to the enrollment date.
*Prohibit health plans in the individual market from charging higher premiums to individuals based solely on the determination that the individual has had a preexisting mental health condition.
NAMI is strongly supporting this proposal and urges its passage should Senator Durbin choose to offer it as an amendment to S 1052.
It is possible that Senator Tim Hutchinson (R-AR) may offer an amendment to vastly expand multi-employer health plans that are exempt from state consumer protections under the federal ERISA law. This Association Health Plan (AHP) proposal would allow multi-employer plans to evade the 32 state mental illness parity laws that NAMI advocates have worked hard over the past decade to pass. NAMI therefore opposes Senator Hutchinson's amendment if offered.