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Parity at last

November 1, 2008
by Douglas J. Edwards, Editor-in-Chief
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Business and insurance groups' support was key to its passage
U.S. rep. patrick kennedy (d-r.i.) speaks at a parity rally in washington, d.c., on september 17
U.S. Rep. Patrick Kennedy (D-R.I.) speaks at a parity rally in Washington, D.C., on September 17. Charles Votaw Photography

An advocate's work is never done.

After last month's historic House vote that sent the mental health and substance use parity bill to President Bush's desk, supporters across the field began rejoicing. As people came together in impromptu celebrations, Pamela Greenberg, MPP, chair of the Coalition for Fairness in Mental Illness Coverage, was still hard at work, writing a press release about the important victory.

“It was the adult decision,” she jokes, admitting she was very tempted to join in the immediate get-togethers.

Greenberg's and many, many others' long fight for parity finally was realized on October 3, when Bush signed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, part of the $700 billion financial bailout package.

The new federal parity law applies to Medicaid managed care plans, State Children's Health Insurance Programs, and group health plans with more than 50 employees that provide mental health and substance use benefits. Under the new law, health plans' financial requirements for mental health and substance use benefits can be no more restrictive than financial requirements for most medical and surgical benefits. This includes co-pays, co-insurance, deductibles, out-of-pocket expenses, and annual and lifetime limits (the latter having been established with the 1996 parity law). The law does not mandate coverage for mental health or substance use care or for specific conditions.

While the legislative ins and outs that lead to parity will be analyzed for years to come (Greenberg says it surely will be the topic of someone's dissertation), one thing is quite clear immediately: The behavioral healthcare field would not have achieved this victory without the business and insurance communities' support.

“This bill passed in large part because of them, so they deserve the recognition, too,” says Greenberg, who is also president/CEO of the Association for Behavioral Health and Wellness, representing managed behavioral healthcare organizations (MBHOs), as well as a member of Behavioral Healthcare's Editorial Board.

Support from the other side

For years the business and insurance communities were opposed to parity legislation. But senators working for its passage invited them to the negotiating table—a game-changing moment.

“As contentious as it was within the field, the decision by the Senate to build a coalition and negotiate directly with the business and insurance communities was probably the turning point,” says Chuck Ingoglia, vice-president of public policy and practice improvement at the National Council for Community Behavioral Healthcare. “We finally then had an ability for us to sit down with our biggest opponents and come up with a bill that is pretty darn good.”

E. Neil Trautwein, chair of the ad hoc coalition representing business and insurance interests in the parity discussions, says being included definitely helped bring them onboard: “That process of working with the Hill, working with the advocates, helped build confidence, made this into a shared enterprise, and ultimately led to full-fledged coalition support for the bill.”

Parity milestones

May 12, 1992 Federal mental health parity legislation is first introduced. Various parity bills will be introduced during the next 16 years.

1993 to 1994

Congress debates President Clinton's health plan, which includes a phase-in of full parity by January 1, 2001. The plan is not passed.


The Coalition for Fairness in Mental Illness Coverage is formed, which represents consumers, family members, health professionals, and healthcare systems and administrators in parity negotiations.

September 26, 1996

Clinton signs the Mental Health Parity Act of 1996, which requires parity for only annual and lifetime dollar limits.


Clinton directs the Federal Employees Health Benefits (FEHB) Program to institute mental health and substance use parity, which takes effect January 1, 2001.

April 29, 2002

President Bush endorses parity.

October 25, 2002

Sen. Paul Wellstone (D-Minn.), a strong supporter of parity, dies in a plane crash.

July 23, 2003

President's New Freedom Commission on Mental Health endorses parity.

December 12, 2005

National Business Group on Health issues report that supports voluntary parity.

July 15, 2008

Congress overrides Bush's veto of the Medicare Improvements for Patients and Providers Act of 2008, which over 6 years phases out the 50% co-pay for mental health ambulatory care under Medicare Part B.

October 3, 2008

As part of a financial industry bailout package, Congress passes the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which Bush signs the same day.

October 3, 2009

Parity law regulations are due from the Departments of Health and Human Services, Labor, and Treasury.

January 1, 2010

The legislation takes effect for most group health plan members.

Sources: Pamela Greenberg; Mental Health America; Sundararaman R, Redhead CS. The Mental Health Parity Act: A Legislative History. Congressional Research Service. July 18, 2008.