Bipartisan friendships have not been on display in Washington, DC of late, but a recent event there showed how two committed advocates for consumers battling mental health and substance use disorders are letting neither their retirement from Congress nor their partisan affiliations stop them from achieving their goal.

Former Congressmen Patrick Kennedy (D-RI) and Jim Ramstad (R-MN) joined together to announce nationwide hearings on the federal law that requires equal treatment for behavioral health and physical health (the Mental Health Parity and Addiction Equity Act, or the parity law for short). The two, who were avid supporters of the bill before its passage, plan to visit at least 10 states in 2012 with more visits planned in 2013.

Both men have been candid about their struggles with addiction. Ramstad has been in recovery for nearly three decades and became Kennedy’s Alcoholics Anonymous sponsor in 2006 after Kennedy sought treatment. Their goal is to make parity a reality by publicizing how behavioral health is still treated differently than physical health, improve enforcement of the parity law and reduce the stigma surrounding brain diseases.

What is the parity law? The law, passed by Congress in 2008, bars most health plans that offer mental health and substance use disorders benefits from putting restrictions in place that don’t apply to physical health benefits. These restrictions typically fall into two categories: quantitative (e.g., visit limits or cost-sharing requirements that differ from physical health) and non-quantitative (e.g., rules governing hospital admissions that are stricter than physical health). Currently, many insured patients who enter the emergency room needing treatment for a behavioral health issue do not receive appropriate, timely care because of difficulty negotiating with insurance companies.

Although the parity law doesn’t require any health plan to cover mental health and substance use disorders conditions, it is the first of a two-part effort to ensure consumers battling behavioral health illnesses can get the care they need. Part two is the Affordable Care Act (ACA), which lists mental health and substance use disorders as Essential Health Benefits, required for health plans participating in the Exchanges as well as for consumers newly eligible for Medicaid.

The ACA also expands the reach of the parity law by requiring coverage of these benefits in the same manner as other covered medical and surgical benefits for all health plans in the Exchanges, as well as those newly eligible for Medicaid.

So, if the law passed in 2008, what’s the problem? There are a few hold-ups. The regulations implementing the parity law have not been finished. The parity law is governed by three cabinet departments – Health and Human Services, Labor and the Treasury. While the law is currently enforceable, final regulations are required to ensure health plans and states understand the rules by which they must abide. More importantly, insurers must be held accountable for compliance that can only be achieved through educating the key players about the parity law: hospitals, doctors, businesses, insurers, state and local government officials, and, of course, consumers.

Mr. Kennedy and Mr. Ramstad’s road show is an excellent opportunity for stakeholders to explore parity in their state and address the stigma surrounding mental health and substance use disorders. For the current list of cities and dates, click here.

What can advocates do? Advocate for robust mental health and substance use disorders benefits by educating state officials and encouraging them to choose an Essential Health Benefits benchmark that incorporates existing state mental health and substance use disorders mandates. Most states will chose a benchmark by September 30 that will be the benefits blueprint for health plans offered through the Exchange.

There are 10(!) possible options for each state. By choosing the plan with the most consumer-friendly mental health and substance use disorders state mandates, advocates can go a long way toward advancing access for people in need of behavioral health services.

— Tom Emswiler, Policy Analyst