It’s taken 7 years to get to this point, but it appears that with the passage of a House bill that calls for mental health parity. What is mental health parity? Well, it’s simple really — treating mental health disorders as equals to other medical ailments. Insurers have long treated the two as distinct, separate concerns that are covered (or not covered, as is so often the case) in vastly different ways.

Now both the U.S. House and the U.S. Senate have passed mental health parity bills. The two very different bills must now be reconciled in a committee:

Both bills bar insurance plans from charging disparate deductibles and co-payments for mental-health services compared with other medical benefits. They also prevent plans from placing more stringent treatment limits on mental benefits than they do for other care. Both versions apply to group insurance and employer plans with at least 50 beneficiaries, not smaller businesses or the individual insurance market.

The House and Senate differ over which mental disorders insurers would have to cover and how the new federal requirements would interact with state laws, among other provisions.

Some are up in arms because the House version of the bill, like many House versions of bills, is more liberal than the conservative Senate version. That’s fine, as these things are usually worked out in a compromise in committee.

Stuck in both plans is an easy out, however: a good ol’ “Cost Exemption” clause. This clause basically says that mental health parity need not apply to any health plan if the costs of providing mental health parity exceed 2% in the first year, or 1% in any subsequent year. In other words, we like mental health parity as long as it doesn’t cost us anything. The minute a health plan actually has to start providing increased mental health services (1% more!), mental health parity apparently need not apply for a subsequent plan year. I suppose this is some sort of standard clause in such legislation, to ensure companies don’t go bankrupt in trying to adhere to new government regulations. But it still seems like it’s an easy way to be exempt from the law year after year simply by showing that the provision of mental health services will result in a 1% cost increase of providing the health plan.

In fact, the most striking component of both bills is how the majority of the text in both is centered around the exemptions from mental health parity.

One of the other significant differences between the two bills is that the House version would also specifically cover substance-abuse disorders (which are a form of mental disorders, but often found in their own category), while the Senate bill would not. Apparently it would still be okay to discriminate against those people who are grappling with a substance abuse problem.

I have to say this is progress, but it is slow and painful process to watch.

Sort of how they make sausages.

The Wall Street Journal has the story: House Moves Closer to Mental-Health Bill (I think the headline editor made a mistake, because the article clearly states the House passed the legislation; now it’s up to Congress as a whole to reconcile the two versions of the bill).

Dr. John Grohol is the CEO and founder of Psych Central. He is an author, researcher and expert in mental health online, and has been writing about online behavior, mental health and psychology issues -- as well as the intersection of technology and human behavior -- since 1992. Dr. Grohol sits on the editorial board of the journal Cyberpsychology, Behavior and Social Networking and is a founding board member and treasurer of the Society for Participatory Medicine.

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Mental Health is Medicine’s Second Fiddle - World of Psychology (3/26/2008)

    Last reviewed: By John M. Grohol, Psy.D. on 6 Mar 2008
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