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Parity, genetic privacy bills face snags

Conflict between the House and Senate mental health parity legislation poses a problem, while one senator's concerns hamper a genetic protection measure.

By Doug Trapp, amednews staff. Feb. 25, 2008.

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Washington -- Bills to protect Americans from misuse of their genetic information and to prevent discrimination in mental health benefits attracted broad support last year but still face a tough road this year because of unresolved disputes.

Both the Genetic Information Nondiscrimination Act of 2007 and the House and Senate mental health parity bills have an array of co-sponsors and support. All of the measures, except the House mental parity measure, were approved by one chamber of Congress last year.

The success of either legislative effort this year could come down to how quickly lawmakers begin work on them. Nicholas Meyers, director of government relations for the American Psychiatric Assn., said speed is going to be a key in the push for greater mental health parity protection. "My gut tells me the longer this goes on, the more difficult it gets to do it."

Mental health parity on House agenda

Mental health parity legislation could advance along two main pathways. House lawmakers could adopt their stronger version and force the Senate into a conference committee to negotiate the differences between the two bills. Or House lawmakers could pass the Senate bill, which would send the legislation to President Bush.

The Senate passed its carefully negotiated bill, the Mental Health Parity Act of 2007, unanimously in September 2007 after more than a year of negotiations between insurance and business associations, issue advocates and three key senators.

Existing law, the Mental Health Parity Act of 1996, prohibits insurers from imposing stricter lifetime or annual caps on mental health benefits than they have for physical health benefits. The Senate bill would expand on that statute by including substance abuse treatment and requiring insurers to bring equality to deductibles, co-payments, coinsurance, the number of visits and days allowed in the hospital.

House sponsors want stronger protections. Three House committees approved the Paul Wellstone Mental Health and Addiction Equity Act of 2007 last year. The bill would require insurers to provide more out-of-network mental health coverage and to cover more illnesses in general than the Senate version.

One key issue with the House bill is the $3.1 billion in federal funding needed to offset its cost over 10 years, according to a November 2007 Congressional Budget Office estimate. Under the bill, the cost of health premiums would rise, which would increase the amount of salaries deducted for premiums, according to the CBO. This would lower the amount of salaries subject to payroll taxes.

Melissa Wagoner, spokeswoman for Sen. Edward Kennedy (D, Mass.), said Kennedy and other Senate bill sponsors are waiting for the House to act. The House bill is expected to get a full House vote as soon as technical differences between the three committee-approved measures are resolved, according to Kathryn Grant, spokeswoman for Democratic Majority Leader Rep. Steny Hoyer (D, Md.). "The hope is that it will be brought to the floor for a vote early this year," she said.

The American Medical Association supports both the House and Senate mental health parity measures.

Meanwhile, lawmakers still are trying to reinstate the mental health parity protections that Congress adopted in 1996 and extended repeatedly since then.

In December 2007, lawmakers failed to reauthorize the 1996 act through fiscal 2008 because of a House-Senate dispute over what should be included in a bill providing tax benefits to members of the military. The parity extension was attached to the military measure.

But on Feb. 7 the House took the first step toward reinstating the law by voting 384-23 to approve a bill with a one-year extension. The measure was referred to the Senate Finance Committee but was not scheduled for a vote as of press time in mid-February.

The short lapse in parity protection is not expected to affect anyone's mental health benefits because insurance companies already have approved their coverage and budgets for 2008, said Karin Hope, legislative director for Rep. Jim Ramstad (R, Minn.), one of the House parity bill's co-sponsors. The APA's Meyers agreed.

Genetic protection on hold

The genetic nondiscrimination act, adopted by the House 420-3 in April 2007, also faces hurdles.

The measure was on track to be adopted by the Senate in December 2007 as part of a fiscal 2008 omnibus spending bill, but a veto threat from Bush led Democrats to remove it from that measure, according to two aides familiar with the negotiations.

The White House has concerns that the nondiscrimination bill would expand businesses' legal liability. This stance surprised bill backers in light of an April 2007 Bush administration statement that seemed to indicate support for the measure. The legislation has been around in some form for 13 years but hasn't been approved by both chambers in the same session of Congress.

The current bill would prohibit health insurers from using genetic information to determine health plan eligibility or to set premiums. It would bar employers from using genetic information in hiring, firing, job placement or promotion decisions.

Sen. Tom Coburn, MD (R, Okla.), shares the administration's concerns and wants to add language to the Senate bill to protect businesses from lawsuits if, for example, they share their employees' genetic information with law enforcement agencies.

"If the language is not precise, you are going to invite predatory lawsuits," said John Hart, a spokesman for Dr. Coburn. House lawmakers added this language before adopting the bill.

For months, Dr. Coburn has had a legislative hold on the Senate measure. This means the bill would require 60 votes and 30 hours of floor debate before it could be adopted. Hart said Dr. Coburn only wants the chance to offer amendments instead of having the legislation approved by a voice vote without debate or attached to another bill, as is typical in the Senate.

Kennedy, who chairs the Senate panel with jurisdiction over the genetic nondiscrimination bill, would like to see the Senate adopt it this year, said his spokeswoman Wagoner. A hearing on the legislation had not been scheduled as of press time.

Rep. Louise Slaughter (D, N.Y.), a sponsor of the House bill, said the lack of genetic protection is holding back scientific research because many Americans are declining to participate in research for fear their genetic information will be used against them. "We simply cannot afford to wait any longer," she said.

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