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WASHINGTON — It was one of those moments that shows why Sen. Pete Domenici, an Albuquerque Republican, wants to run again in 2008.
With his wife, Nancy, beaming from the second row of the Senate press gallery, Domenici on Monday announced a major step forward in their joint effort over two decades to improve the treatment of mental illnesses.
Health insurance companies and mental health groups had reached agreement with Domenici and leaders of the Senate Health, Education, Labor and Pensions Committee on a bill to guarantee that mental health patients would receive coverage on par with patients with physical ailments in large group employer health plans.
The bill would not require insurance companies to provide mental health benefits. But if they do provide benefits, they cannot be any more restrictive than most other medical and surgical benefits, including co-payments, coinsurance, out-of-pocket expenses, annual and lifetime limits, and duration of treatment.
"This is a very special and joyous occasion, to finally be ready to tell the American people, and then the U.S. Senate, and then hopefully the U.S. House and the president, that we have a bill that's a winner for millions of Americans, millions of people that suffer from mental illness," said Domenici.
Sen. Ted Kennedy, a Massachusetts Democrat and chairman of the HELP Committee, along with the ranking Republican, Michael Enzi of Wyoming, credited both Domenicis for the mental health bill effort. Their committee takes up the measure this week.
"I think those of us who know the senator know that this is a real partnership, and that she has been a very strong advocate and a spokesperson for so many of these causes and issues, as well," said Kennedy.
"I, too, want to congratulate you, Senator Domenici, and your wife, for the passion, the effort, the persistence, the knowledge, the capability that you've put into this act. It's been astounding," said Enzi.
Like many Americans, the Domenicis confronted the issue in their own family. When their daughter Clare, now in her 40s, was a freshman in college, she was diagnosed with mental health problems.
The Domenicis began attending meetings of mental health advocates in Maryland and then national conventions.
"What that gave me was a feel beyond anything I had known about how many people were really being totally discriminated against by the insurance companies," said Domenici. "Families were broken. Mothers and fathers were saying their kids were gone. `We don't know what to do. We don't have any money left. We're stone broke.' "
Domenici and the late Sen. Paul Wellstone, a Minnesota Democrat, took a first step in 1996 with a law specifying that insurance companies had to provide the same lifetime and annual benefits for mental health coverage as other ailments. But it did not prevent other limitations, like higher deductibles and co-pays. Since then, more employers have been demanding mental health coverage.
Domenici's further legislative efforts were thwarted by the insurance lobby in the House. Even this bill, hailed as a "historic breakthrough" by the National Alliance on Mental Illness, comes with some compromises.
The bill does not apply to plans with fewer than 50 employees. Kennedy said they talked about going as low as 15, but there is a fear some companies would drop health insurance altogether.
The bill does not require companies to offer a specific set of benefits. State laws that do would be preempted, although states could still require plans to cover mental illnesses.
Companies that experience a surge in mental health coverage costs - 2 percent of total costs in the first year - could enjoy a one-year reprieve on providing equal coverage. Domenici said he doubts many would qualify for the exemption.
Fifty health and mental health advocacy groups endorsed the Domenici bill Monday. So did the National Retail Federation, Aetna and three major insurance industry groups, with the warning that they would drop their support if there are any major changes.
Enzi said the test of the "tenuous" compromise will be to keep amendments off the bill, and Kennedy said he wants to move the bill through the Senate by April. Domenici said he plans to talk to potential sponsors in the House, including other members of the New Mexico delegation.
But Domenici was optimistic enough that he started talking about his next effort to help the mentally ill. He said he's going to start work on a "mammoth bill" to fund grants to states to build communal homes for the mentally ill and disabled who were left out of state institutions.
"That's why they sleep in the street. There are not enough good homes," said Domenici.
