Acknowledging that it took the leverage of the world’s financial crisis to get the job done, mental health activists nevertheless rejoiced last month when Congress added key provisions of long-sought mental health parity legislation to the $700 billion financial bailout package.

“For the first time, employers and group health insurance plans will be required to provide equal coverage for mental and physical illnesses,” says LIUNA General Secretary-Treasurer and LHSFNA Labor Co-Chairman Armand E. Sabitoni. “This should ease access to care for patients with illnesses such as depression, autism, schizophrenia, eating disorders and alcohol or drug addictions.”  

Currently, many insurers require higher co-payments and deductibles and impose stricter day and visit limits on mental health care than on other health care treatment and service. The new rules will apply to all employers with 50 or more employees.

It is estimated that one in four Americans has a diagnosable mental disorder. Federal officials said the new law would enhance coverage for 113 million people and would likely raise premiums by an average of 0.2 percent. The effective date for most plans is January 1, 2010.

“LIUNA health and welfare funds are among those health care providers who must reassess and redesign their benefits packages over the course of the next year,” says the LHSFNA’s Health Promotion Division Director Mary Jane McArthur, who has worked with local funds on a variety of benefit package redesign assessments. “Along with our consultants, we will assist LIUNA funds as they tackle this new requirement.”

The law overcomes an enduring stigma against mental illnesses whose diagnosis and treatment used to be more uncertain than most physical illnesses. For this reason, employers and insurers were reluctant to provide coverage and did so only with additional fees and constraints. However, in recent decades, mental health science has advanced rapidly, and today, many causes are much better understood. Moreover, employers have realized that help with these disorders can significantly reduce lost work days and so-called “presentee” days, when employees are at work but performing below average due to mental health problems.

With bi-partisan leadership from Senators Pete Domenici (R – NM) and the late Paul Wellstone (D – MN) and prominent support from Betty Ford, Rosalynn Carter and Tipper Gore, the bill made slow but steady progress over the last decade. This year, the House and Senate passed different versions in March and September, respectively, and a breakthrough came when the House agreed to drop a provision requiring insurers to cover any condition listed by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders – a long, all-inclusive list. Under the new law, employers and insurers will decide which conditions to cover, but cannot discriminate in the way covered mental health benefits are paid.

While some critics called mental health parity a pork-barrel addendum and asserted that it did not belong in the financial bailout package, advocates felt the connection was reasonable and fortuitous. “This is really a good fit because of the state of the country,” said David Wellstone, Senator Wellstone’s son who has been an activist on the issue since his father’s death in a 2002 plane crash. “Everybody is nervous, you’ll have more issues with mental health and substance abuse.”  

[Steve Clark]