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06.27.09

Clothed in dress pants, sundresses and fancy shirts, 106 people walked down the center aisle of the Detroit Rescue Mission Ministries auditorium Friday to celebrate a new beginning

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PRO-ACT receives 2009 Joel Hernandez Voice of the Recovery Community Award! Learn more...

 

The Recovery Bill of Rights

is a statement of the principle that all Americans have a right to recover from addiction to alcohol and other drugs. Learn more…

 

Campaigns: Addiction Recovery Insurance Equity

Victory! Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 signed into law

On October 3, President Bush signed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 into law as part of the Emergency Economic Stabilization Act (HR 1424). The law will begin to end the insurance discrimination facing people with addiction and mental illness.

The victory came after years of advocacy that picked up its pace over the last two years under the leadership of Representatives Jim Ramstad (R-MN) and Patrick Kennedy (D-RI) in the US House of Representatives. They were joined by the House and Senate leadership and Senators including Pete Domenici (R-NM), Edward Kennedy (D-MA), Mike Enzi (R-WY) and Christopher Dodd (D-CT) in providing the Congressional leadership that led to final passage.

Recovery advocates across the country were joined by David Wellstone, son of the late Senator Paul Wellstone in countless Call-in Days, email campaigns, visits with members of Congress at home and in Washington, DC and media outreach to tell the story of insurance discrimination. This victory would not have been possible without your tireless advocacy and the efforts of allied organizations across the country.

What does this victory mean?

When the law goes into effect on October 3, 2009, group health plans that offer coverage for addiction and mental illness will be required to provide benefits in the same way as they offer them for all other medical and surgical coverage. That means that they will no longer be able to impose different limits on inpatient days or outpatient visits or require higher deductibles or cost sharing when people are seeking treatment for addiction or mental illness than for other covered medical and surgical procedures.

The victory also means that the voices of the organized recovery community and our allies were heard more than ever before in our nation’s capitol. Today, more people in Washington, DC and across the country know about the reality of recovery from addiction and that there is an organized constituency that is advocating on behalf of recovery.

What will the law do?

The law applies to all group health plans with 51 or more employees. It will cover 82 million individuals in self-insured employer health plans that are not governed by state parity laws and another 31 million in plans that are subject to state regulation.

  • State Laws: It protects and preserves State laws that provide greater protection than the federal law
  • Out-of-network coverage: It extends out-of-network coverage for substance use disorders and mental illness where there is out-of-network coverage for medical and surgical conditions
  • Medical necessity criteria: It requires that medical necessity criteria and reasons for any denials of reimbursement be available to participants and beneficiaries upon request

Faces & Voices will be providing more information about the law in the coming months. If you’d like to read the law, click here.

Recent updates

Parity: What Does The New Law Mean?

Jim Ramstad capped his 18 years in Congress with one last visit to the Oval Office, where President Bush signed a document representing the Minnesota Republican's life work: a legacy bill opening the door to treatment for millions of Americans suffering from mental illness or chemical addiction. Learn more...

November 17, 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Celebration powerpoint

Parity legislation helps people with mental illness More than one in four Americans will suffer a mental or addictive disorder at some point in life. Lawmakers have now granted them a level playing field in health insurance. Learn more...

The long-held dream of parity in behavioral healthcare is now a reality: The U.S. House of Representatives voted 263-171 to approve the Wall Street bailout bill, which includes a provision that mandates parity coverage for addiction and mental-health care, and President George Bush swiftly signed the measure into law...learn more

Two years ago last May, Jim Ramstad, a veteran congressman from the suburbs of Minneapolis-St. Paul, paid a quiet visit to a colleague whose drug abuse...learn more

Congress is within a whisker of passing a sound and fair-minded bill to require that group health insurance coverage for mental illness and substance abuse be provided...learn more

Sign-on letter to Members of Congress asking for action on insurance discrimination in September 2008. Learn more...

September 24, 2008: On Tuesday, the US House and US Senate voted on the "Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act...learn more

September 17, 2008: Join us on September 17 at 9:30 am for a rally on Capitol Hill...learn more

September 10, 2008: Thanks to everyone who called in on September 10th! Learn more...

August 11, 2008: Meet with your member of Congress over recess and ask them to end insurance discrimination! Learn more...

July 30, 2008: The US Senate failed to pass a bill that included the compromise bill that has been negotiated by the House and Senate by a vote of 51 to 43. To see how your Senator voted click here. Former First Ladies Betty Ford and Rosalyn Carter wrote to Senate leaders supporting passage of the bill.

July 1, 2008: Although House and Senate leaders have not decided yet where they will find nearly $4 billion over 10 years to pay for the cost offsets required by Congressional rules, negotiations have successfully concluded on the key policy provisions.  This compromise is the result of long negotiations and advocacy of organizations all across the country. The compromise includes many key provisions that were included in the House-passed bill, the Paul Wellstone Mental Health and Addiction Equity Act and would be an important step in ending insurance discrimination facing people with addiction and mental illness. Here are some key points in the compromise:

  • The compromise requires parity in insurance coverage for addiction and mental health treatment for both in-network and out-of-network coverage.  This does not mean that the bill requires that insurers cover addiction and mental services, only that if they do cover these services, there must be parity with medical/surgical benefits.  This of course would be a very positive development both in requiring fairness in insurance coverage and taking a strong stand against discrimination toward people in recovery or still suffering from addiction and mental illness.

  • The compromise requires plans to disclose their medical necessity criteria and reasons for any denials of coverage.  This would be a major breakthrough, as many plans refuse to disclose medical necessity criteria or reasons for denial, especially when addiction treatment is sought. 

  • On the issue of protection of state laws, the compromise bill language is silent.  The House bill explicitly protected state laws, and in earlier versions the Senate bill explicitly preempted state laws.  Silence is a victory for those of us who agree with the House approach that state laws should be protected, since in most situations Congress must take explicit action to overrule a state law in order for state laws to be preempted.  However, to make protection of state laws even more ironclad, we will be working to ensure that the legislative history of the bill makes clear that the sponsors’ intention is to protect all state laws.  That way, as important as the passage of a federal parity law would be, stronger state laws would remain in effect and states would be free to enact additional stronger protections in the years to come.

March 6, 2008: The U.S. House of Representatives passed the Paul Wellstone Mental Health and Addiction Equity Act by a bipartisan vote of 268-148. The Senate passed its version of the bill, the Mental Health Parity Act of 2007, by unanimous consent in September 2007 (click here to see a comparison of the two bills). The two houses of Congress will now need to meet and reach a compromise on parity if the legislation is to move swiftly toward a vote in a legislative calendar shortened by the presidential election season. We will keep you updated about future advocacy opportunities to help end insurance discrimination.

US House passes Paul Wellstone Mental Health and Addiction Equity Act!


(Representatives Jim Ramstad, Patrick Kennedy, Nancy Pelosi, Steny Hoyer, former First Lady Rossalyn Carter and David Wellstone rally for passage of the Wellstone bill in front of the U.S. Capitol Building)

Press coverage

Check out recently published Letters to the Editor and Editorials from recovery advocates around the country!

Check out recent news coverage from around the country!

What is Insurance Discrimination?

Most health plans continue to impose limits on how much treatment is covered or more costly financial requirements on mental health and addiction care than on care for other health conditions, discriminating against people seeking help for addiction.

Equal coverage for drug and alcohol treatment and recovery support services would require health insurers to provide coverage at the same level as for other chronic, relapsing disorders such as diabetes and hypertension. Discriminatory policies require individuals and their family members to pay higher deductibles and co-payments and receive less coverage for number of visits, days of coverage, and annual or lifetime dollar limits for treatment.

Four states have comprehensive parity for addiction for all citizens – Connecticut, Maryland, Minnesota, and Vermont. Seven other states require some lesser level of coverage. The Alcohol Policy Information System lists the different coverage offered for each state.

All Federal employees have parity under the Federal Employee Health Benefit Plan, the largest employer-sponsored health program in the country, covering 9 million federal employees, their families, and retirees.

Recent studies have shown that the economic benefits of treating people with addiction outweigh the costs. Researchers found that the benefits outweighed the costs seven-fold, because of increased job earnings and reduced costs related to crime and imprisonment. They also found reduced costs for emergency room visits, outpatient care and residential care.

Greater public attention and understanding

Representatives Kennedy and Ramstad, co-chairs of the Congressional Caucus on Addiction Treatment and Recovery have been holding field hearings across the country (Read testimony from the New Jersey Field Hearing on February 26th and testimony from Deirdre Drohan Forbes and Thom Forbes from the New York Field Hearing on March 16th) with allied members of Congress to bring the stories of the toll of insurance discrimination and the hope of recovery to their communities and the media. The well-attended hearings have received great coverage in the media and mobilized advocates for insurance equity.

New calls for insurance reform

For years Representatives Ramstad and Kennedy have fought for equal treatment of mental illnesses and addiction in health care. Bipartisan majorities in the US House of Representatives have supported their efforts to enact the Paul Wellstone Mental Health and Addiction Equity Act since 2002. Unfortunately they were never able to bring the bill to the floor of the House for a vote because they were blocked by the Republican House leadership.

The chances of passing meaningful insurance reform are improving:

  • A 2006 Institute of Medicine report called for laws requiring insurers to offer the coverage that is needed for high quality, comprehensive health coverage for addiction.
  • The use of addiction treatment paid for with employer-based health insurance has declined significantly over recent years – taxpayers are footing the bill for over 75 percent of treatment today. From 1992 to 2001, the percentage of people who used employer-based health coverage to pay for treatment dropped 23 percent.
  • HBO’s show ADDICTION, set to air March 15, 2007, will show the impact of unfair insurance laws on families who have lost their children to addiction.

Faces & Voices of Recovery and the fight for insurance equity

Faces & Voices of Recovery believes that everyone has a right to be free from addiction, regardless of the particular path taken. We know that recovery from addiction to alcohol and other drugs is real for millions of Americans and tens of thousands more get well every year. That’s why our Right to Addiction Recovery platform calls for “a healthcare system that fully addresses the medical needs of people with addiction to alcohol and other drugs and provides a recovery continuum of care,” calling for public and private insurance that provides access to coverage equivalent to other medical conditions.

Talking about insurance discrimination

Most Americans have no idea about the discrimination that people with addiction and their families face when they’re trying to get help. That’s why we need to let our friends, neighbors and opinion leaders know:

  1. What insurance discrimination is and means
  2. What insurance equity will mean

Here are some ways to talk about this critical issue with your friends and neighbors:

  • Insurance discrimination denies people with addiction the same insurance protection as people with other health issues.
  • As a result of this discrimination, many are unable to get the treatment and recovery support services necessary to achieve long-term recovery.
  • We must ensure that appropriate recovery support services and treatments are available to those who need them.
  • It is crucial, therefore, that we stop insurance discrimination, which denies people with addiction from getting the same protection as people with other health issues.
  • I am living proof that people can recover from addiction and make a better life for themselves and their families, but I would not have been able to do it without help and support.
  • Unfortunately, many people are not so lucky. Many are denied access to services because their insurance companies will not pay for it or are not required to cover it.
  • Insurance discrimination for those who need help to recover from addiction needs to end and that is what we are fighting to do.

We will be sending out more information about the proposals for insurance equity and opportunities for you to weigh in to support an end to addiction recovery insurance discrimination!

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