National Alliance on Mental Illness
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National Legislation

The 1996 Domenici-Wellstone Mental Health Parity Act (MHPA) was a first step towards recognizing the discrimination that exists in most healthcare policies, that discrimination is wrong, and that calls out for corrective action in health-benefit design by eliminating lifetime and annual financial caps. These caps had often been used to deny our members insurance coverage for necessary treatment. The result was that our members most commonly had to rely on the public mental health system. The MHPA set standards that apply nationally, including to ERISA self-insured plans.

Unfortunately, the compromises that were necessary to pass this legislation meant that many important measures for truly equal coverage had to be surrendered.

  • For example, it is still perfectly legal to charge onerous co-pays for all services for mental illnesses and to restrict the number of hospital days and outpatient visits without regard to the patient's condition.
  • The law does not apply to companies of fewer than 50 employees, and no company has to meet this standard if they opt out of offering mental health coverage altogether.
  • Additionally, any company can request a waiver if the cost of parity exceeds more than one percent of the plan's healthcare costs.

Fortunately, efforts are underway in Congress in 2001 to expand the MHPA to reach full parity. The Mental Health Equitable Treatment Act (S. 543) was introduced in March 2001 by Senators Domenici and Wellstone.


S. 543 would:

  • provide to all insured Americans similar parity coverage to that in the Federal Employees Health Benefit Plan (FEHBP) – the program covering 9.5 million federal workers and their families (including members of Congress).
  • In addition, S 543 eliminates the October 1, 2001 sunset of the MHPA and lowers the small business exemption to firms with 25 or fewer workers, expanding parity coverage to an additional 15 million people.

NAMI enthusiastically supports S 543 and urges all senators to support this historic legislation by cosponsoring it. S. 543 is core to NAMI's mission so that the next generation will not have to live out their lives on disability or in public institutions, unable to get the very care that would give them back productive lives.

Insurance discrimination enforces the invalid message that mental illnesses are "untreatable" and "hopeless." The effort to end insurance discrimination received a major boost in December 1999 with the release of the U.S. Surgeon General’s Report on Mental Health which documents the scientific evidence that treatment is effective and concludes that there is no justification for health plans to cover treatment for serious brain disorders such as schizophrenia and bipolar disorder differently from any other disease.