The president made his announcement in an apt place—New Mexico, the home state of Sen. Pete Domenici (R), a longtime champion of parity.
Bush also announced the creation of the New Freedom Commission on Mental Health, whose members will advise him on much-needed improvements to the mental health system in the United States.
His landmark announcements drew praise from APA, mental health advocacy groups, and the leading sponsors of parity legislation, Sens. Domenici and Paul Wellstone (D-Minn.) and Reps. Marge Roukema (R-N.J.) and Patrick Kennedy (D-R.I.). They are the sponsors in their respective houses of Congress of the Mental Health Equitable Treatment Act (S 543 and HR 4066).
APA President Richard Harding, M.D., praised Bush in a written statement for "his commitment to end discrimination against patients seeking treatment for mental illness by supporting mental health parity legislation."
He also said that APA "is deeply appreciative of the White House’s interest and support of mental health parity and encourages President Bush and Congress to pass the strongest mental heath legislation into law."
Bush’s statement did not include details of the scope of parity coverage the White House was prepared to endorse. APA supports full parity legislation, that is, legislation that requires private health insurers offering mental health benefits to cover treatment for all mental disorders, including substance abuse, at the same level as other medical illnesses. Those who support parity for "serious mental illnesses" are generally referring to coverage for such disorders as schizophrenia, bipolar disorder, psychotic disorders, major depression, schizoaffective disorders, and obsessive-compulsive disorder.
The parity bills in the Senate and House would extend coverage to all DSM disorders, allow the use of managed care to control costs, and exempt companies with 50 or fewer employees from compliance.
The president said in his speech, which he gave at the University of New Mexico, "Our country must make a commitment: Americans with mental illness deserve our understanding, and they deserve our excellent care. They deserve a health care system that treats their illness with the same urgency as a physical illness."
Bush also thanked Domenici for his tireless advocacy on behalf of people with mental illnesses. Domenici has a son with schizophrenia.
"We share this commitment: health plans should not be allowed to apply unfair treatment limitations or financial requirements on mental health benefits," said Bush.
The president promised to work with Congress to reach an agreement on mental health parity legislation this year. "It is critical. . .as we provide full mental health parity that we do not significantly run up the costs of health care. I’ll work with the senator. I will work with the speaker. I will work with their House and Senate colleagues to reach an agreement on mental health parity—this year."
The president did not provide any details of how costs could be limited in the legislation. House Republican leaders contend that requiring mental health coverage for all DSM disorders will drive up health care costs for employers and workers.
Bush’s endorsement of parity was not breaking new ground for him. As governor of Texas, he signed parity legislation in 1997 for people with "serious mental illnesses."
Rep. John Boehner (R-Ohio), chair of the House Committee on Education and the Workforce, argued in a statement last month that limited parity laws in some states have been successful because they "strike an appropriate balance that doesn’t jeopardize workers’ existing benefits or discourage employers from voluntarily providing quality benefits to their employees."
Average health care costs for employers rose by 13 percent last year, and many Americans lack health insurance, said Boehner.
He and other Republican leaders favor limiting the list of DSM disorders to "serious mental illnesses."
Another controversial issue is whether employers should be exempted from the parity legislation if their annual health care premiums rise above 1 percent. Domenici and Wellstone have opposed efforts to include the exemption in their bill; such an exemption was in the 1996 parity law.
The new commission that Bush announced in his New Mexico speech has one year to recommend improvements to the public mental health system.
The commission is charged with identifying the needs of patients and barriers to care, and studying community-based models of care that have been successful in coordinating and providing mental health services, according to a statement from the White House.
Bush announced that Michael Hogan, director of the Ohio Department of Mental Health, has been appointed to chair the 15-member commission. "He has been focused on how our mental health system does and doesn’t work," said Bush.
The White House is expected to announce the appointment of the remaining 14 members this month. They will represent clinicians, payers, administrators, and consumers of mental health services, according to an executive order issued by Bush last month.
In addition, up to seven ex-officio members will be appointed by the secretaries of the departments of Health and Human Services, Labor, Education, and Veterans Affairs.
Bush called stigma, the fragmented mental health system, and parity the three major obstacles to treatment. "Stigma leads to isolation and discourages people from seeking the treatment they need. Political leaders, health care professionals, and all Americans must understand and send this message: mental disability is not a scandal. It is an illness and, like other physical illnesses, it is treatable."
Bush acknowledged that many Americans fall through the cracks of the fragmented public mental health system.
Harding called the establishment of the New Freedom Commission on Mental Health "an important step forward in bringing help to the millions of Americans tragically afflicted with mental illnesses."
APA hopes that the commission will address the patchwork of federal and state policies regarding coverage of mental illness. Medicare still requires patients with mental disorders to pay a discriminatory co-pay of 50 percent rather than 20 percent, which is charged for other medical illnesses, said Harding.
"State Medicaid budgets are stressed and increasingly unable to pay for mental health services. While community-based care may be optimal, there is no national infrastructure to provide it," said Harding.
These are the tasks that have been set for the commission:
• Assess the quality and effectiveness of services delivered by public and private providers and federal, state, and local governments to individuals with serious mental illnesses and children with serious emotional disturbances.
• Identify innovative mental health treatments, services, and technologies that have been demonstrated to be effective and can be widely replicated in different settings.
• Formulate policy options that can be implemented and coordinated by federal, state, and local governments and public and private providers to provide effective integrated treatment to people with serious mental illnesses.
President Bush’s announcements and executive order are posted on the White House Web site at www.whitehouse.gov/news/releases/2002/04/20020429-1.html. Harding’s statement is posted on APA’s Web site at www.psych.org/pub_pol_adv/parity42902.pdf. ▪