Mental Health Parity Urged

President Bush on Monday stepped into the growing debate over insurance benefits for the mentally ill, calling for legislation to eliminate disparities between coverage of patients with mental and physical ailments.

“Our health insurance system must treat mental illness like any other disease,” Bush said in an appearance before mental health professionals in Albuquerque, before flying to Los Angeles.

The president did not endorse a specific bill or detail provisions he could support. But lobbyists on both sides of the issue said Bush’s speech signaled his willingness to work with lawmakers on a measure that would require wider insurance coverage for the most serious mental illnesses. These would include major depression, bipolar disorder, schizophrenia and obsessive-compulsive disorder.

Such coverage generally is opposed by many of Bush’s business allies, who warn about its effect on health-care costs.

Bush took note of such concerns. While stressing that he hoped Congress could send him a bill this year, he said such legislation should “not significantly run up the cost of health care.”

White House Press Secretary Ari Fleischer added that the administration’s goal was to achieve “maximum parity” in insurance coverage “without driving up costs so high that people lose insurance in the end.”

Bush also announced the creation of a presidential commission to recommend improvements in the nation’s mental health care. The 22-member panel will be asked to identify patient needs and barriers to care, and to recommend improvements within a year. Bush named Michael Hogan, the director of Ohio’s department of mental health, as chairman.

At the center of the insurance debate is whether mental health patients should receive coverage that is on a par with benefits provided for physical illnesses. In most insurance plans, such parity has long been lacking, and the inequity has emerged as a political issue. Democrat Al Gore regularly won applause during his 2000 presidential campaign when he called for equivalent coverage.

Bush’s remarks were his most extensive on the insurance issue since he became president.

“Our country must make a commitment,” he said at the University of New Mexico appearance. “Americans with mental illness deserve our understanding and they deserve excellent care. They deserve a health care system that treats their illness with the same urgency as a physical illness.”

He added: “Health plans should not be allowed to apply unfair treatment limitations or financial requirements on mental health benefits.”

Bush identified such inequity in coverage as one of the three major obstacles to confronting what he termed “the hidden sufferings of Americans with mental illness.”

The other obstacles were the stigma that often surrounds mental illness and a fragmented system for delivering services to the mentally ill, he added.

“Many Americans fall through the cracks of the current system,” Bush said, in part because many mental disorders are hard to diagnose.

These are some of the problems he wants the new commission to examine.

A 1999 surgeon general’s report found that more than 50 million Americans--roughly 1 in 5--suffer from mental illness each year, but that fewer than half of them seek treatment. The National Institutes of Mental Health estimates the cost of untreated mental illness, including criminal justice and social welfare costs, at about $300 billion a year.

White House officials said they have begun preliminary talks with the congressional supporters of improving insurance coverage for mental illness. So far, Bush has been unwilling to require unlimited coverage for all of the 277 conditions listed in the Diagnostic and Statistical Manual of Mental Disorders.

Still, supporters of parity in mental health coverage were heartened by his remarks on Monday.

The American Psychiatric Assn. issued a statement expressing its “gratitude and praise” to Bush for “his commitment to ending discrimination ... against patients seeking treatment for mental illness by supporting mental health parity legislation.”

But a statement by the American Assn. of Health Plans, a trade group representing more than 1,000 health maintenance organizations, illustrated the difficulties the administration will face in trying to broker an agreement on the issue.

“Proposals to mandate an expansion of mental health coverage at the federal level would add billions of dollars to health-care costs at a time when 40 million Americans lack access to health insurance, and many more are struggling to afford the coverage they have,” the group said.

Also, the Health Care Coalition, a group made up of such politically powerful groups as the U.S. Chamber of Commerce, the National Assn. of Manufacturers and the National Federation of Independent Business, has prepared an advertisement telling Congress to keep out of health care.

“Not one more dime. Not one more dollar. Not one more bill that raises health-care costs,” the ad says.

Bush shared the stage Monday with Sen. Pete V. Domenici (R-N.M.), a conservative who has joined with Sen. Paul Wellstone (D-Minn.), a liberal, to lead the push for an insurance parity bill.

Their measure would not require any employer or group health insurance plan to cover mental health care. It applies only to plans that already offer mental health coverage, and it exempts businesses with 50 or fewer employees.

For Domenici and Wellstone, the campaign for stronger mental health coverage involves a personal element. Both have watched family members struggle with mental illness.

Their bill would prohibit coverage limits imposed in a 1996 bill, and would expand the range of mental illnesses covered. It includes almost all conditions except substance abuse.

California and 31 other states have mental health parity laws. The California statute requires equal insurance coverage for all severe mental illnesses.

A Texas law, signed by then-Gov. Bush, is narrower, exempting small businesses and restricting the types of illnesses covered, while limiting outpatient visits to 60 a year and inpatient treatment to 45 days annually.

The Congressional Budget Office estimated that the Domenici-Wellstone bill would increase health insurance costs an average of 0.9%, or roughly $23 billion a year. Opponents of the bill say the 0.9% figure is far too low.

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Gerstenzang reported from Albuquerque, Kemper from Washington.