Mental Health Parity and Addiction Equity

Act of 2008
by Darryl S. Inaba, PharmD., CADC III

On Friday, October 3, 2008 the US House of Representatives approved the Emergency

Economic Stabilization Act of 2008,

On Friday, October 3, 2008 the US House of Representatives approved the Emergency

Economic Stabilization Act of 2008 [HR 1424]. The media focused on the $700 billion “bailout”
package designed to salvage the nation’s economic crisis and few Americans noticed the Mental
Health Parity and Addiction Equity Act of 2008 [HR 6983], that was one of the 20 attached bills
that President Bush quickly signed into law a few days later (1).

For those of us in the Substance Abuse Treatment Community, the Parity and Equity Act
generated more interest than the “bailout”. David Wellstone, son of the late Senator Paul
Wellstone, who championed the Parity and Equity Act with Senator Pete Domenici (R. NM),
was ecstatic. He noted that his father was one of the advocates of this legislation and had fought
12 long years for this moment after the 1996 passage of the Mental Health Parity Act.(2)

I believe that the battle to mandate treatment benefits for addictive disorders that are comparable
with those provided for other chronic persistent medical disorders actually began in earnest 20
years ago. In 1987, psychiatrist Lewis L. Judd was named Director of the National Institute of
Mental Health (NIMH), a post he held until 1990. (3) During Dr. Judd’s tenure he was
instrumental in moving forward President George HW Bush’s Proclamation 6158, designating
the 1990s as the “Decade of the Brain.” (4) Six years later, Dr. Judd’s leadership resulted in
Senators’ Wellstone and Domenici’s championship of the Mental Health Parity Act which was
signed into law by President Clinton in 1996. The Act banned discriminatory practices by
insurance and health care providers from applying lower annual and lifetime spending limits for
mental health treatment services. At NIMH, Dr. Judd provided the medical validation for this to
occur through a three point strategy: prevalence, costs, and de-stigmatization of the mental
illness. NIMH was able to demonstrate that more Americans experience some type of mental
health disorder during their lifetimes than those who will experience a major physical illness like
diabetes, heart disease, cancer or hypertension. Next, it was demonstrated that mental illnesses
cost the American economy more losses than all physical illnesses. Finally, new medical
technologies like brain imaging made it possible to objectively diagnose mental disorders
thereby disproving the concept that symptoms of these conditions were merely improvised by
those claiming to suffer mental illness. Unfortunately, much stigma still exists that symptoms of
mental disorders are conjured up by unethical or lazy individuals to avoid basic life
responsibilities. Through these efforts, Congress had to accept mental disorders to be biological
conditions just like other medical diseases. As jubilant as Dr. Judd was at the passage of the
Mental Health Parity Act of 1996, I was angered that it had excluded Substance Use Disorders
and in some ways it was passed at the expense of substance use disorders. Dr. Judd
acknowledged this but quickly pointed out that the huge stigma of mental illness in our society
was much less than the stigma that exists regarding addiction. So much so that the Bill would not
have had any chance of passage if it included substance abuse disorders in 1996. He then
stressed the need for all to now work with Senators Wellstone and Domenici on a substance
abuse parity act.

Dr. Judd’s projection of public stigma regarding substance use disorder is validated by the fact
that it has taken 12 years since the Mental Health Parity Act to accomplish the enactment of the
Mental Health Parity and Addiction Equity Act. This is especially disappointing since the
“Decade of the Brain” actually demonstrated addiction and alcoholism to impact more
Americans during their lifetimes than even mental health disorders. In fact, it revealed that
Substance Use Disorder is America’s number one public health problems resulting in more
deaths and medical complications than any other illness. Addiction also results in greater costs to
American economy than mental illness and physical illness. Significantly, the discoveries during
the “Decade of the Brain” validate chemical dependency, like mental disorders, results from
neuro-cellular, neuro-chemical, and neuro-functional brain differences in those affected. It is
biology and not a matter of intent or will power that robs an addict of their ability to control their
use of substances, and further; this biological difference then conspires to get addicts using again
when they try to stop.

Over the next dozen years, efforts on a federal substance abuse parity act morphed into the
Mental Health Parity and Addiction Equity Act to include provisions that address loopholes in
the original Mental Health Parity Act along with the establishment of equity for addiction
treatment. The bill moved so slowly through congress that several states enacted their own
substance abuse parity acts. By 2008, only Iowa and Wyoming had no parity provisions for
substance abuse treatment, most states had some parity regulations while Connecticut, Maryland,
Minnesota, Oregon and Vermont had the best parity laws. (5) Though most states had enacted
their own parity acts, these still seemed to have minimal impact on treatment utilizations maybe
because of vast differences between each state’s law and various loopholes that enabled
insurance companies to still set some discriminatory limits for mental health and substance abuse
treatment.

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008
includes substance abuse treatment provisions and adds to the original Mental Health Parity Act
of 1996 by banning differences in co-pays, deductibles, coinsurance, out of network coverage,
out-of pocket expenses and various treatment limitations like caps on visits, limits on days, or
limits on duration of treatment for mental health or addiction therapy. (6) Though buried in the
Emergency Economic Stabilization Act of 2008, passage of the Mental Health Parity and
Addiction Equity Act may prove to be the single most important occurrence in the history of
chemical dependency treatment. Hopefully, it will start to erode the tremendous gap between
treatment resources and those who want or need treatment for their substance use disorder by
making such resources readily accessible through health insurance coverages. In addition, I
sincerely hope that passage of this vital act will finally begin to reduce the great stigma about
addiction and about those who are most vulnerable to its devastation.

The chemical dependency treatment community and those with substance use disorders owe a
debt of gratitude to the late Senator Paul Wellstone, his son David, Senator Pete Domenici, and
especially to Dr. Lewis Judd for their combined passions, perseverance, and their deep
dedication to ending the discrimination in the treatment of mental health and addiction disorders.

Darryl S. Inaba, PharmD., CADC III

October 2008

References

1. Emergency Economic Stabilization Act of 2008

http://www.opencongress.org/bill/110-h1424/ show accessed 10/8/08).

2. (Frommer, F. (2008), After 12 years, Wellstone mental health parity act is law, Associated
Press http://minnesota:publicradio.org/display/web/2008/10/303/parity_finalpassage/ accessed
10/8/08)

3. NIMH during the tenure of Director Lewis L. Judd, M.D. (1987-1990): the decade of the brain
and the four national research plans http://www.faqs.org/abstracts/psychology-and-mental-
health/NIMH-during-the- tenure-of-Director-Lewis-L-Judd-MD-1987-1990-the-decade-of-the-
brain-and-the-four-na.html accessed 10/8/08)

4. Project on the decade of the brain (July 17, 1990), Presidential Proclamation 6158
http://www.loc.gov/loc/brain/proclaim.html accessed 10/8/08)

5. What have states done to ensure insurance parity (2008), Mental Health America, updated July
2008 http://www.mentalhealthamerica.net/go/parity/states accessed 10/8/08)

6. Mental health parity & addiction Equity is now law (Oct. 8, 2008), Occupational Health &
Safety http://ohsonline.com/Articles/2008/10/8-Mental-Health-Parity-Act-is-Now-Law.aspx?p=1
accessed 10/9/08)

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