Legislation under consideration in Congress became more likely to include
benefits for mental illness—including addiction care—after mental
health advocates urged federal lawmakers to include mandates for parity
Mental health advocates were concerned after early versions of a bill being
considered by the Senate Health, Education, Labor, and Pensions Committee
appeared to omit any reference to mental health insurance parity. The
committee—one of two in the Senate leading health reform
efforts—is viewed as supportive of mental health parity since it is
chaired by Sen. Edward Kennedy (D-Mass.), who sponsored landmark federal
parity legislation enacted in 2008.
In a June letter to Kennedy and Sen. Mike Enzi (R-Wyo.), the senior
Republican on the committee, APA urged them to close a loophole in their
version of health reform that was seen as undermining the 2008 parity law by
appearing to exempt from parity requirements those insurance plans offered
through planned "exchanges" or insurance marketplaces through
which many of those now uninsured could purchase subsidized coverage.
The APA letter asked that the bill extend parity requirements to all
insurance plans to avoid the possibility of employers dropping insurance
coverage for their workers and pushing employees into the exchange market,
where they might lose parity protections.
The federal parity law, known as the Paul Wellstone and Pete Domenici
Mental Health Parity and Addiction Equity Act of 2008, passed last October,
requires health plans that offer mental health coverage to have the same
benefits, copayments, and treatment limits as for other types of health care.
The law goes into effect on January 1, 2010, for most calendar-year plans.
Employers with 50 or fewer employees are exempt from the law.
Three weeks after APA sent its letter, Kennedy's committee approved a
health reform measure that explicitly requires mental health parity to apply
to group insurance plans offered through any new insurance-exchange
However, it remains unclear whether in that committee's bill the parity
requirement also would apply to small group or individual plans offered
through the exchanges. The difference could be significant because many of the
approximately 47 million uninsured U.S. residents could obtain individual
policies through the insurance exchanges.
Due to the millions of people potentially affected, full parity in
insurance plans offered through the exchanges has been strongly urged by
mental health advocates.
"We worked for 18 years to get [the parity law] passed, and we don't
want to see it undermined by health care reform," said Andrew Sperling,
J.D., director of legislative affairs for the National Alliance on Mental
Illness, in an interview with Psychiatric News.
A health reform bill under consideration in the House of Representatives
includes more explicit parity requirements for all plans offered through the
exchanges, as well as requiring mental health and substance abuse treatment
coverage in all of the plans.
In a July 14 letter to the House committee chairs leading the deliberations
on health reform, APA Medical Director James H. Scully Jr., M.D., praised the
inclusion of parity requirements and mental health treatment, including for
substance use disorders, within the basic benefit package required of
insurance plans offered through the exchange.
"This provision recognizes the crucial role of mental health within
the overall health of our nation and builds on the remarkable achievement of
enacting mental health 'parity' last year," Scully said.
Although many of the details of the health care reform bill under
consideration in the Senate Finance Committee, chaired by Sen. Max Baucus
(D-Mont.), were not released by press time in mid-July, mental health
advocates have expressed optimism that insurance coverage for psychiatric
illness also will be required in that bill. Initial drafts of the Finance
Committee bill contained coverage mandates for mental health care, including
substance use treatment, in all insurance plans included in similar insurance
"We are very pleased to see that the principle of nondiscrimination
and parity for behavioral health services would be maintained in the new
Health Insurance Exchange and health care coverage provisions proposed"
in the House bill, said David Shern, Ph.D., president and CEO of Mental Health
America, during congressional testimony in June.