Millions of Americans with mental disorders do not have equal access to health insurance. Many health plans discriminate against these people by limiting mental health and substance abuse healthcare by imposing lower day and visit limits, higher co-payments and deductibles and lower annual and lifetime spending caps.
The National Mental Health Association (NMHA) and is local and state affiliates support comprehensive health insurance parity legislation, which would ban these practices by requiring the same health insurance coverage for mental disorders as physical disorders.
To date, 34 states have made into law some form of mental health parity. Several have enacted laws that require insurance parity only for a small set of specified diagnoses or serious mental illnesses, however. These laws discriminate against children and adult whose illnesses can be as disabling as those specified in the laws, but do not fit neatly within the statutes’ criteria. Adults excluded from protection under these laws include those who have multiple personality disorders, anorexia nervosa and bulimia, post-traumatic stress syndrome, and substance abuse disorders. Children with serious emotional disturbances and substance abuse disorders are also excluded. Therefore, NMHA advocates for inclusion in laws all disorders listed in the Diagnostic and Statistical Manual of Mental Disorders—IV (DSM-IV).
The laws in three states can serve as models for legislation other states that are either considering the issue for the first time or are considering revising their existing parity law. These states are Vermont, Maryland and Connecticut. To obtain copies of these states’ laws, as well as NMHA’s parity-related reports, contact NMHA’s Advocacy Resource Center.
In 1996, Congress passed the Mental Health Parity Act (P.L. 104-204), which made it unlawful for companies with more than 50 employees to set annual and lifetime dollar insurance limits for mental health care (unless the same dollar-limits apply to medical and surgical care). Many employers and insurers violated the spirit of that law, however, by placing other restrictions on mental health benefits, such as limits on the number of covered outpatient office visits and number of days for inpatient care.
Repeated legislative efforts in Congress to close these loopholes have won broad bipartisan support. President Bush at one time expressed support for, and pledged to push for enactment, of parity legislation, but has not renewed that call. Congressional leaders have blocked efforts to bring an expanded parity bill to an up-or-down vote, however, and Congress has instead simply kept the 1996 law in force, through a series of one-year extensions.
This year, Reps. Jim Ramstad, R-Minn, and Patrick Kennedy, D-R.I., have introduced the Senator Paul Wellstone Mental Health Equitable Treatment Act, H.R. 1402, a measure that would require employers with more than 50 employees to provide comprehensive mental health and substance-use parity. While a parity bill has not been introduced this year in the Senate, Sens. Pete Domenici, R-N.M., and Edward Kennedy, D-Mass., who sponsored parity legislation in the last Congress, continue to work on this issue behind the scenes with an eye to passing a bill this year. To stay up to date on what’s happening in Congress on mental health parity legislation, check out our latest Legislative Alerts.
Technical Assistance Resources
NMHA has developed a series of resources to help advocates in their parity campaigns. In addition, NMHA will research additional questions on this important topic. The following documents are available through the Advocacy Resource Center:
1. Expanding Mental Health Parity Toolkit. This toolkit provides background information for people who are amending their current parity laws are working to pass parity for the first time. Toolkit contents include: MHA Contact List; Expanding Parity Fact Sheet; Skeleton Media Announcement; State Insurance Parity Laws Charts; Advocacy Check List for 2001; Substance Abuse Insurance Parity: A Guide for Advocates; Media information on the Surgeon General’s Report; Why Mental Health Parity makes Economic Sense; State Parity Language for Children; and Parity Case Study: Connecticut.
2. Strategies for Negotiating Comprehensive Parity. Discusses strategies for keeping the parity debate focused on providing protections for all Americans along with specific responses to scenarios that could jeopardize comprehensive or full parity proposals.
3. Substance Abuse Insurance Parity: A Guide for Advocates. Provides background information on the issues surrounding substance abuse parity.
4. Research Studies. NMHA collects research studies on the implementation of parity as well as cost analyses and other research on the topic. Please contact the Advocacy Resource Center if you are interested in some of these more in depth studies.
Updated August 2005
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