OneWorld.net (U.S.)

SAN FRANCISCO, Oct 7 (OneWorld) - Tucked away on page 310 of the $700 billion Wall Street bailout bill Congress passed last Friday was a provision mental health advocates have been working toward for over a decade: a provision making it illegal for health insurance companies to discriminate against patients suffering from psychological or behavioral disorders, or those battling addiction to drugs or alcohol.

Minnesota Congressman Keith Ellison (right) chats with David Wellstone, the son of former Minnesota Senator Paul Wellstone, after a press conference about the Mental Health Parity Act in March. © Rep. Keith Ellison (flickr)It became law when President Bush signed the bailout bill the same day.

"This was really, really important," said Andrew Sperling, the legislative director of the National Alliance on Mental Illness, the nation's largest grassroots organization for people with mental illness and their families.

"We expect this to eliminate many barriers to care for people with schizophrenia, bipolar disorders, and other conditions that simply don't exist for those with physical illnesses," Sperling added.

Currently, many employers and group health plans provide less coverage for mental health care than for the treatment of physical conditions like cancer, diabetes, or broken bones. They will need to adjust their benefits to comply with the new law, which requires equivalence, or parity, in the coverage.

"It used to be that the amount of time you could get to see a specialist or therapist for mental health was limited to a small number of outpatient visits, whereas there would be no limit to the number of visits to a physical specialist if it was medically necessary," explained Rusty Selix, who heads up the nonprofit Mental Health Association in California, a state where parity has been the law since the 1990s. "Now, you can't have a limit on the number of therapy sessions unless you have a similar limit for physical specialists."

"After 10 years of debate, Congress has finally agreed to end discrimination in health insurance coverage that plagues persons living with mental illness for so long."
- Sen. Edward Kennedy"The same is true for hospital stays," he added. "A lot of insurance companies would only approve a small number of hospital days for a person with mental illness." Co-payments for equivalent services will also have to be equal, he noted.

Passage of the mental health bill surprised even some of its supporters. One of its original sponsors, New Mexico Senator Pete Domenici, is retiring this year because of a degenerative brain disease. The other original sponsor, former Minnesota Senator Paul Wellstone, died in a plane crash in 2002.

Massachusetts Senator Edward Kennedy, who took up the bill after Wellstone's death, was not able to vote because he is being treated for brain cancer.

The provision's passage owed a great deal to Congress' complicated rules and lawmakers' desire to enact the Wall Street bailout as quickly as possible. Under federal law, all spending bills must originate in the House of Representatives. So when the House voted down an early version of the bailout, Senate leaders went looking for another bill that had already passed the house.

They found one in HR 1424, a version of the mental health parity bill which had passed the House back in March.

"It was partly the arcaneness of our system that it got passed," joked Ron Manderscheid, the Director of Mental Health and Substance Use at the company SRA International. "Some of our leading lights weren't there."

Manderscheid believes the new parity law will help "integrate" mental health care and physical health care together. "Patients are more likely to get better mental care from their primary care physician," he said. "In the long run that physician will have more experience working with mental health specialists and the overall quality of care will improve." 

The new law won't cover everyone. Employers with fewer than 50 employees are exempt from the parity rule and insurance companies aren't bound to provide equal coverage to Americans who buy their health insurance as individuals. And the bill does nothing for the estimated 40 to 50 million Americans with no insurance at all -- at least a third of whom are battling mental illness or substance addiction.

But it will cover millions of people with mental illness. "After 10 years of debate, Congress has finally agreed to end discrimination in health insurance coverage that plagues persons living with mental illness for so long." Senator Edward Kennedy said in a statement. "It will now be the law of the land that people with such illnesses deserve the same access to affordable coverage as those with physical illnesses."