WASHINGTON — Taking another major step to expand the government's role in regulating health insurance, Congress agreed Tuesday to legislation requiring employers to increase insurance coverage for mental illness and guaranteeing 48-hour hospital stays for new mothers and their infants.
The strong appeal of health issues in an election year produced easy passage of a measure to give the increased protection to Americans who already have health insurance at work.
Action by the Republican-controlled Congress constituted a major change in federal policy and congressional attitude, coming two years after a Democrat-controlled Congress had ignored President Clinton's call for universal and mandatory health coverage by business.
Instead, the newly successful approach to health care reform is incremental, providing improvements for the majority of Americans who have coverage through their jobs without dealing with the problems of the 41 million people who are uninsured.
The new benefits, included in an appropriations bill for the Departments of Veterans Affairs and Housing and Urban Development and several independent agencies, were approved by a vote of 388 to 25 in the House. The Senate had signed off on the measure earlier Tuesday under a shortcut procedure that does not require a special vote.
The bill now will be sent to the White House, where President Clinton has indicated that he will sign it.
The new legislation follows passage last month of a bill that Clinton signed into law which makes it easier for workers to get health coverage when they move to a new job and for small companies to arrange health insurance for their employees.
Together, the changes comprise the biggest package of federal health legislation in nearly a decade.
The bill approved Tuesday, because it would require parity in insurance coverage for mental illness for the first time, is "historic legislation," said Rep. Bob Wise (D-W.Va.). "This shows what Republicans and Democrats can do when they work together for health care."
The guarantee that a mother with insurance can stay in the hospital for two days after giving birth is "vital and so important, " said Rep. Gerald B. H. Solomon (R-N.Y.), speaking of a constituent who gave birth and was sent home in a day. "Several days later, her right lung exploded and she had three strokes . . . and she will never again have a normal life," he said.
A third health provision would allocate money for treatment of Vietnam veterans' children with spina bifida. Those eligible are the children of veterans exposed to the chemical Agent Orange.
Congress is rushing toward adjournment at the end of the week and legislators of both parties are convinced that the new maternity and mental health benefits will be welcomed and remembered by voters in November. The health measures were added to the Senate version of the funding bill and the House agreed to accept them.
The legislative vehicle for the health measures is one of the key spending bills that must be passed by Congress to operate the federal government during the fiscal year starting Oct. 1.
"It's pretty clear that members of Congress of both parties have their ears firmly affixed to the ground during the electoral season," said Edward Howard, executive vice president of the Alliance for Health Reform, a nonpartisan research and education group. "The rumble they hear is the uneasiness of voters."
The legislation would apply new rules to all health insurance plans. The maternity provision is a response to widespread complaints from women who believed that they were sent home too quickly after giving birth.
The measure, slated to take effect on Jan. 1, 1998, would require a health plan to pay for at least 48 hours of hospital coverage for a mother after a regular delivery and 96 hours after a caesarean-section birth. A mother could leave the hospital sooner if she chose.
Insurance companies and health maintenance organizations would be forbidden to pressure doctors to send patients home early or to offer any rebates to doctors or patients for a quick discharge.
The mental health provision creates parity for spending on physical ailments and mental illnesses. Currently, many health plans have separate lifetime spending limits, such as $1 million for physical conditions and $50,000 for mental illness coverage. Plans also may have annual limits applied to mental health coverage.
These financial differentials will become illegal in 1998. A health plan must have equal treatment. This is likely to mean a single financial cap, covering all health care spending.
Advocates said that the cost to business would be minimal, just 0.16%, but business sources fear that it could be much higher. To reassure business concerns, the legislation provides an escape clause: If a firm's premiums rise more than 1% because of mental health coverage, the parity rule would be dropped.
As indicated by the collapse of Clinton's massive health care plan--which ironically helped sweep the Republicans to control of Congress in the 1994 elections--voters are suspicious of any large-scale health reform.
But the recent congressional actions show that, despite the failure of the earlier Clinton plan, strong support exists for a more piecemeal approach to health care reform.
Indeed, pollsters have found that voters eagerly seek protection for themselves and members of their families.