Some employers are circumventing the 1996 law meant to reduce the disparity between mental health and other types of health coverage, according to a survey by the U.S. General Accounting Office (GAO). The result, says the report, is that Americans are seeing little or no increase in access to mental health services.

In response, APA is urging Congress to pass legislation to completely ban discrimination in mental health insurance coverage.

The 1996 Mental Health Parity Act prohibits employer-sponsored group health plans from imposing annual and lifetime dollar limits on mental health coverage that are more restrictive than those for medical and surgical coverage. Congress is expected to begin work in earnest to reauthorize the law after the first of the year, because it is set to sunset Sept. 30, 2001.

The GAO survey of 863 employers has found that 86 percent are complying with the law, but most are also restricting mental health benefits in some other way, most often by covering fewer office visits or fewer hospital days.

APA recently told Congress that the GAO report is one reason the arguments for more comprehensive protection are more evident than ever before. The association is backing a bill sponsored by Rep. Marge Roukema (R­N.J.). Her H.R. 1515 aims to outlaw discrimination in any mental health benefit design feature and for any diagnosis.

APA is also supporting a bill (S. 796) introduced by Senators Pete Domenici (R­N.M.) and Paul Wellstone (D­Minn.), but is advocating that Congress expand it to cover all diagnoses. The bill seeks to lengthen the list of methods by which insurance plans may not discriminate: It would outlaw lower limits on outpatient or hospital days for mental health services. It would also reduce the number of "small employer" plans exempted from the rules, by lowering the "small employer" definition from 50 employees to 25.

The Domenici-Wellstone bill also seeks full parity for those diagnoses it terms "severe mental illnesses." It would ban any health plan discrimination for a list of "biologically based" illnesses, including schizophrenia, bipolar depression and major depression.

But APA, which has long supported full parity for all mental health diagnoses, fears that under the Domenici-Wellstone bill's incremental approach, employers would almost certainly offset the perceived cost of new parity requirements by restricting mental health coverage through other avenues, just as the GAO report shows happened under the 1996 law. This time, the association cautions, the only avenues left would be by increasing costs for people whose illnesses are not labeled as "SMI," through co-payments, deductibles or out-of-pocket payments. Given the smaller pool of beneficiaries who would bear those costs, the increases for those patients could be drastic, perhaps even prohibitive for access to service, APA says.

"APA believes that it is wrong, and bad public policy, to divide persons into groups for parity coverage, based on the perceived underlying reason for their mental disorder," the association said in written testimony to the committee looking at the GAO report.

In addition, APA's testimony pointed out, several of the 11 states that have "full parity" law--that is, comprehensive rules against discrimination--have found that those rules increase costs only 2 percent or less.

The GAO report, "Mental Health Parity Act," is available on the Internet at: http://www.gao.gov.