WASHINGTON - Long-stalled legislation to fling open the doors of treatment to those with mental health issues remains deadlocked in Congress, casting a shadow on a pivotal race to replace Rep. Jim Ramstad, who has staked his political legacy on the bill's passage.
The nine-term Minnesota Republican has said he has no plans to run for reelection this year, but he wants to see his mental health legislation become law before he leaves the House.
Yet legislators and advocates who have worked closely on the bill say it remains mired in a standoff between competing House and Senate versions, and that Ramstad's more ambitious House plan -- named for the late Sen. Paul Wellstone -- has little chance of becoming law.
Ramstad, 61, says negotiations are at a "delicate phase" and that there's still hope. "I fully expect the bill will pass this year, and I'm not retiring until Dec. 31," he said.
Political observers note that Ramstad has left himself an opening to renege on his planned retirement by linking it to his signature "parity" bill, which would require insurers to cover mental health conditions the same way as physical ailments.
Ramstad, a recovering alcoholic with a deep personal interest in mental health and chemical dependency, remains elusive on the question of retirement.
In an interview, he said "I haven't left anything open." But he declined to say unequivocally whether he will leave Congress at the end of the year if he does not get the mental health parity bill he wants.
"In one capacity or another I will continue to lead the fight for people with mental illness and addiction," he said, declining to elaborate further.
Since his surprise retirement announcement in September, Ramstad has been dogged by reports that he is weighing entreaties from Republican leaders to reconsider.
Meanwhile, the campaign of Republican hopeful Erik Paulsen, a former Ramstad staffer, has reported almost $390,000 in campaign fundraising, a larger haul than any of the DFLers in the race. Paulsen announced his candidacy Sunday.
But Eric Tostrud, Paulsen's finance chairman, has suggested that there's another $100,000 in contributions "on the table" as potential donors wait to see what Ramstad does.
Compromise elusive
It also remains unclear how much compromise Ramstad would require from the Senate to declare victory on a parity bill.
"There's no question we're going to continue to fight for the House bill," Ramstad said. "We might not get everything we want. We probably won't get everything we want. I've been around long enough to know that. But we're going to push for the strongest bill we can get."
To be sure, both sides are expected to hold to their strongest negotiating positions in public, and Ramstad made clear that he doesn't want to "negotiate in the press."
Critics of the House bill say Ramstad and lead sponsor Patrick Kennedy, D-R.I., are shooting for the moon. Carrying forward a cause that Ramstad has championed since the 1990s -- along with Wellstone, whose brother suffered from a bipolar disorder -- their bill would dramatically expand health insurance for people with mental disorders or chemical dependency.
Over the years, it has run into a solid wall of opposition from employers and insurers, who fear it would mandate expensive new treatments and drive up costs. A less stringent plan, which has the backing of a broad coalition of insurance, professional and business groups, was approved unanimously by the Senate last year.
Backers of the Senate version say that's the best deal they're likely to get and that pushing for more coverage mandates could fracture a fragile coalition they've formed with some consumer groups.
Marilyn Richmond of the American Psychological Association calls the Senate plan a "historic opportunity" to pass legislation ending insurance practices that discriminate against the mentally ill. But, she warned, "it's at risk of ending in deadlock if Congress is unable to negotiate a bill that is acceptable to both the House and the Senate."
Another backer of the Senate plan is fellow Minnesota Republican John Kline, who says Ramstad's "overreaching" has delayed a final deal. As the ranking Republican on the House subcommittee that deals with health legislation, Kline sought unsuccessfully last year to scrap the House version and replace it with the Senate bill.
"Had we done that," he said, "we would have a mental health parity law."
Instead, Kline says, two years of negotiations are now hanging in the balance, with Ramstad holding the most important cards. "It's in the hands of the proponents of mental health parity to get this into law by moving to the Senate version," he said. "If not, it's going to be difficult."
Legacy at stake
But Ramstad and his allies don't see much reform in the Senate bill, even if it's being carried by Sen. Ted Kennedy, D-Mass., Patrick Kennedy's father. One of the core differences is that the House bill bases coverage on conditions outlined in the diagnostic manual of the American Psychiatric Association. The Senate version largely defers to insurers on how to decide what conditions are covered.
David Wellstone, the late senator's son, believes that discretion would leave too many people without coverage. He feels strongly enough about it that he requested that the Wellstone name be dropped from the Senate bill. "There's no way I'm going to leave my dad's name on a bill that is not as strong as it could be," he said.
Another Ramstad ally is Chaska resident Kitty Westin, who became a national advocate for treatments of eating disorders after her 21-year-old daughter Anna committed suicide in a struggle with anorexia. The Senate bill, Westin notes, still excludes eating disorders.
Wellstone and Westin have been buoyed by Ramstad's strong backing in the House. Headed for a final vote on the House floor in coming weeks, the Paul Wellstone Mental Health and Addiction Equity Act has 273 co-sponsors, more than enough for easy passage.
But then it will be up to a conference committee to reconcile House and Senate versions that many skeptics say are irreconcilable.
"It's not just a policy issue," Ramstad said, "it's a matter of life and death for a lot of people."
It may also be a matter of Ramstad's political legacy, if not his future.
"He is so committed and passionate about it," Westin said. "He's worked so hard. It's something that will always be a part of his legacy."
Kevin Diaz • 202-408-2753