**[Top Ten Reasons NOT to Support the Mental Health Parity
Act]{.underline}**

(H.R. 1424---Patrick Kennedy)

1.  **Increases Health Insurance Costs**. CBO estimates that H.R. 1424
    would impose mandates on private insurance companies totaling \$3
    billion annually by 2012. These costs will ultimately be borne by
    employers offering health insurance and employees seeking to obtain
    coverage.

2.  **Increases Costs for Business Due to Private-Sector Mandates**. The
    bill contains multiple new federal mandates on the private sector,
    affecting the design and structure of health insurance plans. The
    bill also increases the threshold level at which employers suffering
    increased claim costs as a result of implementing the new federal
    mandates can claim an exemption from the provisions of H.R. 1424.

3.  **Decreases Mental Health Coverage**. While the bill imposes several
    new federal mandates on those employers who choose to offer mental
    health coverage, there is nothing in H.R. 1424 that would require
    plans to cover these conditions. Thus H.R. 1424 could have the
    perverse effect of actually *decreasing mental health coverage*, by
    encouraging employers frustrated with the bill's onerous burdens to
    drop mental health insurance altogether.

4.  **Increases the Number of Uninsured**. By increasing the cost of
    health insurance, H.R. 1424 will lead directly to an increase in the
    number of uninsured Americans. In addition, some employers could
    decide to drop group health insurance coverage altogether rather
    than face a potentially conflicting array of state mandates and
    regulations to which they could be subjected under H.R. 1424.

5.  **Erodes Federal Pre-emption for Employers**. While H.R. 1424 does
    pre-empt state laws that conflict with the bill, it also explicitly
    permits additional state laws that provide more stringent consumer
    protections. This provision would undo three decades of strict
    federal pre-emption for group health plans, creating a patchwork of
    laws across all 50 states with which large employers would have to
    comply.

6.  **Codification of Treatment Mandate for Health Plans**. H.R. 1424
    would incorporate into federal law the Diagnostic and Statistical
    Manual of Mental Disorders (DSM-IV) classification definitions as
    the parameter of mental health treatment for health plans. The broad
    parameters included in the DSM-IV categories will obligate employers
    to cover "disorders" such as "jet lag" and "caffeine intoxication."

7.  **Intergovernmental Mandate**. The bill would pre-empt state laws
    governing mental health coverage that conflict with the bill---but
    would not pre-empt laws providing more stringent consumer
    protections for employees. Additionally, CBO notes that some state
    and local governments would face increased costs for health
    insurance provided to their employees.

8.  **Violation of UMRA**. CBO estimates that the costs of the mandates
    to the private sector in the bill would be **[at least \$1.3 billion
    in 2008, rising to \$3 billion in 2012]{.underline}** and thus
    exceed the annual threshold established in the Unfunded Mandates
    Reform Act or UMRA (\$131 million in FY2007, adjusted annually for
    inflation).

9.  **Lack of Conscience Clause**. H.R. 1424 would mandate that
    employers offering mental health benefits cover all diagnoses under
    DSM-IV. The bill does not include an exemption for groups to exclude
    coverage of mental disorders, particularly psycho-sexual disorders,
    for which they have religious or moral objections.

10. **Lack of Medical Management Tools**. H.R. 1424 does not include
    language permitting group health plans to negotiate separate
    reimbursement rates or provider payment rates and delivery service
    systems for different benefits. These tools would empower plans to
    utilize medical management practices in order to reduce claim costs.

***For more information, contact Chris Jacobs at 6-8585.***