APA district branches that previously opposed terms in a Senate-passed
mental health parity bill are supporting a compromise measure that addresses a
number of their key concerns.
Several district branches (DBs) had contacted APA's Department of
Government Relations over the last year to voice opposition to a federal
parity bill that passed the Senate in September 2007. The Mental Health Parity
Act of 2007 (S 558) would have required insurers to apply the same treatment
limitations and cost-sharing requirements to treatment of mental illness,
including substance abuse, as they did for other medical services. Similarly,
day and visit maximums, copays, and deductibles, would have had to be applied
The Senate bill—arrived at after years of negotiations among Senate
parity supporters, business groups, and the insurance industry—drew
opposition for language that many psychiatrists in states with strong mental
health parity laws said would create a "ceiling," or national
limit, on the maximum parity benefits that insurers could be required to
Some state parity laws go beyond the requirements of the Senate bill or
even a stronger House measure (HR 1424), with provisions such as those
requiring insurers to allow any licensed mental health or substance abuse
treatment provider willing to meet the insurer's terms and conditions
into the insurer's network or list of authorized providers.
"Vermont has a broad-based parity bill, which was passed in 1997,
with active support from" the Vermont Psychiatric Association (VPA),
David Fassler, M.D., VPA's legislative representative and
secretary-treasurer of APA, told Psychiatric News. "We were
concerned that early drafts of the federal parity bill, specifically the
Senate version, contained a preemption clause designed to override such
existing state legislation."
Like several other DBs, the VPA contacted APA and its state congressional
delegation to voice its concerns about the Senate bill.
John McCulley, executive director of the Oregon Psychiatric Association,
said that the DB also had voiced concerns to APA about the Senate bill,
because its member psychiatrists were concerned that Oregon's strong
parity law, which was enacted in 2005, could be undermined by the federal
"Any time we can provide parity for more people, it will be
helpful," McCulley said.
Many other mental health advocacy groups and state officials also contacted
members of Congress to voice their preemption concerns stemming from the
Senate bill. For example, Vermont's Department of Banking, Insurance,
Securities, and Health Care Administration sent House Speaker Nancy Pelosi
(D-Calif.) an analysis that also outlined areas of its state parity law that
the Senate bill might override. Advocates for a stronger mental health parity
bill called for federal legislation that would establish a base level of
mental health parity requirements and allow states to add onto that with their
The DB opposition to the Senate parity bill was in contrast to other mental
health advocates who supported it as the most politically realistic option at
this time. Mental health advocates who supported the Senate version were
concerned that changes to the carefully negotiated Senate measure, which
marked the first time that business and insurance-industry leaders had
supported a parity expansion, would keep any parity measure from passing in
the current Congress.
A parity measure that was more popular with mental health advocates and
provided only a floor for mental health and substance abuse benefits passed
the House of Representatives in March. Congressional negotiators wrestled with
differences in the House and Senate versions of parity until a compromise was
announced in June. The compromise language dropped the Senate's ceiling
on benefits, while retaining other less-controversial components of the Senate
bill (Psychiatric News, September 19).
The compromise language has drawn widespread support from previously
critical DBs primarily because it allows their stronger state provisions to
continue while broadening access to parity coverage, even within those states,
by applying to insurance plans that federal law has long barred states from
regulating. The federal compromise measure would require equal coverage for
both mental and physical health in those plans that provide a mental health
benefit, and it would affect coverage of nearly 113 million people. Nearly 82
million of those people affected are insured through plans that fall under the
Employee Retirement Income Security Act (ERISA), which are not subject to
state parity law requirements. The compromise bill would provide the first
expansion in parity requirements for ERISA plans—principally the
insurance plans of large, self-insured companies—since a limited federal
parity law was enacted in 1996.
"To have comprehensive parity outside of the government [health care
insurance] systems, you have to have both state and federal parity,"
said Barry Perlman, M.D., chair of APA's Committee on Government
Relations and legislative director for the New York State Psychiatric
Association, which also had raised concerns about the earlier Senate parity
measure. "They really complement each other."
Fassler said that the compromise bill "represents progress,
particularly with respect to ERISA," although it is not the ideal
federal legislation that some parity advocates would like to have. Many parity
advocates were hoping for strong federal legislation that would include such
measures as requiring all health insurance plans to offer an option with
mental health coverage and cover all conditions listed in DSM-IV.
The compromise also "could have a significant impact in Vermont where
many larger employers are self-insured and not subject to state insurance
regulations," Fassler noted.
To finally obtain parity for mental health treatment, including that for
substance abuse, supporters will need to advocate for the compromise
measure's passage in the final weeks of the current Congress. Senate and
House supporters are scrambling to find funding offsets for the bill's
$3.8 billion, 10-year cost before the compromise can be voted on in both
The text of the parity compromise can be accessed at<http://thomas.loc.gov>
by searching on the bill number, S 3334. ▪