House Committee on Education and Labor
U.S. House of Representatives

Rep. Howard P. “Buck” McKeon
Ranking Member

Fiscally responsible reforms for students, workers and retirees.



Dear Colleague

March 5, 2008

Two Reasons Why NOT to use DSM for Coverage Purposes

Dear Colleague:

Today the House will consider H.R. 1424, Paul Wellstone Mental Health and Addiction Equity Act. We feel it is important to set the record straight on the use of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

The House bill overreaches in its attempt to achieve mental health parity.  If enacted, H.R. 1424 would impose a broad mandate to cover all mental health conditions listed in the 941-page DSM.  This is an “all or nothing” mandate. 

According to CBO, this will lead some plans who currently offer mental health coverage to drop mental health coverage altogether.  Below are two reasons why the DSM manual should not be used for coverage.

1.    By mandating that all conditions in the DSM be covered, plans offering mental health benefits would be forced to cover everything, including caffeine intoxication, sibling rivalry, and oppositional defiance disorder.

2.    The bill will allow the American Psychiatric Association, which publishes the DSM, to expand the list of covered benefits at any time.  This would then require health plans to cover these benefits, with no further Congressional action.  Allowing a non-governmental entity to change the law at its discretion and without judicial or Congressional review raises serious Constitutional questions.

Importantly, while supporters argue that this is the same list used by the Federal Employees Health Benefits Plan (FEHBP), they neglect to mention that the FEHBP is allowed to manage these benefits – something H.R. 1424 does not allow.

Please contact our staff should you need any additional information.



Nathan Deal         
Energy and Commerce Committee         


Dave Camp
Ways and Means Committee


Howard P. "Buck" McKeon
Senior Republican
Ed and Labor Committee