Year: 2008

I posted about HR 1424 recently, noting that the mental health parity bill was going to be voted on soon. On Wednesday, the House of Representatives passed HR 1424. See this New York Times report for details.

Today an email from the American Mental Health Counselors Association HQ provided more background.

E-News from Washington

Vol. 08-12

March 6, 2008

 

House Passes Historic Parity Legislation!

 

On March 5^th the House of Representatives passed comprehensive legislation requiring private health insurance plans to use the same treatment limitations and financial requirements for mental health and addictive disorder coverage as is used for substantially all other covered services. H.R. 1424, the “Paul Wellstone Mental Health and Addiction Equity Act of 2007,” introduced by Representatives Patrick Kennedy (D-RI) and Jim Ramstad (R-MN), was passed with strong bipartisan support by a vote of 268-148. (House members’ votes are listed online at http://clerk.house.gov/evs/2008/roll101.xml.) The legislation is named for the late Senator Paul Wellstone of Minnesota, a tireless advocate for Americans with mental illness.

 

House passage of H.R. 1424 is an historic step forward for mental health and addiction treatment advocates, and comes after years of hard work by the mental health and addictive disorder advocacy community. Although similar in many respects to legislation passed last year by the Senate, H.R. 1424 provides more consumer protections by requiring plans covering mental and addictive disorder treatments to cover the full range of disorders recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM)—the same range of disorders as is covered for members of Congress and all other federal employees under long-standing requirements for Federal Employee Health Benefits Program (FEHBP) policies. Unlike the Senate’s bill, H.R. 1424 also stipulates that health plan covering out-of-network services for medical and surgical benefits must also offer out-of-network coverage for mental health and addictive disorder benefits. This requirement applies for both outpatient and inpatient care.

 

AMHCA and ACA applaud Representatives Patrick Kennedy (D-RI) and Jim Ramstad (R-MN) for their long, hard, heroic work in gaining House passage of H.R. 1424. During floor debate, both Kennedy and Ramstad spoke about their own personal battles with mental and addictive disorders, their treatment, and how their treatment has enabled them to lead productive lives. AMHCA and ACA also thank those counselors who took the time to contact their representative on this issue.

 

Attention now shifts to House-Senate negotiations to reconcile their chambers’ versions of the parity legislation. Like the business community, the Bush administration argued in favor of the weaker Senate version, issuing a statement of policy expressing opposition to H.R. 1424. Despite this, AMHCA, ACA and other mental health and addictive disorder advocates are now working to build upon the strong bipartisan support for H.R. 1424 and the unanimous passage last year of the Senate’s bill, to encourage the development and enactment of parity legislation that provides consumer protections that are as strong as possible.

Beth Powell

Director, Public Policy and Professional Issues

American Mental Health Counselors Association

I recognize some social conservatives and business advocates do not favor parity. However, I see this as a very family friendly legislation. Severe mental disorders sap the resources of working families and are leading causes of disability. If this bill is law, managed care companies/insurers will still be able to deny inappropriate care for the questionable diagnoses in the DSM (e.g., caffiene intoxication) but will not be able to deny appropriate care for those who need it.

I welcome this announcement – Exodus President Alan Chambers disclosed on ExgayWatch this evening that Exodus let their Director of Government Affairs go in August, 2007 and is going to concentrate on ministry.  His personal blog contains additional personal reflections on a recent thread at XGW authored by Wendy Gritter, Director of New Direction ministry.  Early in February, I was pleased to highlight Wendy’s keynote address at the Exodus Leadership Conference where she called for a change of focus at Exodus.

I believe additional shifts called for by Mrs. Gritter would be helpful, including steps to make resources more scientifically accurate. For now, I wholeheartedly commend the leadership of Exodus for these moves.

McCains wrapped things up tonight. In his speech celebrating his wins, he was inspiring with this killer segment:

We’re the world’s leader, and leaders don’t pine for the past and dread the future. We make the future better than the past. We don’t hide from history. We make history. That, my friends, is the essence of hope in America, hope built on courage, and faith in the values and principles that have made us great.

I like it.

A bill that would force employers to provide mental health and addictions treatment coverage on par with medical conditions will be debated again this week. I say again because parity as a concept has been debated for a decade. It appears that this bill or something akin to it (HR 1424; SB 558) might pass this time around.

WashingtonWatch.com has this description:

Paul Wellstone Mental Health and Addiction Equity Act of 2007 – Amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act, and the Internal Revenue Code to prohibit treatment limits or the imposition of financial requirements on mental health and substance-related disorder benefits in group health plans which are not similarly imposed on substantially all medical and surgical benefits in any category of items or services under such plans.

Directs the Comptroller General to study the effect of the implementation of this Act on various aspects of the health care system, including the cost of and access to health insurance coverage, the quality of health care, Medicare, Medicaid, and state and local mental health and substance abuse treatment spending, and spending on public services.

I favor this bill. Families are often frustrated in their efforts to care for a family members with a mental or emotional disorder due to inconsistent and inadequate insurance coverage. With inadequate coverage, very few people can afford to pay for treatment of chronic disorders. Psychiatric disorders are major causes of diability but with adequate care, some diabilities can be addressed in an effective manner. Even with a significant mental disorder, people can continue to work productively if they have proper care.

For those inclined, the American Counseling Association has a position paper with suggestions for calling legislators to register viewpoints about the issue.

Over at Americans for Truth About Homosexuality (AFTAH), Pete LaBarbera alerted his readers that he was on WGN last night in connection with a story about “gay genes.” He noted in a mass email yesterday (did anyone see it?):

Americans For Truth will be featured tonight in a story on the cable super-station WGN-TV, based in Chicago, concerning the latest academic pursuit of the “gay gene.” It will air between 9:00 and 10:00 Central Time on WGN which reaches across the country. You can learn more about the (liberal biased) Northwestern U. “genetic homosexuality” study at www.gaybros.com. As you know, pro-homosexual advocates are seeking to prove that homosexuality is genetic — with the hope of then declaring the issue outside the bounds of moral debate.

While this is not a strong denouncement of the project, it appears that AFTAH believes the research led by Alan Sanders is biased from the start. LaBarbera is right that some activists would like to prove a genetic source of homosexuality (case in point below). However, what if there are genetic components to sexual orientation? Is there any way to discuss or research these factors without being considered “liberal” and/or “biased?” Isn’t a blanket dismissal of pre-natal factors just as biased?

On the other hand, as if to prove LaBarbera’s point, enter Wayne Besen’s new videos from Dean Hamer and Jack Drescher.  To Dean Hamer, Besen poses the question, “Is homosexuality inborn?” Hamer replies that “there is more and more evidence that sexual orientation has a strong biological component.” Hamer then points to two “population based studies of twins.” One is Kendler’s study in the US and the other is Bailey and Martin’s study in Australia. Hamer says these studies “have shown that genes are the single most important factor in whether a person is gay or straight or somewhere in between.” He said the studies have been replicated and are convincing. I will save for another post a detailed response to those statements, but for now I will say that I do not agree with Dr. Hamer’s characterizations. For instance, in the Australian study, the actual concordance of homosexuality among male identical twins was only 11%. Kenneth Kendler and colleagues in 2000 found a higher concordance (31.6% combining males and females), but did not designate genetics as being a determining factor. About his study of twins, Kenneth Kendler told the BBC,

By no means is sexual orientation genetically determined but clearly genes are playing some role by interacting with a range of environmental factors.

Dr. Drescher’s video provides a more nuanced and I think accurate reading of research. About those who say they know what causes sexual orientation, Dr. Drescher says, “The truth of the matter is, we don’t know, nobody knows, and anybody who says that they know is lying to you.” Drescher also presents a reasonable view of the role of sexual abuse saying that for individual people, such abuse could play a role but as a general rule, believing abuse to be at root is an unfounded stereotype.

Now, coming full circle back to the website LaBarbera noted in his email – gaybros.com, we find a nuanced and I believe accurate view that cuts between activists Besen and LaBarbera. Here are a couple of excerpts:

At the present time, there is no uniformly accepted theory of why some men and some women develop a sexual orientation that is more or less exclusively focused on members of their own sex.

and

Most contemporary researchers believe that sexual orientation – the general disposition of people toward homosexuality, bisexuality, or heterosexuality – is the result of both biological factors and psychological experiences. Most researchers do not believe that sexual orientation is the result of nature (biology, including genetics) alone or nurture (environment) alone. What researchers want to know is how specific factors in biology and psychology interact to guide sexual development. These researchers therefore look for biological and psychological differences between homosexual and heterosexual people, both men and women.

Then after listing the many studies which find biological factors correlated with sexual orientation (e.g., finger length ratio differences, brain differences, etc.), the website says this:

These studies are designed to show a correlation between a trait and sexual orientation. This is not the same as showing that a trait causes sexual orientation. What is not yet known is whether these traits and sexual orientation have a common origin in genetics or other biological influences on development, though these hypotheses are being pursued. In any case, these lines of research are suggestive rather than definitive. Among other factors, it is these and other uncertainties that prompt continued research.

These statements sound anything but biased to me. All concerned would do well to heed them. Working hard to spin what is known may play well to activists but saying homosexuality is or isn’t all “genetic” or “inborn” or “environmental” does not well represent what is known. We need to follow the research where it leads and hold our theories loosely.