Vidhya Alakeson on parity for US mental health patients

Buried in last week’s legislation to bail out Wall Street was a small but important victory for healthcare in America. At the same time as passing a $700 billion rescue package for the financial sector last Friday, the US House of Representatives also passed a bill on mental health parity. Rumour has it that parity was added to the bail-out bill as a sweetener for reluctant House members.
By the time the parity bill arrived on the floor of the House, it had become heavy with symbolism, and that was even before it became embedded in the wider bail-out legislation. The bill was dedicated to Paul Wellstone, a senator and strong advocate for mental health who died tragically in a plane crash in 2002, and it was championed by a unique father-son team –  Ted Kennedy in the Senate and Patrick Kennedy in the House. With Ted Kennedy now seriously ill, there was a new sense of urgency attached to getting parity passed.
Mental health advocates have been fighting for parity legislation for well over twenty years.  The new legislation means that private insurers, if they offer mental health and substance use benefits, cannot place different conditions on those benefits than they do on physical health benefits, for example copayments or treatment limitations.
For a long time, parity was resisted because the assumption was that it would lead to a dramatic escalation in healthcare costs because demand for mental health treatment was infinite. To a large degree, this assumption was rooted in out-dated notions of mental illnesses as conditions with no scientific or physiological basis.
The path to securing last week’s parity legislation began in 1999 when President Clinton mandated parity in the Federal Employees’ Health Benefits Program, the collection of health plans that cover all federal employees, including senators and members of the House of Representatives. A study that looked at the impacts of parity found very modest increases in costs, largely because parity had been implemented hand in hand with managed care. This eliminated the business community’s main objection to extending parity to the wider insurance market but it took another 10 years to get there.
Earlier this year, Congress closed another loophole in mental health access to mental health services by passing a separate bill that introduced parity in Medicare, the federal health insurance program for all Americans over the age 65. Prior to that, anyone accessing mental health services under Medicare was forced to pay for half the costs of treatment, compared to only 20% of the costs for physical health treatment. Unsurprisingly, many older Americans on low incomes went without treatment, often ending up in hospital as a result.
Now that America has mental health parity, advocates can turn their attention to other issues. This is particularly important in the context of health reform under the new administration. Without parity, the entire mental health focus would have been on the benefit package – what mental health and substance use services were covered and with what restrictions. Now advocates can focus on other issues that affect the quality of life of people living with mental health conditions, such as access to good quality physical healthcare.

Vidhya Alakeson is a former Harkness fellow.