In a major victory for addiction treatment and recovery advocates, the U.S. House of Representatives has passed a bill that would mandate that insurers cover addiction and mental illness on par with other illnesses.

"We've waited 12 long years for this historic day," said Rep. Jim Ramstad (R-Minn.), co-chair of the Congressional Addiction, Treatment and Recovery Caucus with Rep. Patrick Kennedy (D-R.I.). "I am grateful that the House has taken this important step to end the discrimination against people who need treatment for mental illness and chemical addiction." Ramstad, who is retiring from the House, cosponsored the parity bill with Kennedy, who said he hoped passage of the legislation "will help to erase the stigma associated with mental illness and substance abuse."

The House voted 268 to 148 in favor of H.R. 1424, the Paul Wellstone Mental Health and Addiction Equity Act, rebuffing attempts to substitute a version of parity legislation previously approved by the Senate generally considered by advocates to be weaker than the House legislation. The House bill received critical support from Speaker Nancy Pelosi (D-Calif.), who appeared at a pre-vote rally on the steps of the Capitol and spoke in favor of the measure during the floor debate on March 5. Pelosi said that ensuring that Americans have equal access to addiction and mental-health treatment has economic benefits and also would benefit returning veterans.

"Illness of the brain must be treated like illness anywhere else in the body," said Pelosi, who called the Wellstone Act "a comprehensive bill to help end discrimination against those who seek treatment for mental illness."

Parity supporters sought -- and received -- a strong bipartisan vote in favor of the bill to back their case for adoption of the House legislation in negotiations with the Senate, which passed the Mental Health Parity Act of 2007 by unanimous consent on Sept. 18. 2007.

Congress Needs Meeting of Minds

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.

"The Paul Wellstone Mental Health and Addiction Equity Act of 2007 is the right solution to ending insurance discrimination facing people with alcohol and drug problems and their families," said Merlyn Karst, chair of the Faces & Voices of Recovery Board of Directors. "We urge the Congress to come together and hammer out the differences between the strong bill that the House passed today and the Senate-passed version of the parity legislation, S. 558."

Pat Taylor, executive director of Faces and Voices of Recovery, said that while there are "significant differences" between the two bills, "we think they can be worked out." Unlike the Senate bill, for example, the House legislation requires that out-of-plan addiction and mental-health treatment be covered by insurers if plans do so for other illnesses, and that insurers include coverage of all illnesses listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the "bible" of the mental-health field. That's the same standard used in the Federal Employees Health Benefits Plan.

"I think we may have some Senate Democrats who had supported the Senate bill now come out in support of the House bill," said Dave Wellstone, son of the late senator from Minnesota and a parity advocate for the group Wellstone Action. Wellstone predicted that Congress would reach a compromise on parity that "looks a little more like the House bill" than the current Senate legislation. "There are better patient protections in the House bill and the costs are the same, so there's no need, in my mind, to pass a weaker bill just because that's what insurers want," he said.

The Bush administration, the U.S. Chamber of Commerce, and some health insurers are among the opponents of the House legislation, although Bush has not threatened to veto the measure. The trade group America's Health Insurance Plans (AHIP) has supported the Senate bill, sponsored by Sens. Edward Kennedy (D-Mass.) and Pete Dominici (R-N.M.) but not the House bill.

"Health insurance plans support the bipartisan mental-health parity legislation (S. 558) that passed the Senate by unanimous consent because it is a balanced approach that would preserve access to health plans' medical management and quality improvement programs," said Karen Ignagni, president and CEO of AHIP. "Unfortunately, the House legislation would turn back the clock on advances in the quality of care and impose excessive costs on patients and employers. Though well-intentioned, this legislation would undermine the progress that has been achieved in improving behavioral-health benefits through coordinated-care strategies."