No one was happier than Hazelden's William Cope Moyers on Oct. 3 when a great victory for people seeking help for alcohol and other drug addiction was announced as part of the federal government's financial rescue package.

On that day, President George W. Bush signed into law the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. The bill essentially puts care for addiction and mental illness on equal footing with other medical and surgical conditions.

Shortly after getting word of the Act's passage, Moyers issued an email to staff at Hazelden, where he is executive director of the Center for Public Advocacy. "It took almost 13 years of hard work and perseverance, but today Hazelden's commitment to expanding access to treatment through private health insurance finally achieved the ultimate result," Moyers wrote. "...Today Hazelden celebrates the success of our mission to help people who need help. Thank you for being part of this effort. Thank you for honoring this mission."

Indeed, the new law was the result of a mission-driven goal, one that probably will not yield significant patient census gains for Hazelden, but one that will clearly expand access to care for the broad spectrum of people seeking addiction and mental health treatment. The legislation is a victory for all who advocate for fair and equal treatment of alcoholics and addicts everywhere.

Moyers expressed his gratitude to a long list of parity supporters. Topping that list was the late Sen. Paul Wellstone, a Democrat from Minnesota and namesake of the bill, and Rep. Jim Ramstad, a Republican from Minnesota. Wellstone died in a plane crash with his wife Sheila and their daughter Marcia on Oct. 25, 2002 in northern Minnesota. Wellstone and Ramstad were avid supporters of parity from the get-go in the 1990s and sponsored early legislative attempts to end discrimination in coverage for addiction and mental illness. Their advocacy became a lightning rod that sparked grassroots action among people in recovery nationwide. After Wellstone's death, David Wellstone, Paul's son, took up his father's charge, working tirelessly for parity.

Wellstone was the 'father of parity'
"If Paul were here today, he would have given me one of those trademark Wellstone slaps on the back in celebration," said Ramstad. "I thought of him every day I worked on parity. Paul deserves the credit--he was the true father of parity."

Ramstad was equally responsible for parity, and as a grateful recovering alcoholic, parity's passage meant the world to him. He calls parity the most significant legislation of his Congressional career. "Definitely, this is my signature piece of legislation," said Ramstad, who is retiring at the end of this year after 18 years in Congress. "Parity was not just another public policy issue. It is a matter of life or death for the millions of Americans who stand to benefit from this critical legislation. The bill de-stigmatizes addiction and mental illness, because diseases of the brain will now be treated the same as diseases of the body."

Moyers and Ramstad also praised Sen. Pete Domenici (R-N.M.) and Rep. Patrick Kennedy (D-R.I.), more recent champions of parity. Kennedy and Ramstad sponsored the House version of parity, while Domenici led the charge in the Senate.

Credit was due to a wide range of advocates, including Faces & Voices of Recovery, a group that provided a strong grassroots push for parity; the Alliance for Addiction Recovery; the Association of Addiction Professionals; the National Association of Addiction Treatment Providers; and Carol McDaid, a lobbyist who has represented Hazelden and a consortium of treatment providers in the fight for parity. "It was a total team effort," said Ramstad. "I could easily list more than 1,000 supporters."

"It was the collective voices of thousands of constituents, including many dedicated Hazelden alumni, who pushed parity over the finish line," said Moyers. "Those many faces and voices of recovery helped to humanize the face of addiction."

What the Act covers
Under the new Act, 113 million people across the country will have the right to non-discriminatory addiction and mental health coverage, including 82 million individuals enrolled in self-funded plans who previously lacked parity protections. The new law requires co-pays, deductibles and annual and lifetime caps on addiction and mental health benefits to be the same as those for medical and surgical benefits. If an employer with more than 50 employees chooses to provide coverage for addiction, then it must do so on the same basis as it does for other conditions. The law does not require insurance plans to cover addiction and mental health benefits, but 93 percent of large employers currently provide such coverage. The law, which takes effect Jan. 1, 2010, does not apply to plans with 50 or fewer employees.

"Parity is not the end all," said Moyers. "But it is a major step toward expanding access to treatment and recovery by requiring employers and insurance companies to help people the same way they help people with diabetes, heart disease, cancer and other illnesses. We anticipate that more people will get help, because insurance will now cover addiction and mental health conditions more fully."

A step toward reducing the unmet need
Just how many more people will access treatment as a result of parity legislation is unknown. But given the many barriers to care--the stigma, shame, denial, and limited third-party reimbursement for care associated with addiction--any measure to ease the path to recovery is a victory. Each year the National Survey on Drug Use and Health documents the unmet need of addiction treatment. According to the 2007 study, 23.2 million people 12 or older needed treatment for an illicit drug or alcohol use problem, but only 2.4 million (or 10 percent) of those people received treatment at a specialty facility (defined as hospitals [inpatient only], drug or alcohol rehabilitation facilities [inpatient or outpatient], or mental health centers) in the past year.

Parity will likely provide the greatest gains in outpatient treatment, predicts Moyers. It will be far more beneficial to the overall field than for many Twelve Step residential programs like Hazelden, he adds. Moyers said there will be a process over the next two years in which treatment providers, consumers and insurance companies will learn how to apply the new requirements. He said treatment providers will have to push hard when it comes to applying benefits to services, and consumers will need to push back harder when insurance companies provide obstacles.

Ramstad is quick to point out that the Congressional Budget Office predicts that health care premiums will increase by only 0.2 percent with parity, and the cost benefits will be immense. "Over 10 years, the legislation will save the American people as much as $550 billion," he said, "because there will be fewer prison cells occupied, decreased health care costs, and billions of dollars saved in lost productivity."

'Bipartisan disease, bipartisan approach'
Utilization and the cost benefits of increased access to care will be measured in the future. What is clear now, however, is that parity represents a huge civil rights victory for addiction and mental health.

"The passage of parity shines a bright light into a dark corner of health care," said Moyers. "Addiction is a bipartisan disease and deserves a bipartisan approach. It's an illness that reaches across both sides of the aisle in Congress."

Indeed, each of parity's Congressional sponsors had a deep personal connection with addiction or mental illness. Wellstone had a brother with severe mental illness, Ramstad is a grateful recovering alcoholic who got sober in 1981, Domenici has a daughter with mental illness, and Kennedy is in recovery from alcohol and other drug addiction.

'An important first step'
"The victory of parity was an important first step in ending discrimination against individuals in treatment and those seeking treatment," said Helen Taws, director of Hazelden's Center for Public Advocacy. "The victory also substantiates the need to develop and position a 'voice' for the field of addiction in the discussion on health care reform with a new administration in Washington, D.C. Addiction treatment must be a part of that conversation. While much work remains to ensure that individuals can fully access the addiction treatment benefits to which they are entitled, Hazelden and the field is now in a better position than ever before to advocate for the needs of individuals needing help for addiction to alcohol and other drugs."

The Center for Public Advocacy is taking the lead by sponsoring a forum on Dec. 9 to develop collectively a "voice" that can represent the field of addiction in health care reform. Parity marks the culmination of 13 years of hard work, and, as Taws suggests, it opens the door for greater advocacy in the years to come.

"Beginning in 1996, when the first parity bill was introduced in Congress, to as recently as the week before the law was signed, when Hazelden board members and senior staff were on Capitol Hill in a final push for parity, Hazelden has never wavered in its support for parity," said Moyers. "Parity represents progress at work that will continue. The Center for Public Advocacy will work to advance Hazelden's mission through public education, public policy and public benefit so that all who seek recovery are able to access it, and we will continue our pursuit of overcoming the stigma of addiction."

--by Marty Duda

Published October 17, 2008