As meaningful as the journey toward comprehensive insurance parity legislation proved to be for the mental health community, it could be argued that the struggle for equity was even more pivotal for addiction treatment providers and advocates. After all, no one ever doubted that any attempt to extend parity beyond the scope of a limited 1996 federal law would cover mental illnesses, but the addiction community routinely would hear terms such as “deal breaker” used to describe addiction's potential inclusion in any legislation.
“I never would have thought after Sen. [Paul] Wellstone told me they were going to have to cut us out of the first parity act in 1996 that I'd now be celebrating arm in arm with mental health advocates,” says Carol McDaid, principal of the lobbying firm Capitol Decisions, Inc., and the chief parity advocate representing the addiction field.
McDaid, whose clients include two nationally known addiction treatment centers, the American Society of Addiction Medicine, and the marketers of the alcohol dependence medication Vivitrol, receives the most individual credit in the addiction advocacy arena for preserving addiction's place in the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. But in general, field leaders believe the interests of addiction treatment and recovery were well served—and probably protected for some time—because of participation from a broad coalition that included treatment professionals and individuals in recovery.
“I think this issue transcended the individual interest of either the recovery community or treatment organizations,” says Ronald J. Hunsicker, DMin, president and CEO of the National Association of Addiction Treatment Providers (NAATP). “This was a basic civil rights piece of legislation. It is not going to put money in the coffers of treatment organizations—it is just the right thing to do.”
Moreover, the cooperative efforts of groups that have not always worked in harmony received a further boost from the openness of two high-profile persons in recovery: U.S. Reps. Patrick J. Kennedy (D-R.I.) and Jim Ramstad (R-Minn.), the House's lead sponsors of parity legislation. Treatment and recovery community leaders say these House members' willingness to share their own stories of addiction and redemption unleashed a flurry of storytelling that humanized the issue of insurance discrimination for members of Congress reluctant to impose coverage mandates.
“If I had a dime for every time a member of Congress referred to [Kennedy or Ramstad] as a profile in courage, I'd be wealthy,” McDaid says. She refers to their consistent presence in the parity debate as “a walking, talking destigmatization commercial.”
Mobilizing average citizens
For a recovery community whose efforts in the public-policy arena often have been held back by a reluctance to go public with personal accounts, a strong presence in the parity discussions on Capitol Hill was no small feat. The mobilization efforts spearheaded by the group Faces and Voices of Recovery have received much credit for keeping congressional leaders focused on parity legislation during its many ups and downs.
“We had benefited from treatment, and we wanted to see it happen for others,” says Tom Coderre, who was Faces and Voices' national field director for the past two years and became the Rhode Island State Senate's chief of staff this month.
Faces and Voices took an approach heavy on collecting and sharing information about people's treatment experiences. It established an insurance discrimination registry, discovering that some individuals had not even stopped to consider that they had been discriminated against when they were denied access to a treatment program because of their insurance coverage's terms, Coderre explains. He says people tend to blame themselves rather than see that they are not being treated fairly.
More than a dozen hearings conducted by Kennedy and Ramstad across the country in 2007 gave voice to the recovery stories of both average citizens and the two House members themselves. Many of these stories were repeated routinely during the debate on Capitol Hill, opening lawmakers' eyes to addiction's insidious influence in all walks of their communities.
Sometimes the advocacy community targeted a specific legislator at a key juncture. Learning that Sen. Jim DeMint (R-S.C.) was considering blocking a Senate plan to pass parity under unanimous consent provisions, recovery advocates identified and enlisted a DeMint supporter in recovery who, because of his community standing, had not been public about his battle with addiction. The community leader agreed to speak with DeMint, and soon the concern about a hold on the bill subsided.
“You can never underestimate the power of one individual,” notes Coderre.
Or the power of hundreds, as advocates and House switchboard operators found out. The field conducted several call-in days during the past two years, leading to unprecedented levels of participation in the recovery community. One such event last spring was particularly memorable for McDaid.
“When [House Speaker Nancy] Pelosi's health policy person tells me in March, at the time when they're trying to schedule a vote on parity, to ‘call off the dogs,’ that's what I'm looking for,” McDaid recalls. “While some would argue that you don't want to annoy legislators, I believed that to have gone through this for 12 years and to lack money and media, you had to make up for it in grassroots voices.”