Civil Rights for the Brain

In the late 1980s, Nancy and Sen. Pete V. Domenici (R-N.M.) watched as one of their eight children, a petite, upbeat blond college student, descended into schizophrenia. They felt guilty about draining the family’s resources to cover her hospitalization and outpatient treatment but could not allow the young woman to face the fate of so many people who can’t afford treatment for severe mental illness: living in a cardboard box on some city sidewalk or under a bridge.

Severe mental illness tears up American families, forcing far too many to choose between treatment for their loved ones and bankruptcy. But many insurers that cover physical diseases such as cancer and kidney stones deny coverage for equally debilitating and hard-wired mental illnesses such as schizophrenia and bipolar disorder. “All too often,” Domenici says, “insurers discriminate against illnesses of the brain.”

This week, a House-Senate conference committee will vote on a bill to outlaw disparities in coverage between mental and physical illnesses.

The bill, co-authored by Domenici and Sen. Paul Wellstone (D-Minn.)--whose family nearly went broke getting hospital care for Wellstone’s mentally ill older brother--is solid and necessary. But the Health Insurance Assn. of America is fighting the measure, arguing that it could undermine employer profits by requiring possibly bogus care for workers’ every emotional quirk. An association spokesman asks: Should a company pay “if you take your child to a psychologist because he’s addicted to baseball cards?”

Domenici, a fiscal conservative who has chaired the Senate Budget Committee, answers such concerns with a Congressional Budget Office report (echoed by at least one Wall Street analysis) that mental health coverage would raise insurance premiums by less than 1%.

Domenici and Wellstone have also modified the bill to exempt firms with 50 or fewer employees. And larger health plans and employers could still define which mental health treatments are “medically necessary,” although they would have to justify their decisions based on medical consensus--as is the case with any affliction.

Opponents of the bill, led by House Ways and Means Chairman William M. Thomas (R-Bakersfield), are pressing the co-authors to give business yet another out, exempting employers who can show that parity would increase their premiums by more than 1%. Domenici and Wellstone are offering a compromise bailout point of 2.5%. Thomas and President Bush should accept the higher figure and make sure this fair and long-overdue bill becomes law.

Today, Domenici’s daughter is getting treatment and has a part-time job. Wellstone’s big brother in Minnesota also has a job and lives on his own. The senator says that after work his brother often tends a flower garden, where he weeds and plants until darkness sets in, afterward identifying the blossoms by their scent and feel.

Other Americans aren’t so fortunate. You’ve probably seen some of them, dressed in rags and pushing shopping carts filled with their belongings down the sidewalks of the wealthiest nation on Earth.