The Senate approved a compromise mental health insurance parity measure
last month, which marked the first time either chamber of Congress has passed
a stand-alone, comprehensive parity bill.
The measure (S 558), which was passed on September 18, is a carefully
worded compromise between a limited earlier Senate version and a more generous
House bill. The bill would provide strong federal protections for mental
health care, including substance use disorders, and require health care plans'
treatment limitations and cost-sharing requirements to be equal to those for
other medical services.
The Mental Health Parity Act of 2007 would require equal application of
treatment limitations, number of visits, copays, deductibles, and
APA has long fought for parity legislation. APA's advocacy received help
from the Coalition for Fairness in Mental Illness Coverage, to which APA
belongs. The coalition has worked with Senate parity
supporters—including Sen. Edward Kennedy (D-Mass.), chair of the Senate
Health, Education, Labor, and Pensions Committee—for 10 years on federal
"As physicians on the front line of treatment for Americans
struggling with mental illness, including substance use disorders, we know
firsthand that treatment works," said APA President Carolyn Robinowitz,
M.D., in a written statement. "Nondiscriminatory access to mental health
care, including substance use disorder treatment, will make a real difference
in the lives of millions of Americans."
The final legislation, passed by voice vote, was the result of a compromise
between health care organizations and the business and insurance communities.
Data on the minimal costs of offering parity for mental health care overcame
long-standing opposition from the business community to parity
The measure aims to provide a solid new federal "floor" of
parity protections for mental health and substance disorder services, while
ensuring that state parity laws that are more protective of patients' access
to care would not be preempted by federal law.
The Senate bill mandates mental health coverage for nearly 113 million
people who have insurance coverage.
The bill is a "landmark agreement between health care organizations
and the business and insurance communities," Robinowitz said. "APA
is proud to have been a part of this effort."
The Senate bill came after nearly two years of talks between the bill's
sponsors—including Sen. Pete Domenici (R-N.M.) and Sen. Michael Enzi
(R-Wyo.)—and mental health advocates and business-community
representatives. The negotiations yielded progress by avoiding the most
contentious issues, such as specifying the specific mental illnesses that
would be covered and convincing parity opponents that the idea wasn't as
expensive as they thought because plans already cover them.
The compromise became acceptable to mental health care advocates after
Senate supporters researched nearly 150 health plans across the country and
showed that those plans already paid for coverage of almost all of the most
serious mental illnesses.
The Senate-approved compromise addressed the thorny issue of whether to
preempt tougher state mental health parity laws. Business groups at first
pushed for preemption but then compromised on a federal "floor" of
benefits after states with strong parity laws objected to the possibility of
having their laws preempted.
"The bill we passed represents an agreement, after 10 long years of
stalemate, not only between Democrats and Republicans, but also with the
mental health community, businesses, and the insurance industry,"
Kennedy said in a statement. "We came together and decided that for too
long, persons living with mental health disorders have suffered discrimination
at all levels of society."
The push for parity legislation has shifted to the House of
Representatives, where the Ways and Means Subcommittee on Health voted in
support of its version (HR 1424). The subcommittee approved the measure on
September 19 on a 10-3 bipartisan vote that augured well for passage by the
The House bill contains several provisions that differ from those in the
Senate bill. It includes, for example, a more specific definition of the
conditions insurers would have to cover, and it would go into effect January
1, 2008, rather than a year after becoming law, as specified in the Senate
The subcommittee rejected an amendment that would have allowed insurers to
define which mental health conditions their policies covered, instead of the
House bill's language that requires coverage of all illnesses in
Specifying which mental illnesses health plans would be required to cover
in a parity law continued to draw protests from business groups, which have
long argued that mental health parity was the beginning of a federal effort to
mandate what benefits they would have to provide.
The House Ways and Means Committee passed the bill on September 26 by
27-13, with the support of three Republicans and all of the panel's Democrats.
The committee rejected several amendments, including one that would have
replaced the House language with the text of the Senate-passed bill and an
amendment that sought to remove the use of DSM-IV as the basis for
The final panel with jurisdiction over the bill, the Energy and Commerce
Committee, had not scheduled a vote by press time.
If the House passes its parity bill, a conference committee will still have
to work to resolve differences between the House and Senate versions. Although
the full House is expected to easily pass a parity bill, the legislation that
eventually emerges from a conference between the two chambers is more likely
to resemble the Senate package, because that version is a hard-won compromise
with wide support from insurers and businesses, according to mental health
The text of the Mental Health Parity Act of 2007 can be accessed at<http://thomas.loc.gov> by searching on the bill number, S 558.
The text of the Paul Wellstone Mental Health and Addiction Equity Act of 2007
is posted at<http://thomas.loc.gov/cgi-bin/bdquery/z?d110:h.r.01424:>.▪