The U.S. Senate and House of Representatives both passed consensus versions of the addiction and mental-health parity bill on Sept. 23, a historic vote that brings the goal of equal coverage for behavioral-health problems closer to reality than ever before.

While tantalizingly close to final passage, however, the recently renamed Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act still faces several significant procedural hurdles before it can be sent to President Bush for his expected approval (the administration this week issued a statement supporting parity).

During an evening session of Congress, the House voted 376-47 to resoundingly approve a standalone version of the parity bill, which bars health plans from imposing any caps or limits on addiction and mental-health treatment that don't apply to other health conditions. The bill does not require addiction and mental illness coverage to be included in health plans, however.

In the Senate, the parity bill was attached to the Renewable Energy and Job Creation Act of 2008 -- popularly known as the "tax extenders" bill because it would extend and add tax breaks for energy conservation and renewable energy projects -- which passed the same night by a 93-2 margin.

"Today, after ten years of stalemate, the United States Senate passed our legislation to require insurance companies to cover mental illnesses and physical illnesses equally," said Sen. Ted Kennedy (D-Mass.), a primary sponsor of the legislation along with Sens. Pete Dominica (R-N.M.) and Christopher Dodd (D-Conn.). "This is a civil-rights issue. With passage of this bill, fundamental justice arrives for millions of our fellow Americans who deal with mental illness. Today, the United States Senate says to them loud and clear, you will no longer have to suffer in the shadows."

"Untreated mental illness results in 1.3 billion lost days of work or school in our country every year. Yet bipartisan and independent research shows there is no significant cost to insuring mental illness like any other medical disease," added House Speaker Nancy Pelosi (D-Calif.), a cosponsor and strong support of the House bill. "With this legislation, we are making an investment in the strength and productivity of our nation."

"We are so close to ending discrimination against those who need treatment for mental illness and chemical addiction," said Rep. Patrick Kennedy (D-R.I.), sponsor of the House legislation.

Rep. Kennedy's somewhat qualified enthusiasm reflects the political reality that the parity bill could still end up unsigned at the end of the current Congress, which is less than a week away from its scheduled adjournment. Because the House and Senate used distinctly different vehicles to approve parity -- a freestanding bill versus an amendment to a larger bill -- final passage is not assured despite Wednesday's vote.

Carol McDaid, principal at Capitol Decisions Inc., and a longtime lobbyist on addiction issues, said that parity advocates could seek a unanimous consent vote to approve the standalone bill in the Senate, but that opens up the possibility that a single Senator could put a hold on the legislation under the Senate rules, which would effectively kill the measure this year.

A safer path would be to win passage in the House as an amendment to the tax-extenders bill, but McDaid said there is some concern that fiscally conservative House Democrats could seek to derail the renewable-energy measure because it does not provide for complete cost-offsets as required under the House's "Paygo" rules. "It looks like we have a better chance with the tax-extenders bill," said McDaid, although she added, "We'll go on any train that's leaving the station."

If the bill fails to pass through either of these vehicles, the final option would be to add parity as an amendment to the continuing budget resolution (CR) -- likely to be the last piece of legislation that Congress will pass before adjourning. With the ongoing crisis on Wall Street it's not impossible that Congress would come back in for a lame-duck session after the November presidential elections, but McDaid and other treatment advocates are determined to get parity to a final vote before then.

"[Tuesday] was a historic day ... I'm very optimistic [about passage] if we keep the pressure on around the message that parity should not be held hostage over a fight on an unrelated bill, and that Congress not adjourn without a vote," said Andrew Sperling, director of legislative affairs for the National Alliance for the Mentally Ill. "We have to get it done this year."