Parity Prospects Improve in Senate Reform Bill

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 insurance coverage.

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 market.

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 exchanges.

“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.

Information on the unified House bill is posted at<http://energycommerce.house.gov/index.php?option=com_content&view=article&id=1706:house-democrats-introduce-bill-to-provide-quality-affordable-health-care-for-all-americans&catid=122:media-advisories&Itemid=55>. Information on the Senate HELP Committee bill is posted at<http://help.senate.gov/Maj_press/2009_07_15_b.pdf>.▪