Critics of a mental health bill are questioning if Congress should be pushing for insurance coverage of illnesses like social phobia — described as the irrational fear of embarrassment — saying it could lead to coverage of jet lag, caffeine addiction and other commonplace phobias or vices.
The Mental Health Equitable Treatment Act, introduced by Sen. Pete Domenici, R-N.M., and the late Sen. Paul Wellstone, D-Minn., last year, has huge support in the Senate. The House companion bill was introduced by Rep. Marge Roukema, a New Jersey Democrat.
The bill is sure to be a top priority in Congress, if Domenici has his way. After Wellstone's death in a plane crash last month, Domenici said he is putting it at the top of his list of objectives.
And now that the Republicans have regained control of the Senate, the incoming Energy Committee chairman will have much of the authority he needs to get it done.
"Certainly, this is something that has been a priority for him for years," Domenici spokeswoman Sarah Echols told Fox News. Echols predicted that if the bill doesn't get a last push it needs this year, "then definitely next year" it will be on the table for a vote.
Interim Sen. Dean Barkley, who is filling Wellstone's seat until Republican Sen.-elect Norm Coleman is sworn in in January, also has made the bill an urgent to-do item.
"I talked with Wellstone's office about that and said I'd do whatever I could," Barkley said.
The Domenici-Wellstone bill tries to give mental health illnesses the same importance as physical illnesses by prohibiting employee group health plans and insurance companies from imposing treatment limitations or financial requirements on mental health problems unless those same limitations are placed on physical ailments.
The bill exempts small businesses that have fewer than 50 employees.
Mental heath conditions to be considered for coverage include those in the 941-page Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, produced by the American Psychiatric Association.
Mental health proponents say this is exactly the step needed to make sure the mentally ill get the care they need. Earlier this year, President Bush pledged to help Domenici push the bill through Congress.
"Our health insurance system must treat serious mental illness like any other disease," Bush said in February. "It is critical that ... as we provide full mental health parity, that we do not significantly run up the cost of health care."
But critics say the move will only raise insurance rates and open the door for taxpayers to pay for coverage for every type of fear out there.
"The mental health mandates in the Domenici-Wellstone legislation are a hidden tax on businesses and workers," Donald Young, president of the Health Insurance Association of America, said in a statement.
He said the problem with the bill is that "it goes far beyond this commonsense definition to an open-ended mandate for coverage of everything mental health advocates want."
Insurance groups and other businesses that buy insurance say if parity is adopted, floodgates will open for "peripheral" conditions not worthy of insurance coverage, especially if the federal government is basing coverage on a book of illnesses that's constantly changing.
"New mental illnesses are being included in DSM 4 all the time," said Larry Akey, spokesman for the Health Insurance Association of America. "If we're expected to pay for every illness that's contained in a diagnostic manual of an association, over which neither the government nor our member companies have any control, who knows what disease will be discovered that insurers will be expected to pay for."
Parity advocates say the criticisms are exaggerated.
The bill does not say that all substance abuse disorders are covered and does not force health plans to pay for "peripheral" treatments any more than they do already. The APA said health plans would be no more likely to pay for treatment of those peripheral conditions than they do now for freckles, corns, baldness, premature grayness, or first-degree sunburn — all of which are listed in the American Medical Association's list of medical conditions that can be considered for insurance coverage.
The National Mental Health Association released a survey last month showing that 83 percent of Americans think it's unfair for health insurance companies to limit mental health benefits and require people to pay more out-of-pocket for that type of care. About 79 percent support what is being referred to as parity legislation, even if it means an increase in insurance premiums, the survey said.
"The writing's on the wall here," NMHA President Michael Faenza said in a statement. "The American public believes insurance discrimination is unfair and supports mental health parity."
Groups are hopeful movement on the bill will happen soon. Echols said there are no firm plans yet to work on the bill during the lame-duck session, but they will know more in a few days.
"With the president's support and with the majority of the House and Senate on board, we're hopeful," said an APA spokeswoman.