MENTAL HEALTH advocacy groups are applauding a new law that is designed to end insurance discrimination against people with mental illnesses and addictions.

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, included in the economic bailout bill that President Bush signed into law Oct. 3, is expected to bring improved mental health insurance benefits to about one in three Americans. The result of a passionate 12-year battle by mental health advocates, including families and friends of people with addiction disorders and mental illness, the law requires health insurance plans that offer mental health coverage to provide it at the same coverage level as medical and surgical services.

"This long overdue legislation will not only benefit the millions suffering from mental illness and addiction by making it easier for them to access care, but will also make great strides in reducing the stigma and discrimination they experience," said APHA Executive Director Georges C. Benjamin, MD, FACP, FACEP (E).

The law "augurs well for future efforts at health reform," said Ralph Ibson, JD, vice president of government affairs for Mental Health America.

"What we think is particularly significant about this law and its passage this year is the extent to which the process brought together the business and insurance community and mental health advocacy groups, so that rather than having proponents and opponents, there was an effort to find a way to achieve a common goal," Ibson said. "I tend to view this not solely as a health insurance reform, but as advancing parity as a metaphor, as laying a foundation for advocacy around the idea that mental health should be approached with the same urgency as for other serious health conditions."

Public health advocates expect the new law -which for most health plans becomes effective Jan. 1, 2010--to open doors to treatment for a broad spectrum of conditions, including eating disorders, autism, schizophrenia, depression, and alcohol and drug addiction. According to Mental Health America, the law is projected to provide parity protection to 113 million Americans, including 82 million people enrolled in self-funded plans regulated under the federal Employee Retirement Income Security Act that are not subject to state mental health parity laws. Existing stronger state parity laws will be permitted to trump the federal requirements, policy experts said. However, only a handful of states -including Connecticut, Maryland, Minnesota, Oregon and Vermont--have comprehensive parity laws that apply to all mental health and substance abuse disorders under private insurance plans, with no exemptions.

According to the National Institute of Mental Health, about one in four adults in the United States suffers from a mental health disorder in any given year. However, about 67 percent of adults and 80 percent of children who require mental health services do not receive help, in part because of discriminatory practices that include higher co-payments and stricter limits on mental health benefits imposed by most insurers.

The new law signals that the mental health and substance use care fields are "coming of age," said APHA member Ron Manderscheid, PhD, director of mental health and substance use programs for the Constella Group in Rockville, Md.

"Most Americans now recognize that mental and substance use conditions are illnesses like any others and need to be considered as such by the insurance industry and health care providers," Manderscheid said.

Specifically, the new law requires that deductibles, co-pays, co-insurance, out-of-pocket expenses, visit and day limitations, and innetwork and out-of-network benefits must be offered on the same footing for mental health and substance use conditions. However, the law does not apply to companies that employ 50 or fewer workers, and employers who provide mental health and substance use coverage will not have to comply with the parity standard if their costs go up by more than 2 percent in the first year or rise by 1 percent in succeeding years. …