The measure, which was the product of more than two years of negotiations among lawmakers, insurers, patient advocates and the business community, would require equality between mental health and medical/surgical benefits on treatment limitations, costs—such as deductibles and co-payments—and out-of-network coverage. It does not mandate mental health coverage.

Now the Senate will have to wait on the House. On that side of the Capitol, a bill was approved on Wednesday, September 19, by a Ways and Means subcommittee. It has been sent to the Energy and Commerce Committee. The Education and Labor Committee has already passed it.

Business lobbyists oppose the House version as strongly as they support the Senate bill. Among their most significant problems with the House approach is that it would require that mental health plans cover all diseases included in the Diagnostic and Statistical Manual-IV.

Employers worry that they would have to cover substance disorders like caffeine addiction. They also are concerned that the House bill would curtail managed care.

Proponents assert that using the DSM would end “discrimination by diagnosis” and dispute that the House bill would limit medical management.

Senators gingerly addressed prospects for a conference committee during a media availability on September 19.

“I don’t want to start on a footing that will make it more difficult to get a bill [through],” says Sen. Pete Domenici, R-New Mexico, one of the measure’s authors, as he declined to elaborate on potential sticking points.

He acknowledged, though, that the diverse coalition backing the Senate bill gives it momentum.

“We’ll go to conference carrying that with us, knowing that it makes the bill pretty passable,” Domenici says.

There is some chance that the House will take up the Senate bill and approve it rather than vote on its own version. One reason is because of an agreement hammered out by Domenici and Sen. Edward Kennedy, D-Massachusetts, on policy toward pre-emption of state mental health parity laws.

The legislators, in concert with business, insurance and patient groups, decided that the Senate bill would keep in place a law that allows states to regulate insurance, and the federal government to regulate group health plans.

This approach essentially would ensure a federal floor for mental health benefits that could then be increased by individual states. Although business lobbyists preferred previous language that would allow federal law to prevail, they backed the modification because it ensured Senate passage.

“In a way, we authored this change,” says E. Neil Trautwein, vice president and employee benefits counsel at the National Retail Federation. “It is a standard we know and can live with.”

Kennedy commended business groups and other members of the coalition for their flexibility, saying they “looked at hard practical realities” rather than blocking progress.

Kennedy and Domenici are now on the cusp of achieving a breakthrough in mental health coverage that they have advocated for years.

About 26 percent of American adults, or 58 million people, suffer from a diagnosable mental disorder annually, but only a third receive treatment. The senators say their bill will improve coverage for 113 million people.

“Today, the U.S. Senate says to them, loud and clear: You will no longer suffer in the shadows,” Kennedy says. “The stigma against the mentally ill is a blatant form of discrimination.”

Domenici, who has a family member with a mental illness, was moved by the bill’s success.

“We’ve been living an absolutely, totally unfair situation,” he says in reference to mental coverage being denied or made more expensive than physical benefits. “The way we’ve been doing it is wrong. [The Senate bill] is a matter of simple fairness.”

Advocates hope that change will occur soon, if the House embraces the Senate bill. “Then we can all enjoy a Rose Garden signing ceremony,” Trautwein says.

Such a celebration might be a harbinger for increased cooperation between business and the Democratic majorities on Capitol Hill.

The participation of a wide range of interest groups in cobbling together the Senate bill “allowed for the vetting of the concerns that all these stakeholders brought to the table,” says Kathryn Wilber, health policy legal counsel at the American Benefits Council.

The process might be viable in the future when Congress tackles larger health care issues. “This is a model that would work going down that road,” Wilber says.

—Mark Schoeff Jr.