Mental health parity for insurance coverage became law in the state of Washington in March 2005 when Governor Christine Gregoire signed the bill passed by both houses of the legislature. This was the culmination of an eight-year effort by a coalition of dozens of organizations representing clinicians and consumers. The Seattle Psychoanalytic Society and Institute (SPSI) played an active role from the beginning, starting with our decision to hire Laura Groshong to be our lobbyist in Olympia in 1997. Groshong is a social worker, trained in psychoanalysis, who combines clinical practice with part-time work as a lobbyist.
With remarkable persistence over eight years, she helped organize a network of lobbyists from all the mental health organizations in Washington as well as the state medical society. This network developed relationships with state legislators and educated them over time to the needs of our patients. It included organizations representing psychoanalysts, psychotherapists, psychiatrists, psychologists, social workers, physicians, consumers, and many others. In the last three years this coalition grew to include 126 different organizations. The coalition hired a well-known and charismatic former Seattle politician who energized the effort, largely by speaking publicly and often of his own bipolar disorder and its successful treatment.
When we started in 1997, Groshong told me, one legislator said to her that people didn't need mental health treatment; they needed religion. After eight years of work, many state legislators rose in the recent debate to speak openly of the mental health treatment from which their relatives had benefited, and some even spoke of the treatment they personally had received.
This law almost did not happen. Many observers believe it only passed now because for the first time in many years, both houses of the legislature have Democratic majorities and the governor is a Democrat. However, those majorities are both very slim, and Gregoire's margin of victory in a highly contested election was exactly 129 votes!
Naturally, compromises were necessary. Each of the seven mental health organizations represented by lobbyists in Olympia had its own priorities. The psychologists and psychiatrists certainly had different positions on prescribing privileges. In weekly meetings the seven lobbyists agreed in the first few months to set these differences aside in order to pursue the common goal of mental health insurance parity. It took several more years to come to agreement on exactly what to ask for in a new statute. Then Ron Bachman, a consultant who had worked on parity in 30 states, was brought in. He had the statistics to counter the message from the insurers and business interests that mental health care was too costly to be included as a mandated benefit. Agreeing to limit the mandate to companies with more than 50 employees was one way to keep the costs down. In the end, according to PricewaterhouseCoopers, this law will add only 0.5 percent to the premiums of most workers.
The coalition that formed to urge passage of this law has already decided to remain in existence for three more years in order to monitor the law's implementation. We understand that protecting mental health coverage will require a long-term, coordinated effort.
The final law requires companies with more than 50 employees that have group insurance for their employees to provide the same coverage for all DSM-IV diagnoses as they provide for any other medical condition. This means that mental health benefits can still be managed, but only if medical benefits are managed at the same level. The likely implementation will involve an increase in the covered number of outpatient sessions a year, especially for Axis II diagnoses, to a figure as high as 50-60 a year.
The new rules will be phased in over five years. Beginning in 2006, policies that cover medical and surgical services must cover mental health services as well, and co-payments and co-insurance for mental health services must be the same as those for other medical services. By 2008, limits on out-of-pocket expenses (stop-loss) must be identical. By 2010, policies must have the same limits for mental health services as they have for other services. Mental health care and other health care will no longer have separate deductibles.
Of course, the final result will be determined by the way the regulations implementing this law are written. The coalition that formed to urge passage of this law has already decided to remain in existence for three more years in order to monitor the law's implementation. We understand that protecting mental health coverage will require a long-term, coordinated effort.
Although the state of Washington, since it insures itself, is not required to comply with this law, it has announced that it will. Some large self-insured corporations, like Boeing and Microsoft, are also expected to yield to pressure to comply with the new rules. The new law will not affect those with individual policies, and, of course, it will not help the state's 750,000 uninsured. In the end, however, it is estimated that 1.6 million Washingtonians will see an improvement in their mental health insurance coverage.
Michael Gundle, M.D., is a training and supervising analyst at the Seattle Psychoanalytic Society and Institute, where he currently serves as director.