In the forefront of advocacy

by Communications Staff

November 6, 2008 — A full mental health parity law—one of the few substantial health care reforms of the last decade — is the result of years of hard work by practicing psychologists and other mental health and health advocates. By successfully combining grassroots advocacy, direct lobbying on Capitol Hill and political giving, the American Psychological Association Practice Organization (APAPO), along with a broad coalition of organizations, was crucial in achieving victory.

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 is the culmination of a long legislative history of mental health parity. The APAPO was central in crafting the language of the law and in leading a coalition of groups that supported this legislation.

Legislative efforts to achieve mental health parity began as early as 1993, when the Maryland General Assembly passed parity legislation. Within a few years similar laws were enacted in Rhode Island, Maine, New Hampshire and Minnesota. However, state-level parity laws could cover only a small portion of people in each state.

U.S. Senator Pete Domenici (R-NM) introduced the first federal parity bill in 1992, but it proposed parity only for a small list of severe mental illnesses.

The first national-level parity measure passed the Senate in 1996, sponsored by Senators Domenici and Paul Wellstone (D-MN). Psychology's advocates successfully made the case that limiting protections to just certain diagnoses would merely codify discriminatory treatment of insureds in the health insurance marketplace.

The new full parity bill in the Senate would have prohibited insurers from imposing restrictions on financial requirements and treatment limits related to insurance coverage for mental disorders that were different from limits on physical illness.

The measure passed the Senate as part of insurance portability legislation, but was dropped in negotiations with the House. Instead, a limited version that prohibited only discriminatory annual and lifetime dollar limits was passed and signed into law late in 1996.

The Mental Health Parity Act of 1996 contained loopholes exploited by insurers to significantly weaken parity protections afforded by the law. In 2001, Senators Domenici and Wellstone introduced more comprehensive mental health parity legislation that had majority co-sponsorship in both the House and Senate.

Staff for the APAPO worked to expand support for the bill beyond traditional health and mental health groups by reaching out to and winning endorsements from education, social service, law enforcement and faith community organizations. However, insurance and business organizations again blocked this bill in the House.

With the death of Senator Wellstone in 2002, Senator Edward Kennedy (D-MA) stepped in as lead co-sponsor of the legislation. Although mental health parity was introduced during the 2003 and 2004 sessions and earned co-sponsorship by a majority of senators and representatives, the same opponents of the 2001 legislation blocked these later bills as well.

By 2005, key Senate staffers and other mental health organizations turned to the APA Practice Organization to engage critics and supporters of mental health parity in detailed negotiations regarding the framework of a new parity bill. Staff and consultants for the APAPO demonstrated they had the comprehensive legal knowledge of existing statutes and of the economic costs and benefits of mental health parity.

Combined with their negotiations skills, this wealth of knowledge enabled the APAPO's representatives to bring together opponents and advocates of parity legislation.

Early in 2007, Senators Domenici, Kennedy and Mike Enzi (R-WY) unveiled compromise legislation that took a pragmatic approach of avoiding the most controversial features of the earlier bill that had been blocked repeatedly. The APAPO gathered support from over 200 groups nationally, including allies in mental health and related fields, as well as from employer and insurer organizations that had previously opposed mental health parity.

The APAPO also rallied psychologists to demonstrate their strong support for mental health parity legislation. The annual APA Practice Organization State Leadership Conference provided a venue for psychology leaders from throughout the United States to advocate for parity in face-to-face meetings with their members of Congress and staff.

In addition, members utilized the Legislative Action Center to send their elected officials on Capitol Hill approximately 40,000 email messages supporting parity legislation in 2007 and 2008. They augmented the emails with countless calls to congressional offices.

Government Relations staff for the APAPO credit members' participation in grassroots advocacy as a crucial factor in the passage of parity legislation. Another key factor involved psychologists' donations to AAP/PLAN, psychology's national political action committee. Thanks to these donations, APAPO lobbyists attending fundraising events for members of Congress had strategic opportunities to reinforce the message that passage of parity legislation this year was essential.

And the messages — from lobbyists, grassroots psychologists, staff for the APA Practice Organization and other parity supporters — got through. On the eve of Congress adjourning for 2008, the nation gained an historic full mental health parity law.