- The Washington Times - Monday, November 26, 2001

In the name of enhancing workers' access to mental health benefits, the Senate has approved legislation that is likely to send health costs skyrocketing and slash other benefits to employees. The bill, introduced by Sens. Paul Wellstone and Pete Domenici and cosponsored by at least 65 senators, would outlaw all "disparities" between coverage of physical and mental health problems in group health plans sponsored by firms with more than 50 workers. Known as Domenici-Wellstone II, it is an effort to "correct" problems created by the Mental Health Parity Act of 1996 (better known as the MHPA or Domenici-Wellstone I), which was strongly supported by the Clinton administration and what by then had become a very docile Republican Congress.

The MHPA created a new and shifting set of access roadblocks to mental health benefits for workers. The National Center for Policy Analysis has noted, for example, that it barred plans from imposing lifetime or annual expense limits on mental-health benefits unless they were also imposed on treatment of physical illnesses. But, because it only dealt with dollar limits, the MHPA left a loophole permitting plans to impose other restrictions on mental health benefits, such as higher deductibles. The House of Representatives this year voted to extend the MHPA, which was to have expired Sept. 30. That was bad enough. But the Senate-passed Domenici-Wellstone II bill would go well beyond current law, by prohibiting health insurance plans from imposing different (i.e., higher) deductibles or co-payments for mental health treatment.

The overwhelming majority of employees who have employer-based health insurance have access to mental health coverage; according to one employer survey published in the journal Health Affairs, 91 percent of small companies (between 10 and 499 employees) and 99 percent of large firms offer mental health and substance abuse coverage in their most highly utilized medical plans. But that's not good enough for supporters of Domenici-Wellstone II, who are demanding that employee mental health coverage be provided in a manner which is essentially identical to coverage for physical illnesses. This ignores the reality that insurance companies need to differentiate between physical and mental health benefits: It is simply much easier to determine whether a broken leg has been treated than to figure out if a broken psyche has been mended. If an insurer is compelled by Washington to write a virtual blank check for mental health benefits, it is an invitation to soaring costs and abuse something the federal government is very familiar with. Medicare, for example, saw the average annual cost for each senior getting such services soar from $1,642 in 1993 to more than $10,000 by 1997. Medicare administrator Nancy Ann DeParle suggested that 90 percent of these patients had no mental illness serious enough to qualify for such treatment.

The Wellstone-Domenici approach with its one-size-fits-all federal mandate is a veritable blueprint for institutionalizing such foolishness in the private sector. And it's obvious who the victims are going to be: American workers. Mental health coverage isn't free; if an employer is forced to squander additional resources on some mental health services of questionable value, that means less is available to pay for everything else, including things workers actually need, such as more comprehensive treatment for serious physical illnesses (or, for that matter, higher salaries and better pensions). Congress needs to jettison the Wellstone-Domenici approach in favor of more flexible, commonsense ideas like expanded Health Savings Accounts, which would give individual consumers more money to spend as they see fit on mental or physical health care. And President Bush needs to veto any free-standing bill or appropriations measure containing any version of Wellstone-Domenici II.

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