NASW Health Care Reform Roundup – January 21, 2010

Jan 21, 2010

Democrats Regroup on Strategy for Health Care Reform

Democratic congressional leaders are currently developing a new strategy to pass health care reform after the stunning loss of a Senate seat in Massachusetts. Although their new strategy will be finalized after some days have elapsed and is not yet final, several conclusions are apparent from their public comments. First, Democrats fear that failing to enact the health care bill now could increase voter anger later in this election year. Second, many legislative strategists prefer what is described as a two-bill strategy, one immediately following the next.

Under the two-bill strategy, the first step would require House passage of the Senate health bill (HR. 3590). Getting to majority House support for this bill (at least 218 votes) is extremely difficult because many Democrats have important differences with provisions in the Senate bill. Democratic House leaders say they do not now have the necessary votes to pass the Senate measure. The second bill would be necessary to secure the necessary votes in the House for the first bill. The second bill would be considered under procedures known as budget reconciliation.  This bill would include many compromises and changes to the Senate bill. The reconciliation measure would also include any provisions negotiated with the White House and Senate leaders. The two-bill option has important legislative advantages. Most importantly, any bill taken up under reconciliation procedures may move under fast-track floor procedures in the House and Senate, and passage requires 51 votes in the Senate, instead of a filibuster-proof 60 votes.

Another strategy would involve going back to the drawing board and breaking the bill into smaller components, passing those where there is more agreement. Given this highly fluid political environment, NASW will continue to press for its legislative priorities as Congress debates a new approach. Our current Action Alert is here, and we urge members to track our actions here.

Mental Health and Substance Abuse Parity Update

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) became effective for most private health plans on January 1, 2010, but federal agency regulations defining how it will be interpreted have not been cleared by the Administration. Thus health insurance carriers, which must have their 2010 plan benefits in compliance in the absence of any regulations, may be uncertain or confused about exactly what mental health and substance abuse benefits are required to be equivalent to medical and surgical benefits they offer.

According to a HHS/CMS website here, the now current federal law applies to two different types of coverage:

  • 1) Large group self-funded group health plans (CMS has jurisdiction over self-funded public sector (non-federal governmental) plans, while the Department of Labor has jurisdiction over private sector self-funded group health plans.
  • 2) Large group fully insured group health plans.

Some state’s insurance regulations may also contain additional coverage protections for fully insured group health plans or individual coverage. MHPAEA is designed to prevent large group health plans from imposing financial requirements and treatment limitations on mental health and substance use disorder (MH/SUD) benefits that are more restrictive than financial requirements and treatment limitations on medical/surgical benefits.  MHPAEA also prevents large group health plans from placing annual or lifetime dollar limits on mental health and substance abuse benefits that are lower than annual or lifetime dollar limits for medical/surgical benefits offered under the plan.

The law does not apply to small group health plans or health insurance coverage in the individual (non-employment based) market, but individual state law may require mental health parity in such cases. MHPAEA defines large group health plans as those with more than 50 workers and does not apply to group health plans sponsored by employers with fewer than 51 workers. Federal summary information about the law is available here and NASW has prepared its own summary, posted here and shown under January 2009.