GOVERNMENTPhysicians lobbying Congress for health law expansionsAt stake are laws providing equal insurance coverage for treatment of mental illness and patent extensions for drugs tested on children.By Geri Aston, amednews staff. Dec. 17, 2001. Washington -- Several physician groups are pushing lawmakers to pass legislation that would reauthorize and expand two health care laws that expire this year. One bill would ensure that insurance coverage for mental illnesses is equal to that for other illnesses. The other gives pharmaceutical companies financial incentives to conduct studies to determine the safety and proper dosage of drugs for children. The mental health parity measure would expand the original 1996 law, which expired at the end of September. It is attached as an amendment to the Senate fiscal year 2002 spending bill for the departments of Labor, Health and Human Services, and Education, which passed in October. The House-passed version of the appropriations bill includes no such provisions, and at press time lawmakers were negotiating whether mental health parity would be included in the final package. The mental health parity provisions "would open up to millions of people the opportunity for more appropriate coverage of psychiatric illness without discriminatory co-pays and deductibles," said Paul Appelbaum, MD, president-elect of the American Psychiatric Assn. and professor and chair of psychiatry at the University of Massachusetts Medical School, Worcester. The original law banned annual or lifetime spending caps on mental health benefits that are lower than those for medical or surgical benefits. The statute's impact was limited by its narrow scope, according to mental health advocates. Insurers shifted from dollar caps on benefits to restrictions on the number of hospital stays or doctor visits for mental health services and to higher co-payments and deductibles for such care, Dr. Appelbaum said. The new legislation, sponsored by Sen. Pete Domenici (R, N.M.), would prohibit group health plans from imposing treatment limitations or financial requirements on mental health coverage that are not comparable to those for medical or surgical benefits.
The federal mental health parity mandate expired in September.
The bill "would finally end health insurance industry practices that discriminate against those suffering from mental illness by prohibiting health plans from treating mental health benefits differently from the coverage of medical and surgical benefits," said J. Edward Hill, MD, AMA chair-elect. Small businesses, defined as those with between two and 50 workers, would be exempt from the parity rules, and the measure would not require group plans to provide mental health benefits. Advocates argue that mental health parity is affordable. They point to a Congressional Budget Office estimate indicating the bill would increase group health insurance premiums by an average of 0.9%. But that cost increase is of concern to several Republican House leaders who could jeopardize its inclusion in the final spending package. "During this time of economic uncertainty, we believe it would be inappropriate to place additional burdens on employers that may increase the costs of Americans' health insurance premiums," wrote Rep. Billy Tauzin (R, La.), chair of the House Energy and Commerce Committee in a recent letter to members of the House Appropriations Committee. Tauzin also objected to the measure's failure to include a provision found in the original law that exempted employers from the parity rules if those rules caused their health insurance premiums to rise more than 1%.
Since enactment of patent protection in 1998, the FDA approved pediatric testing of 188 drugs.
But supporters of the measure remain optimistic about its passage. "Contrary to predictable assertions by businesses that 'opposition is growing' to mental health parity, in fact an overwhelming majority of the Senate and a large and clear majority of the House are on record in support of parity," the APA said in a recent statement. In another area of legislation, efforts to extend a 1997 law granting pharmaceutical companies an additional six months of patent protection for drugs tested on children moved forward with last month's passage of a House bill. The Senate approved a similar measure in October. The law is set to expire Jan. 1, 2002. The large margins of victory -- unanimous in the Senate and 338-86 in the House -- indicate that chances for final adoption are excellent, said Richard Gorman, MD, chair of the American Academy of Pediatrics' committee on drugs. At press time, however, lawmakers had not been appointed to the conference committee that would iron out the minor differences between the House and Senate bills, a necessary step before final passage. Approval of the bill is essential, Dr. Gorman said. "What is at stake here is a continuation of the absolute windfall of specific, detailed and important information on pharmaceuticals for children," he said. If Congress fails to act, "children revert to being therapeutic orphans," he added. The law, which went into effect in 1998, also has received good marks from the Food and Drug Administration. "The pediatric exclusivity provision has done more to generate clinical studies and useful prescribing information for the pediatric population than any other regulatory or legislative process to date," the agency said in a January report to Congress. As of April, the FDA had approved the testing of 155 drugs already on the market and 33 not yet approved. By contrast, in the seven years before the law's passage, pediatric studies of only 11 marketed drugs were conducted. In addition to renewing the patent provisions, the legislation pending before Congress would create an FDA Office of Pediatric Therapeutics that would coordinate agency activities affecting the practice of pediatrics. It also would require that the government create a list of drugs that need additional pediatric studies. ADDITIONAL INFORMATION:Extending the lawsMental Health Parity ActPurpose: Banned annual or lifetime dollar caps on mental health benefits that are lower than such limits on medical or surgical benefits.
Food and Drug Administration Modernization ActPurpose: Includes provisions that give pharmaceutical companies six extra months of patent protection for drugs tested on children.
Copyright 2001 American Medical Association. All rights reserved.
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