May 7, 1999

Major new parity legislation designed to close serious loopholes in the 1996 Mental Health Parity Act (MHPA) was introduced in both the House of Representatives and the Senate last month.

A comprehensive parity bill, including coverage of substance abuse disorders, was introduced in the House by Representatives Marge Roukema (R-N.J.), Bob Wise (D-W. Va.), and Peter DeFazio (D-Ore.). A more limited bill was introduced in the Senate by Senators Pete Domenici (R-N.M.) and Paul Wellstone (D-Minn.). At press time, the House bill had 22 sponsors and the Senate bill had seven sponsors. Proponents of the legislation in both chambers predicted that it would be a tough fight to attain passage.

During brief remarks at a press conference called by Roukema, the House parity bill's chief sponsor, and colleagues on April 13, APA President Rodrigo Muņoz thanked the sponsors for "compassionately and responsibly" striving to end discrimination in insurance plans. There is ample evidence that parity "is affordable and is the right thing for America," said Muņoz.

APA President-elect Allan Tasman, M.D., echoed those sentiments the next day when Domenici and Wellstone held a press conference to announce the Senate version of the new parity bill. The Senate bill, if passed, "will ensure millions of Americans will realize the hope and spirit of the mental health parity act of 1996," said Tasman. Alluding to the omission of substance abuse coverage from the Senate bill, Tasman added, "We look forward to the day when we will enact full parity legislation for all people suffering from all forms of mental illness, including those with substance abuse disorders; until we reach that day we stand with you in our journey down the road to full parity for all Americans."

In a statement distributed during the April 13 House press conference to announce introduction of the Mental Health and Substance Abuse Parity Act of 1999, Roukema excoriated the discriminatory treatment of the mentally ill by insurance plans. She pledged to work with her colleagues to pass new legislation that would close loopholes that remained after passage of the 1996 MHPA.

"Millions of hard-working men and women still find that their health plans place strict limits on both inpatient and outpatient coverage for mental illness," said Roukema. "This type of discrimination is wrong and must end."

The new bill would bar insurance companies from setting different limits or requirements for mental health and substance abuse coverage from those imposed on medical-surgical coverage. The Senate version is considerably more limited and excludes substance abuse coverage. Both versions differ from the 1996 parity bill, which prohibited unequal limits on aggregate annual and lifetime spending limits for mental health care, but did not mandate equality in terms of frequency of treatments, number of visits, copayments, deductibles, out-of-network charges, and out-of-pocket contributions.

Both the House and Senate versions would no longer allow those different limits and would eliminate an opt-out provision that gave businesses the option of dropping coverage of mental health benefits if experience in the first year of providing mental health coverage raised premium costs by 1 percent or more. Both bills also eliminate the 2001 sunset provision in the 1996 bill.

Wise of West Virginia lauded the new legislation as "a big step for people who rely on mental health care." Alluding to objections to parity from the business community, Wise said that "despite loud claims to the contrary, study after study show minimal cost increases for businesses and companies that are going ahead with plans to provide mental health insurance for their employees."

Oregon's DeFazio noted that "mental illnesses and substance abuse problems do not discriminate. They can strike any family at any time in America" regardless of socioeconomic level.

As has been true in prior efforts toward parity, psychologists and psychiatrists were unified in their support for new legislation. Mental illness is "the silent illness in America," said House cosponsor Brian Baird (D-Wash.), a first-term representative and a clinical psychologist. "No one would be ashamed to tell their friends, 'My child has diabetes and is going for treatment.' And no one would be ashamed to expect an insurance company to provide for that treatment," he noted. "But when it comes to mental illness, no one wants to talk about it, no one wants to cover it, no one wants to pay for treatment-even though we know that the treatment is effective."

The results of the 1996 parity bill "taught us an important lesson-partial parity may be no parity at all, because there are many ways around it," remarked Russ Newman, Ph.D., J.D., executive director for professional practice at the American Psychological Association. "It is only full and comprehensive parity that will get us where we want to be."

At the Senate press conference to announce introduction of the Mental Health Equitable Treatment Act of 1999, Domenici stressed aspects of the bill that would close loopholes in the 1996 MHPA. The new bill, he said, "seeks to ensure greater parity in coverage of mental health benefits by prohibiting limits on the number of covered hospital days and outpatient visits for all mental illnesses and by providing full parity for certain specified severe adult and child mental illnesses or diseases." If passed, the law would require compliance for "any group health plan that is providing mental health benefits," he stressed.

The Senate bill mandates full parity for a list of specifically defined biologically based mental illnesses. Those specified illnesses will be covered "with full parity. That means, however, that you cover cancer, liver disease, heart disease" and other medical illnesses, Domenici added.

The bill also makes sure that insurers will no longer be able to sidestep parity requirements by prohibiting limits on the number of covered hospital days and outpatient visits for all mental illnesses, he added.

Sen. John Chafee (R-R.I.) commented that passing the bill "could relieve a whole host of families across our nation of some terrible experiences and worries they've had up to this time. I'll do everything I can to be of help."

In response to questions about the Senate bill's exclusion of parity for substance abuse disorders, Wellstone pointed out that he is working with Republican Rep. Jim Ramstad of Minnesota, who is promoting a bill in the House to cover substance abuse disorders.

"These are all practical decisions at this time," Domenici added. It is a calculation as to how much can be accomplished now without alienating the business community and without generating opposition from senators who would react negatively to legislation covering substance abuse disorders, he explained.