Summary of Motion: The motion would recommit H.R. 1424, the Paul Wellstone Mental Health and Addiction Equity Act, back to the Energy and Commerce Committee with instructions that the committee report the bill back to the House floor forthwith (i.e. instantaneously) with the following amendment:
- The amendment would replace the text of H.R. 1424 with the text of S. 558, the Mental Health Parity Act, sponsored by Sen. Pete Domenici (R-NM), which passed the Senate on September 18, 2007. (See Additional Background below for a summary of the differences between the Senate and House legislation.)
- The amendment would include language explicitly stating that group health plans will not be required to cover abortion services as a result of implementing mental health parity. (See Additional Background below for concerns that mental health provisions may be used to justify further abortion-related coverage.)
- The amended bill would be paid for by extending a web-based demonstration project requiring electronic verification of Medicaid eligibility. This demonstration project began with respect to Supplemental Security Income (SSI) verification, and was extended to three states’ Medicaid programs by Congress in September 2007 (P.L. 110-90). The amendment would extend the demonstration project to all 50 states, saving $4.3 billion over ten years, according to the Administration.
- The amended bill would also be financed through a $600 million transfer from the Physician Assistance and Quality Initiative (PAQI) Fund in 2013, coupled with a $1 billion transfer to the PAQI fund in 2014.
Process: This MTR moves to recommit the bill (with instructions) “forthwith.” If passed, the forthwith directive would technically send the bill back to committee along with the MTR instructions, requiring the committee to immediately return the bill to the House along with the amendment. In effect, the chairman of the committee would take the floor and immediately report the bill back to the House with the amendment instructions in the MTR. The House would then vote on the amendment (in essence, a second vote on the MTR with instructions). If this passes, a vote on final passage – with the amendment included – would be before the House.
Additional Background on Mental Health and Abortion Coverage: Some conservatives have raised concerns regarding the Paul Wellstone Mental Health and Addiction Equity Act (H.R. 1424). The Supreme Court decision Doe v. Bolton lists mental health as a reason that abortion is allowed for health exceptions. The House bill, as currently written, could be construed to mandate health care coverage for an abortion as a part of treatment for mental health issues such as depression. As defined by the Court: “Health of the mother includes, ‘all factors—physical, emotional, psychological, familial, and the woman’s age—relevant to the wellbeing of the patient. All these factors may relate to health.’” Furthermore, abortionist Dr. James McMahon, in testimony before the House Judiciary Committee in June 1995, cited 39 partial-birth abortions that were performed because of the mother’s “depression.” Because this issue is unclear and H.R. 1424 lacks a conscience clause applied to this legislation, there appears to be no protection for an employer to reject healthcare coverage for such a procedure if they choose to extend mental health coverage to its employees.
Additional Background on Senate Legislation: On September 18, 2007, the Senate passed its version of the Mental Health Parity Act. This legislation, S. 558, sponsored by Sen. Pete Domenici (R-NM), contains significant variations when compared to H.R. 1424. Specifically, the Senate-passed language:
- Retains ERISA pre-emption for the large employers (those with more than 50 employees) subject to the law—states would not have the option of enacting more stringent and conflicting laws and regulations;
- Remains silent on codifying classes of mental disorders—the language does not require group health plans to offer coverage for all disorders under DSM-IV;
- Does not mandate an out-of-network coverage benefit—plans must offer out-of-network coverage only to the extent they do so for medical and surgical benefits, while the House bill mandates out-of-network coverage for all plans offering mental health benefits; and
- Permits group health insurance plans to utilize medical management practices, including utilization review, authorization, medical necessity and appropriateness criteria, and use of network providers—the House bill includes no such “safe harbor” for plans.
While some conservatives may still have concerns with the mandates imposed by the Senate legislation and the way in which these mandates would increase health insurance premiums, many segments of the business community have embraced the Senate compromise as a reasonable attempt to achieve the goal of both bills without eroding ERISA pre-emption or imposing undue restrictions on benefit plan design. Many of those same trade organizations are opposing H.R. 1424 as a legislative over-reach that will impede their ability to offer quality coverage through group health insurance plans.