WASHINGTON - House and Senate negotiators agreed yesterday to expand insurance coverage for the mentally ill and for new mothers and their infants as the Republican-controlled 104th Congress scrambled to put a voter-friendly polish on its record.
While still struggling to salvage a major immigration bill, Republicans also yielded to President Clinton's demands for more domestic spending for next year, hoping to avoid a repeat of last year's damaging budget fights and get home for at least a month of campaigning before the Nov. 5 elections.
The accommodating mood and willingness to use governmental power for social purposes contrasted sharply with the defiant, anti-government tone of last year's session, prompting Democrats to claim Republicans had undergone a "campaign conversion" of historic proportions.
"I've not seen this dramatic a change in color or stripes since I've been in the zoo," said Senate Minority Leader Thomas Daschle (D-S.D.) Sen. Edward Kennedy (D-Mass.) said Republicans were "running scared" and their "apparent change of heart is cynical and hypocritical."
The health care proposals approved by House-Senate negotiators would:
- Prohibit health insurance plans from establishing more restrictive lifetime or annual limits on coverage for mental illness than they do for physical ailments.
- Bar plans from forcing new mothers out of hospitals after childbirth in less than 48 hours, or 96 hours in cases of a Cesarean delivery, ending a common practice of discharging mothers and newborns after 24 hours or less.
- Provide veterans' health benefits to children born with spina bifida, a crippling birth defect that requires lifetime care, as a result of their parents' exposure to Agent Orange during the Vietnam War.
The fight for greater equity in treatment of mental illnesses was long and hard. Sen. Pete V. Domenici (R-N.M.) who has been fighting for equity for more than a decade, said "today we have a recognition that illnesses and diseases of the brain, when it comes to coverage, will no longer be discriminated against."
Domenici, who was joined by Sen. Paul D. Wellstone (D-Minn.) in pushing for the expanded coverage, said it is common for insurance to limit lifetime mental coverage to $50,000 while allowing up to $1 million for physical illnesses. It is possible for families to use up their entire lifetime mental health insurance coverage in a single hospitalization, said the senator, who has a daughter with mental illness.
There are roughly 40 million Americans who suffer from severe mental illness some time in their lives. The new provisions do not require companies to offer mental health coverage, but require them to impose equivalent lifetime and annual limits if they do.
Business groups fought the provision, killing it as part of an earlier health insurance package and again as a separate bill.
Small businesses with 50 or fewer employees were exempted, and the date of implementation was put off until January 1, 1998.
Heidi Kendall, deputy director for health policy for the Association of Private Pension and Welfare Plans, said the mental health requirements will increase company health care costs and "employees will lose other valuable benefits because employers will not necessarily add more money to their plans."
The Congressional Budget Office said the new provision should increase health insurance premiums by 0.4 percent a year.
The new rules for maternity coverage would end what has come to be known as "drive-through deliveries," forcing mothers to go home with their infants as soon as 10 hours after a normal delivery under insurance rules designed to cut costs.
"It's an example of how sometimes the market spins out of control. You need a check of common sense," said Sen. Bill Bradley (D-N.J.) who led the fight for the maternity provisions.
The spina bifida provision calls for health care, a monthly stipend, vocational rehabilitation and other services for an estimated 2,800 qualifying children.
The health proposals, passed initially by the Senate, are expected to win final approval from Congress next week as part of the annual appropriations bill to fund the veterans and housing and urban development programs. Lawmakers have said they expect Clinton to sign the bill.
In an upbeat assessment of negotiations on spending for next year, House Speaker Newt Gingrich (R-Ga.) Senate Majority Leader Trent Lott (R-Miss.) and other GOP leaders said the talks were going well enough that Congress can probably complete work on all spending issues before the start of the new fiscal year Oct. 1. The lawmakers want to finish the 13 annual spending bills that fund government operations to avoid a repeat of last year's shutdowns. Whatever bills remain unfinished will be wrapped into one catchall spending measure.
House Appropriations Committee Chairman Bob Livingston (R-La.) said Republicans "can approximate" the roughly $6.5 billion of additional domestic spending demanded by Clinton, with much of the cost offset by auctioning broadcasting frequencies and raiding bank and thrift insurance funds. GOP leaders have rejected the administration's call for shifting more than $3 billion from defense to domestic accounts, but signaled yesterday they were prepared to use some defense funds to finance anti-terrorism proposals.
On the bill to curb illegal immigration, Republicans were edging toward a critical decision on whether to drop or scale back a controversial provision that would allow states to bar children who are illegal aliens from public schools. Senators are willing to scuttle the provision because it would kill the whole bill in the Senate, but some House members are pushing for modifications in hopes of salvaging some schools restriction.