ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Friday, September 20, 1996 TAG: 9609200052
SECTION: NATIONAL/INTERNATIONAL PAGE: A-1 EDITION: METRO
DATELINE: WASHINGTON
SOURCE: Associated Press
THE LEGISLATION will make its way to President Clinton's desk next week.
Moving to relieve some fears of expectant mothers, key House and Senate lawmakers agreed Thursday to require health insurers to pay for at least 48-hour hospital stays for mothers and their newborns.
Congress was expected to send the measure next week to President Clinton, who has made it an election-year cause, saying some babies sent home early had died.
Negotiators also agreed on a provision reducing insurance discrimination against mental ailments. Both provisions, which would take effect Jan. 1, 1998, were added to unrelated legislation providing $84 billion in fiscal 1997 for veterans, space, environmental and housing programs.
Also included was a third provision, effective Oct. 1, 1997, that would extend benefits to Vietnam War veterans exposed to Agent Orange whose children suffer from the birth defect spina bifida.
The agreements came as Republicans rushed to finish needed spending legislation by the end of the month and avoid any chances of a battle with the Clinton administration that would cause a new federal shutdown.
The provision on mothers and their newborns was written in response to the large and growing number of health plans that refuse to pay for more than 24 hours in the hospital except in extreme circumstances.
It would require health plans to pay for no less than a 48-hour stay after a normal vaginal delivery and no less than 96 hours following a Caesarean section.
Clinton recommended the provision in his State of the Union address this year and pressed for it during a radio address the day before Mother's Day.
``Saving the life and health of mothers and newborns is more important than saving a few dollars,'' the president said.
Rep. Gerald Solomon, R-N.Y., the measure's sponsor, said he drafted it after learning of a constituent who suffered three strokes a day after she and her newborn were discharged from the hospital within 24 hours.
``Now this woman, this young woman, 19 years of age, is not only unable to lead a normal life, she is unable to take care of that poor child,'' he said.
Under the agreement reached early Thursday, a mother could choose to leave the hospital earlier than 48 hours in consultation with her doctor. But health plans would be prohibited from offering payments or rebates to mothers or doctors to accept less than the minimum stay.
``The decision is appropriately placed where it should be, and that is with the physician and the mother,'' said Rep. Bill Thomas, R-Calif., chairman of the House Ways and Means health subcommittee.
The mental health provision would prohibit insurers from setting separate lifetime and annual coverage limits for mental and physical illnesses. Treatment for alcoholism and drug abuse was not included, though.
If a health plan has a lifetime or annual limit on coverage of medical or surgical services, it either must include mental health in that total or have a separate mental care limit no more restrictive than the medical-surgical limit. If there is no limit on coverage of physical illness, then there can be no limit on mental illness.
Currently, for example, health insurance payments might be cut off after $25,000 for schizophrenia treatment, but the same insurer would pay up to $1 million for cancer.
The provision does not require health plans to cover mental health, and it lets insurers devise separate schemes of copayments and deductibles.
``I wouldn't call it the be-all and end-all,'' said Sen. Paul Wellstone of Minnesota, a liberal Democrat who sponsored the provision with Sen. Pete Domenici, a conservative Republican from New Mexico. ``But it begins to move us out of the Dark Ages and beyond the discrimination.''
Small businesses with 50 or fewer employees would be exempt. Also, to ease concerns of critics who say the provision could inflate insurance costs, the agreement lets health plans opt out of the requirements if their overall costs would be driven up by 1 percent or more.
Over the summer, Domenici and Wellstone had sought to attach the provision to legislation guaranteeing the portability of health insurance from job to job, but temporarily dropped their effort to ensure passage of the larger bill.
Both men have a personal stake in the fight: Domenici's daughter suffers from a mental illness; Wellstone's brother is battling manic depression.
``I say to the millions of families suffering out there: This is not going to solve all your problems,'' Domenici said. ``You still have plenty of discrimination, plenty of stigma. But at least we can say Congress is going to overwhelmingly take one step against discrimination.''
LENGTH: Medium: 86 linesby CNB