McCain vs. Obama on Mental Health & Psychology Issues

Federal Budget

The Congressional Budget for 2008, which passed 52 to 47, included increases in the budgets of the National Institutes of Health (2.1%) and the National Science Foundation (2.5%). McCain voted No on this resolution and Obama voted Yes.

The Congressional Budget for 2007, which passed 51 to 49, included increases in the budgets of the National Institutes of Health (3.5%), the National Science Foundation (6.3%), and Pell grants (the first increase in 4 years). It also included an over 10% increase for funding of veterans’ healthcare needs. Obama voted No on this bill, McCain — a veteran — voted Yes.

The Congressional Budget for 2006, which passed 51 to 49, included increases in the budgets of the National Institutes of Health (3.6%) and the National Science Foundation (2.4%). Obama voted No on this bill and McCain voted Yes.

It’s hard to draw any conclusions from this pattern of votes, since Senators may vote yea or nay on a resolution for political or ideological reasons which are not noted in the public record (or require a great deal more research to determine). Congressional Budgets are non-binding, mean they don’t have the force of law anyway, but serve as a blueprint for that year’s spending by various Senate appropriations committees.

Mental Health Parity

Mental health parity was the big issue in late 2007, as the Senate passed s. 558 (and the House passed HR 1424) to require that mental illness diagnoses get equal reimbursement (“parity”) as regular physical illness diagnoses. Traditionally, this has not been the case for most insurance companies, who place limits on the extent and type of treatment one can receive for things like depression or bipolar disorder.

Fifty-seven Senators, including Obama (but not McCain) were co-sponsors of the Senate version of the bill. The Senate unanimously passed the bill on September 18, 2007. It passed the House on March 5, 2008. It has languished since then in the committee to work out the differences between the two bills. The policy and language of the House-Senate compromise has been agreed to in s. 3335, but key committees are still seeking provisions to offset the cost of the bill. They must agree on the source of $3.8 billion in offsets required under the Budget Act.

This report describes the key compromises:

Definition of mental health benefits subject to parity requirement: mental health and substance abuse disorder benefits are defined under the terms of the plan and in accordance with applicable federal and state law. State law may continue to define what benefits a fully insured plan may be required to cover, but not a self-insured plan. The requirement to use the requirement to use the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) (the compendium of mental health conditions) to determine what benefits must be covered is not included in the measure.

Protection of plan medical management practices: no provision prohibits plan medical management practices or mandates parity in medical management. The agreement includes a rule of construction that it does not affect “terms and conditions” of plans to the extent that they do not conflict with the parity requirements. This language should protect medical necessity provisions. The agreement requires plans to make available their criteria for medical necessity determinations and the reason for any denial of any reimbursement or payment for services for mental health or substance abuse benefits.

Out-of-network coverage: a plan must provide out-of-network coverage for mental health and substance abuse disorders in a manner consistent with the parity requirement if out-of-network coverage is provided for medical and surgical benefits. Other applicable plan terms and conditions, such as those related to medical management, would continue to apply.

Relationship to state laws and remedies: The agreement applies the current law “HIPAA standard” which establishes the federal requirements as a floor and permits states to enact more extensive requirements for insured plans, provided that such laws do not conflict with federal law. The agreement also applies the current law ERISA remedy framework to new mental health parity requirements.

In other words, we get mental health parity (if the bill passes the House and Senate again and the President signs it), but it’s a bit watered down. Also included in the final bill is the 1%/2% exemption clause we noted that appeared in the original versions of both bills. This exempts any health care plan from having to provide mental health parity coverage if it will increase their costs more than 2% in the first year, or more than 1% any year after that. I don’t think it’s going to be hard to show that providing parity coverage is going to increase their overall healthcare costs more than 1%, especially if more people actually start using the benefit. And of course, small employers (under 50 employees) are also exempt.

The Melanie Blocker Stokes Mothers Act

The Melanie Blocker Stokes Mothers Act is a somewhat controversial piece of legislation introduced in 2007 and co-sponsored by 10 Senators, including Senator Hillary Clinton and Senator Barack Obama. If you read the actual wording of the bill, it does not mandate mental health screenings for all new mothers. Instead, it instructs healthcare professionals to offer such screenings — new mothers who do not want the screening can simply refuse. You can read more about the Mothers Act here and responses to the great deal of misinformation and lies being spread about this proposed law.

I’m a big advocate of mental health screenings. We’ve had millions of people take our mental health screenings on Psych Central, which help people understand whether they may have a concern that needs further treatment. While ignorance of mental health issues might be fine for some people, we believe the more light we shed on serious issues like post-partum depression, the better. And mental health screenings of new mothers seem like a reasonable step.

The bill is in a Senate committee right now, so there are no votes to tally on it. But it’s telling that Obama signed on as a co-sponsor of the bill — an action showing strong support for such screenings.