Kennedy

WASHINGTON — A key Senate panel voted overwhelmingly yesterday to push the insurance industry to treat mental illness and addiction on an equal footing with physical ailments, advancing what Sen. Edward M. Kennedy called “one of the most important civil-rights issues facing the nation.”

The action was also a major stride for the signature cause of Rep. Patrick J. Kennedy, who has held hearings across the country this year to drum up support for a further-reaching House version of the “mental health parity” measure, which could improve medical coverage for many of the more than 53 million Americans who suffer from mental illness. The campaign by the congressman, a recovering drug addict and alcoholic who also suffers from bipolar disorder, has generated a warm response from mental health professionals and patients.

The 18-to-3 vote in the Senate Health, Education, Labor and Pensions Committee clears the way for early Senate action on the mental health parity bill, versions of which have had strong bipartisan support on Capitol Hill for years but have succumbed to opposition from business groups. The landmark mental health measure has better prospects for enactment this year in large part because Senator Kennedy and his Republican allies persuaded leaders of the business and insurance industries to negotiate for months with mental health advocates.

Kennedy, the committee chairman, noted that there are limitations in the Senate bill. Businesses with 50 or fewer employees, for example, would be exempt from its provisions. But he called the bill “a very meaningful down payment” toward equal treatment for the mentally ill. Sen. Pete V. Domenici, R-N.M., called this week’s action “a joyous occasion.” Domenici, a longtime champion of the bill, has a grown daughter who suffers from schizophrenia.

“Americans should be encouraged to seek treatment for mental illness and this legislation will enable those in need of care to do so,” said Dr. Thomas F. Anders, president of the American Academy of Child and Adolescent Psychiatry — one of the dozens of mental health advocacy and business groups that endorsed the Senate bill in a rare show of cooperation among interest groups that often clash.

“It’s not easy to put this together” without the kind of painstaking negotiations that went into the Senate bill, said Sen. Christopher J. Dodd, a committee member and longtime legislative ally of Kennedy who has close ties to the insurance industry.

Supporters of the bill point to another key strategic decision by Domenici, Kennedy and Sen. Michael B. Enzi of Wyoming, the ranking Republican on the health panel. In a departure from some earlier models of mental health parity, they opted not to force any company to offer mental health benefits. Rather, they built upon the mental health coverage that a large proportion of insurers already offer. Under the bill, any insurer or employer that includes mental illness in its health plan must cover it on the same basis as it covers physical illnesses and injuries.

That mandate reaches widely across the financial and administrative framework of medical insurance — touching copayments, premiums, the mechanics of managed care networks, the number of covered hospital days, and so on. Example: if a health plan requires a $10 patient copayment for a visit to the doctor’s office for a physical ailment, the plan cannot require a higher copayment for a mental health visit.

All told, such provisions are meant to put an end to premium disparities and other mental health treatment disincentives that, according to patient advocates, have long prevented people from getting the mental health treatment they need — exacerbating the stigma that has long attached to mental illness.

The stigma has gradually lost some of its power as research has produced evidence of the biological origins of many mental illnesses. At the same time, business has increasingly come to view inadequate mental health treatment as a problem that hurts the bottom line. “Businesses recognize that there is a lot of lost productivity because of the failure to provide adequate mental health treatment for employees,” according to William Emmet, a longtime mental health advocate from Rhode Island who heads the Washington-based Campaign for Mental Health Reform.

That realization has helped bring business and insurance leaders to the table with the mental health lobby, Emmet said.

The all-party talks were essential to the drafting of the compromise bill that will now go to the Senate, according to Karen Ignagni, the chief of America’s Health Insurance Plans, a powerful industry umbrella group. Ignagni — who has figured in the defeat of previous mental health parity campaigns — credited Domenici, Kennedy and Enzi with allowing business to offer cost-saving mechanisms that will make broader mental health coverage affordable. A key example, said former Rhode Islander Ignagni, is that the bill allows industry to use “disease management tools” — such as maximizing outpatient treatment, when medically advisable, as an alternative to costlier hospital stays.

Congressman Kennedy and Rep. Jim Ramstad, R-Minn., the lead sponsors of the House mental health parity bill, plan several more hearings. Kennedy applauded the Senate committee’s action yesterday but said the mental health lobby should take care not to compromise too much at a moment when it holds its strongest hand in years. Kennedy said business has come to the bargaining table in large part because it knows that the new Democratic majorities on Capitol Hill greatly improved the chances of enactment of a mental health parity bill.

But Kennedy said his bill, which could get House committee and floor action this spring, is likely to reach somewhat further than the Senate version in ensuring that medical professionals hold greater power than business officials in determining what mental illnesses are to be covered. Kennedy expressed concern, for example, that food disorders could be “stigmatized” and possibly shortchanged under the Senate legislation.

The congressman, who publicly acknowledged and sought treatment for his addiction after a heavily publicized auto accident last year, also sounded a personal note. Kennedy said the hearings, which have featured emotional testimony from people with mental illnesses, have been “an amazingly liberating experience” that has helped him to use his difficult experience to do good for others. “It has been one of the most rewarding experiences” of his public life, he said.

If the Senate and House produce diverging bills, a conference committee will be appointed to fashion a compromise that could go the President Bush, who is on record as favoring mental health parity.

If Patrick Kennedy sits on the House-Senate conference committee, will Senator Kennedy have to stare down his son over their differences? he was asked.

“We’ll find a way to work together,” Senator Kennedy deadpanned. “We always have.”