Mental health advocates are a step closer to crossing off one major New
Year's resolution from their list now that a key Senate committee has given
overwhelming approval to a comprehensive mental health parity bill.
On February 14 the Senate Health, Education, Labor, and Pensions (HELP)
Committee endorsed by an 18-3 vote a major expansion of the limited parity
bill that was passed in 1996.
The Mental Health Parity Act of 2007 (S 558) was introduced two days prior
to committee passage by Sens. Edward Kennedy (D-Mass.), who chairs the HELP
Committee, Michael Enzi (R-Wyo.), and Pete Domenici (R-N.M.).
APA President Pedro Ruiz, M.D., said in a press release lauding last
month's bill introduction that "Americans with mental illness are
unfairly singled out when they are required to pay higher copayments, allowed
fewer doctor visits or days in the hospital, or made to pay higher deductibles
than those that apply to other medical illnesses."
Parity supporters in the House are expected to introduce a similar parity
bill in the next few months.
The HELP Committee's action comes just a few weeks after APA gave the"
Blue Dogs" of Congress an earful about parity coverage of
treatment for mental illness, including substance abuse.
APA leaders met with 13 key members of Congress and their staffs for a
breakfast briefing focused exclusively on parity. The January meeting was the
year's first Blue Dog Democrat Breakfast, a monthly meeting of Democrats from
conservative-leaning states, and provided an opportunity to focus on efforts
to pass legislation expanding the 1996 federal parity law. This law mandates
that group health plans in businesses with 51 or more employees must have
annual lifetime dollar limits for mental health care that are the same as for
other types of medical care, but does not address discriminatory copayments or
"We had 13 representatives and staff to ourselves for an hour,"
said Nicholas Meyers, director of APA's Department of Government Relations."
The Blue Dogs are extremely cohesive and on the issue of parity are
bellwethers for the moderates of both parties who must be clear about and
comfortable with parity if we are to succeed this year."
David Fassler, M.D., chair of the APA Board of Trustees Task Force on
Parity, discussed the scope and burden of mental illness in clinical and
epidemiologic terms. Task force member Howard Goldman, M.D., presented data
from his New England Journal of Medicine study on the costs of parity
during the first year of its implementation in the Federal Employees Health
Benefits Program (FEHBP). That study appeared in the March 30, 2006, New
England Journal of Medicine (Psychiatric News, September 16, 2005).
Mental health parity was mandated in the FEHBP in January 2001, when the
Office of Personnel Management implemented a directive to the approximately
250 participating health plans requiring that mental health and substance
abuse (MH/SA) services be covered to the same extent as general medical care
with respect to deductibles, copayments, and limits on physician visits and
As "centrist" Democrats, the Blue Dogs act as a key block of
swing voters in a divided government. The group has gained in strategic
importance since Democrats regained control of the House and Senate last
November. The Blue Dogs, many of whom are from Southern and rural states, now
All the original members were re-elected in the 2006 midterm elections,
with several newly elected members joining the group.
"I spoke briefly about child-psychiatric issues, emphasizing the
importance of early diagnosis and treatment," Fassler told
Psychiatric News. "I also cited some of the statistics from the
Surgeon General's Report on Mental Health, and from the Centers for Disease
Control and Prevention's Youth Risk-Behavior Survey. Finally, I described our
experience in Vermont with a very broad-based parity bill, which covers all
psychiatric and substance abuse disorders.
"Howard [Goldman] did a great job of summarizing experience with
parity in the Federal Employees Health Benefits Program, which is critical,
since it demonstrates that in a large, real-world sample, parity can be
achieved without a significant increase in overall expenditures.
"We got a number of questions about suicide, cost issues, and some
specific aspects of the proposed legislation," Fassler continued."
My sense was that there's general support for the concept of parity
within this group, and I think they were further reassured by some of the
specific research on the cost issues."
Fassler added that just prior to the breakfast, he spoke with Rep.
Stephanie Herseth (D-S.D.). "We discussed adolescent depression and
suicide, and access to treatment," he said.
Though the 1996 federal parity law has consistently been renewed by
legislators beyond its sunset date, efforts to expand the law's provisions
have not been successful.
"A plan could comply with the 1996 law and still have special
restrictions for mental health," Goldman said. "You could continue
to limit stays in the hospital in ways that were different for general medical
conditions. There were separate deductibles and all kind of distinctions in
cost-sharing arrangements that could be made while continuing to comply with
the law. Moreover, the law wasn't extended to covering treatment for substance
In addition to the Senate parity bill, Reps. Patrick Kennedy (D-R.I.) and
Jim Ramstad (R-Minn.) are traveling the country to hold public forums on
parity (see page 4).
In the NEJM study on parity, Goldman and fellow authors compared
seven health plans in the FEHBP from 1999 through 2002 with a matched set of
health plans that did not have parity mental health and substance abuse
treatment benefits. They examined the rate of use, total spending, and
out-of-pocket spending among users of mental health services, including
treatment for substance abuse.
Their analysis indicated that the observed increase in the rate of use of
mental health and substance abuse services after implementation of parity was
due almost entirely to a general trend in increased use that was observed in
comparison health plans as well as in FEHBP plans. The study found that when
coupled with management of care, implementation of parity in insurance
benefits for behavioral health care can improve insurance protection without
increasing total costs.
Aside from cost, Goldman said some legislators continued to raise an
objection to legislative mandates as a matter of principle, arguing that they
tend to create inefficiencies in the market. But Goldman explained to
lawmakers at the breakfast that in the case of parity, a mandate actually
corrects inefficiencies stemming from adverse selection.
"If some plans offer better benefits and others do not, people who
are likely to be high users will flock to the better plans, thus concentrating
adverse risk in a few plans that are trying to do the right thing," he
said. "So this is an instance where a mandate provides protection to the
plan so that it won't suffer any big cost increases due to adverse
The breakfast meeting with the Blue Dog group was a joint initiative of
APA's Division of Government Relations and its political action committee,
Information about the Blue Dog Coalition is posted at<www.house.gov/ross/BlueDogs/bluedogs.shtml>.▪