Few states have taken action to upgrade their health insurance parity laws
this year as many wait for movement on a federal measure stalled in a
congressional conference committee.
Among the few states to act on their parity laws, the most significant
change was Illinois' addition of two eating disorders to the mental illnesses
that health insurers are required to cover.
"It's very hard to get these mandates passed in Illinois, so we felt
very good about the whole thing," said Meryl Camin Sosa, executive
director of the Illinois Psychiatric Society (IPS).
The measure (HB 1432) amended the state's parity requirement to include
anorexia nervosa and bulimia nervosa as "serious mental
illness[es]" that insurers are required to cover at parity with other
The push to enact the legislation was led by the IPS, which had tried to
have eating disorders included when the state enacted its initial health
insurance parity law in 2002. The eating-disorders bill became the focus of
the IPS's biennial advocacy day at the state capitol, and several of the
legislators that Illinois psychiatrists lobbied eventually became
The measure had stalled in the Illinois General Assembly until the IPS and
the coalition it led sought the support of Blue Cross and Blue Shield. The
insurer, a powerful force in the Illinois legislature, agreed to support the
bill if a provision requiring coverage of "eating disorders not
otherwise specified," such as binge eating, was dropped. The IPS and its
allies agreed, and the measure passed both chambers of the state legislature
by wide margins in May.
In Illinois and other states, opponents of the addition of eating disorders
in state parity laws have criticized it over cost concerns and the belief that
the illnesses are not as serious as other mental health conditions.
Proponents counter that the disorders severely affect the health of those
who suffer from them. The mortality rate of anorexia nervosa, for example, is
nearly 12 times greater than the rate due to all causes of death among females
aged 15 to 24, according to Sheldon Miller, M.D., IPS president.
"Typical coverage for eating disorders by insurance companies fails
to provide adequate reimbursement for even the most basic evidence-based
treatment, as recommended by the American Psychiatric Association," said
Miller in testimony before a committee of the Illinois House in May."
Routine denial by third-party payers for a full course of treatment for
eating disorders is unfortunately common and has been shown to actually
increase costs in the long term."
The legislation was sponsored by Rep. Fred Crespo (D), a first-term
representative and former high school girls' track-and-field coach. After
learning the extent to which eating disorders were having a negative impact on
the lives of the girls he coached, he vowed to make expanded access to
treatment his first priority as an elected official, according to Sosa.
"We did everything we knew how to do," Sosa said.
The only other state to pass a change to its parity law this year was
Vermont, which made technical changes to what advocates consider one of the
strongest parity measures in the nation. The Vermont legislation (S 114),
signed into law in May, mandated that the state insurance commissioner step up
enforcement of the existing parity law, among other provisions.
Among the few state legislatures that have not yet concluded their work for
the year, only New Jersey appears to be considering further parity changes. A
bill (A 2077) that passed an Assembly committee in March would add mandatory
insurance coverage of alcohol and drug addiction treatment to the state's
Specifically, policies would have to cover detoxification and other
treatments, screening and assessment, case management, medication management,
psychiatric consultations, and individual, group, and family counseling.
New Jersey Republicans praised the intent of the bill but criticized its
timing for adding an unknown additional financial burden on the
state—which would have to add the benefit for its employees as
well—during a time of tight budgets.
The national economic downturn and resulting lean state budgets were one
likely factor in the low number of insurance parity expansions state
legislatures considered this year, according to Paula Johnson, deputy director
for state affairs in APA's Department of Government Relations. Another factor
in the lack of state action on parity, she said, was that many states were
awaiting the outcome of ongoing congressional negotiations over competing
federal parity bills (HR 1424, S 558).
Senate and House Democratic leaders have both made resolving differences in
the two bills this summer a priority. In June the ranking Republican on the
Senate Special Committee on Aging, Sen. Gordon Smith (R-Ore.), pushed to add
the Senate parity language to a bill to provide updates for Medicare. However,
the likelihood that any parity measure will pass this year remains