The longtime advocate for improved mental health care introduced her proposal calling for total parity on January 3, during the first day of the new Congressional session. Roukema was the chief sponsor of an almost identical version of the bill that was introduced in the last session of Congress, but the bill never made it to the floor for a vote (Psychiatric News, May 7, 1999).

In introducing the 2001 version of the bill, Roukema emphasized several messages that APA has been trying to get across to lawmakers and the public for many years.

"As a society, we are still struggling to acknowledge that mental illness is a real sickness in need of medical care," she said. "Mental illness is not a character flaw, but a tangible, treatable health problem as real as hypertension, cancer, or heart disease."

Roukema added that research advances have made "mental health care as effective as insulin for a diabetic."

She intends her bill to address the largest obstacle in the way of Americans obtaining that effective medical care, namely inadequate and discriminatory insurance coverage.

"Millions of hardworking men and women still find that their health plans place strict limits on both inpatient and outpatient coverage for mental illness. This type of discrimination is wrong and must end," Roukema said.

The tragic irony in the current way the insurance industry views mental illness coverage, she noted, is that "most people who suffer from mental illness can live normal lives if they receive treatment, but most can’t receive treatment if their insurance plans won’t pay for it."

In proposing a legislative remedy for the lack of insurance parity, Roukema anticipated objections from business and industry, pointing out that a study of the financial effects of parity legislation by the National Advisory Mental Health Council suggested that a parity mandate would increase health care costs by no more than 1 percent. She also cited a finding from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) that assessed the effects of the limited parity legislation enacted in 1996, of which she was also the chief sponsor. The SAMHSA study discovered that 86 percent of the companies who had met the limited parity requirements in their sponsored health plans had incurred no cost increases in providing those upgraded benefits. The data clearly show, she noted, "that parity is not prohibitively expensive" and, in light of the increased productivity and reduction in the number of days lost to sickness, is in fact "a good investment."

Roukema’s bill goes well beyond the 1996 law, which mandated parity between physical and mental illness coverage when it came to annual and lifetime dollar limits. Her bill, known as the Mental Health and Substance Abuse Parity Act, would extend insurance parity to copayments, visit limits, deductibles, and out-of-network charges.

The bill’s provisions state that they apply to substance abuse and chemical dependency benefits as well as other forms of mental health care.

It would also abolish a provision in the 1996 law that allowed businesses a pass on complying with the parity law if they could show that implementing it raised their insurance costs by at least 1 percent.

The bill does not prohibit a group health insurance plan from "negotiating separate reimbursement rates and service delivery systems for different benefits or managing the provisions of benefits through the use of preadmission screening, prior authorization of services, and other mechanisms designed to limit coverage of items and services to those deemed medically necessary."

If enacted, the legislation would take effect on July 1, 2002, and apply to employer-provided insurance plans written after that date.

APA President Daniel Borenstein, M.D., applauded Roukema’s efforts, saying her introduction of the proposal on the first day of the new Congress "underscores her outstanding personal commitment to providing full parity for mental health benefits." He added that "APA looks forward to working with Representative Roukema to ensure that psychiatric patients receive all the treatment they need."

APA’s Division of Government Relations is working with several senators and their staffs on the introduction of a similar bill in the Senate, where last year Senators Pete Domenici (R-N.M.) and Paul Wellstone (D-Minn.), both longtime advocates for better mental health care, sponsored a mental health parity bill.

The parity legislation is available on the Web by going to thomas.loc.gov and searching under "Roukema" or the bill number, which is HR 162 in the 107th Congress. ▪