With comprehensive legislation proposed and a united mental health community, mental health advocates in Washington hope it's full speed ahead this year for a mental health parity bill.

Legislation introduced in both the House and the Senate to prohibit insurance discrimination against mental health care would cover all DSM-IV diagnoses. It would also ban coverage for mental health that is less than physical health coverage in terms of financial and treatment limitations, including frequency of treatment, number of visits or covered hospital days, deductibles, co-insurance, co-payments and maximum levels of payments.

Written to extend and plug loopholes in Mental Health Parity Act of 1996, the legislation was given new interest this spring when long-time advocates Sens. Pete Domenici (R­N.M.) and Paul Wellstone (D­Minn.) introduced a bill that would provide equal protection for beneficiaries with all types of mental health diagnoses. Their legislation proposed last year would have given less comprehensive protection for those diagnoses not in a list of "biologically based" illnesses, which include schizophrenia, bipolar depression, major depression and a few other disorders.

Due to that broad coverage of diagnoses, the largest coalition of mental health advocates in Washington, the Mental Health Liaison Group, which consists of 51 provider and other associations, gave the new Domenici-Wellstone proposal, S.543, the only unanimous endorsement for a piece of legislation in its history.

"Having a mental health disorder can be as serious as having a heart attack or any other debilitating, life-threatening physical health disorder," says Russ Newman, PhD, JD, APA's executive director for practice, who participated in a news conference with Sens. Domenici and Wellstone as they introduced the bill. "With the passage of this bill, insurers may no longer arbitrarily limit the number of hospital days or outpatient treatment sessions, or use higher co-payments or deductibles for people in need of mental health care."

And although much of the attention is focused on the strengthened Senate bill, in the House, Rep. Marge Roukema (R­N.J.) has also introduced legislation for full parity for all diagnoses, as she did last Congress.

New bill, new facts

This year parity legislation starts on its congressional course with new urgency and new ammunition.

First, the 1996 law is due to "sunset" on Sept. 30 unless new legislation is passed to replace it.

In addition, a report from the General Accounting Office (GAO) last year showed that a law that does not cover all aspects of benefits is not likely to work. GAO found that the 1996 law, which forbids health plan discrimination in terms of annual and lifetime dollar limits, has been largely ineffective because of its incremental nature. Most employers have complied with the law by simply shifting the discrimination to another area, often by putting new restrictions on mental health hospital days or outpatient visits or by requiring higher co-payments or deductibles.

Business and insurance interests have argued in past years that putting mental health benefits on an equal footing with other benefits would cause major increases in the cost of insurance. Yet mental health advocates can point to data showing that full parity would cost the average employer only pennies per day, asserts Peter Newbould, director of congressional affairs for the APA Practice Directorate.

And the National Mental Health Advisory Council, the advisory panel to the National Institute of Mental Health, has estimated mental health parity would cause only a 1.4 percent increase in health insurance premiums.

Despite the spread of parity laws across the states, advocates note that a federal law is still necessary: The Employee Retirement Income Security Act (ERISA) exempts self-insured employers from the state laws and thus a large portion of people in states with parity laws are still not covered by parity rules.

And beyond those arguments, in January, through an executive order issued by President Clinton, the 9 million federal employees--including members of Congress--and their dependents were given full mental health parity, provoking the cry in the mental health community that "other Americans deserve nothing less."

Of course, a major new element in the political mix is the new presidential administration. Mental health advocates hope President Bush will support legislation for parity given the fact he signed parity legislation--albeit for serious mental illness only--as governor of Texas.

Other provisions

Neither federal bill is absolutely perfect in the eyes of mental health advocates. Neither would force employers to offer mental health benefits, but if they do, those benefits must be comparable to those for medical and surgical benefits. The Senate bill would reduce the number of "small businesses" exempted by lowering the number of employees from 50 to 25. The House bill would keep that level at 50.

On the other hand, the House bill includes substance abuse benefits and the Senate bill does not. A separate Senate bill sponsored by Sen. Wellstone would propose parity for substance abuse benefits.

Sen. Domenici has long-range vision for mental health parity. Introducing the broad-based bill this spring, he said: "What if 30 years ago our nation had decided to exclude heart disease from health-insurance coverage? Think about some of the wonderful things we would not be doing today like angioplasty, bypasses and valve replacements and the millions of people helped because insurance covered these procedures.

"I submit these medical advances have occurred because insurance dollars have followed the patient through the health-care system."