Legislation Falls Short of Goals to Achieve Parity… and May Put Continued Coverage at Risk for Many

You may have heard that at long last Congress passed a new mental health bill. Known as the Paul Wellstone-Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, this long-awaited legislation represents a decade-plus, bi-partisan effort due largely to the efforts of senators Pete Domenici (R)  of New Mexico and Edward “Ted” Kennedy (D) of Massachusetts, both of whom have family members who suffer from mental illness. Its proponents refer to parity for mental health insurance as no less than a civil rights issue, as it looks to treat people with conditions such as depression or schizophrenia or post-traumatic stress disorders the same way we treat those with heart disease or diabetes or cancer. It does deliver a limited form of parity… but as far as I am concerned, this bill offers only the barest of solutions. It is an unfortunate example of good intentions distorted by less benevolent political machinery.

Though representatives in Congress fought long and hard for even this, it’s only an incremental step and more needs to be done, notes James S. Gordon, MD, director of The Center for Mind-Body Medicine in Washington, DC, and author of Unstuck: Your Guide to the Seven-Stage Journey Out of Depression. In his view, this bill fails to address the underlying crisis in our mental health care system. We need a comprehensive, holistic and individualized approach which addresses the underlying physical, mental, social and spiritual processes that produce disease, he said, adding that this approach should be central to prevention as well as treatment to ensure that all Americans have access to the right kind of care.


In an earlier attempt, a 1996 law barred insurers from setting lifetime caps on mental health care that are lower than for other forms of health care. Insurers weaseled around this provision by charging higher co-payments and setting limits on how many mental health visits they’d cover each year. Also, treatment for substance abuse was not covered.

The new law will require group health plans of 51 or more employees to cover mental illness — including substance abuse — on an even par with physical ailments. When the bill passed, it was widely assumed that the 113 million Americans with access to employer-sponsored insurance would benefit from the legislation, which takes effect October 1, 2009. It sounds like a positive step to help individuals with mental and emotional challenges — unfortunately, the reality falls short.


On the surface, there are positive aspects to the new mental health bill. It forbids insurance plans from demanding higher co-payments for mental health care or setting higher deductibles or limiting doctor visits or covering fewer days of hospitalization for mental illness and substance abuse than for physical illness. Yet there is a long list of loopholes employers can slip through to avoid covering mental health care, which end up nullifying the bill’s effectiveness…

  • The law does nothing for people who work for companies with 50 or fewer employees, or those Americans who have no health insurance at all.
  • Under the new bill, if a company chooses to cover both physical and mental illness, it must do so at an equal level — but they’re free to opt out of or discontinue mental health coverage altogether. No incentive entices employers to offer mental health insurance and no penalty exists to dissuade employers from canceling it.
  • Plans can vary in the mental illnesses and types of substance disorders they cover. For instance, a company may choose to cover alcohol abuse but not drug addiction.
  • Companies may apply for a one-year exemption if their total insurance costs rise by more than 2% once mental health care coverage is added. This merely puts off an inevitable cost increase for the employers, and may boost the odds that the company will reduce or discontinue mental health care coverage in its entirety.
  • The increased corporate health care expense for this added coverage will likely trickle down to employees as they push the higher health insurance premiums down to the employee contributions.


A major problem with this bill is that it benefits a group already lucky enough to have insurance that covers mental health, Dr. Gordon observes. Their coverage may get even better — if you see a therapist, co-payments may be lower when the new law goes into effect, and limits on the permitted number of annual therapy visits and days that are covered for psychiatric hospitalization should be lifted (or at least raised to the level covered for physical illness). But if you don’t currently have coverage for mental health, nothing will change.

Dr. Gordon points out that ultimately, we have to look at the bigger picture. The current approach to mental health care and insurance still involves a practice he finds problematic, which he describes as “keeping everything in separate diagnostic silos.” A diagnosis code — for psychosis, for depression, for obsessive-compulsive disorder or whatever — gets assigned and the care plan unfolds from there. In reality, however, every aspect of physical health has an impact on mental health, just as your mental and emotional state affect your physical well-being. For example, stress can accelerate risk and disease development for virtually every physical and mental ailment, so it is important for people to learn healthful ways to control stress levels before they get sick, notes Dr. Gordon. We need to look at health in a more holistic way that emphasizes not only treatment but prevention — for mental health as well as physical health. This bill is a well-intentioned effort that will likely end up doing more harm than good. We clearly still have a long way to go.