On the Legacy of Senator Pete Domenici

by D. J. Jaffe

I am saddened to learn about the death of Senator Pete Domenici (R., N.M.). He and his wife Nancy are heroes to those who care about the seriously mentally ill and sensible government policy. I served on a board with his wife Nancy and sat with them at several events. I witnessed their extraordinary efforts to stop insurance companies from discriminating against the seriously mentally ill.

Senator Domenici wasn’t the first person to try to stop insurance companies from discriminating against the mentally ill. Hillary Clinton unsuccesfully attempted it in January 1993, when President Bill Clinton created a President’s Health Care Reform Task Force and appointed Ms. Clinton to head it. At the time, the key mental-health issue was whether mental-health coverage should “help all Americans live mentally healthier lives,” or be limited to helping those who are so severely mentally ill that they genuinely need assistance. Ms. Clinton rounded up the usual mental-health trade associations and with their advice, naturally concluded that any national health plan should cover all mental-health services for everyone. This bloated the cost and increased projected premiums by $275 a year per person. That stopped the idea of including any mental-health coverage in a national mental-health plan in its tracks.

Senator Domenici realized her mistake and led a bipartisan group that successfully passed the first mental-health-parity act. His group included Senators Paul Wellstone (D., Minn.) and Ted Kennedy (D., Mass). Unlike today’s leaders who tend to throw money at mental-anything, these leaders had a personal understanding of the difference between setting aside money to “improve mental wellness” in everyone versus meeting the core medical needs of those with severe mental illness. Domenici’s daughter Clare had schizophrenia, Paul Wellstone had a brother with schizophrenia, and Ted Kennedy had a mentally ill and developmentally disabled sister, Rosemary.

These leaders didn’t want to repeat the mistakes Hillary Clinton made, so they commissioned a report to calculate the cost of covering serious mental illness only. It found that requiring private business insurers to end discrimination against the seriously mentally ill and provide parity coverage for narrowly defined severe mental illnesses would increase costs just 10 percent. There would also be significant cost savings for government via decreasing incarceration and hospitalization. This led to the passage of Mental Health Parity Act of 1996. It was watered down but succeeded because Senator Domenici was willing to stand up to the mental-health industry’s desire to cover everything for everyone and limited the bill to the narrow public interest of helping the most seriously ill.

I wish we had more politicians like him.

– D. J. Jaffe is author of Insane Consequences: How the Mental Health Industry Fails the Mentally Ill and Executive Director of Mental Illness Policy Org.

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