Former Congressman Patrick Kennedy testifies at a Massachusetts hearing on mental health parity. (Courtesy of Scott Bryson) Mental health “parity” is officially a done deal. Congress passed a law back in 2008 requiring health insurers to treat mental health on a par with physical health, covering care for mental illness and addiction no less than they cover physical care. Many states have also passed their own mental health parity laws. So why has former Congressman Patrick Kennedy of Rhode Island — lead sponsor of the 2008 bill together with his late father, Sen. Ted Kennedy — spent much of the last couple of years criss-crossing the country to advocate for mental health parity? Why did he feel the need to come to a Massachusetts Division of Insurance hearing this week to push parity yet again? You could find the answer at the hearing itself. It came from Benedetto Mitrano, who testified that his drug-addicted son, Michael, had been through several treatment programs, but died in August. "Insurance always refused to pay for one reason or another," Mitrano said. "He was never 'sick enough.' My son is dead. Is he sick enough for them now?"

He was never 'sick enough.' My son is dead. Is he sick enough for them now?"

And from Dr. Matthew Mostofi, a Tufts Medical Center emergency physician who compared two patients from his previous night's shift, one with appendicitis, who was treated quickly, and one who was suicidal, and had to wait many hours for care, held up by insurance requirements: "Both have emergency medical conditions," he said. "If you look at these two patients, which is more life-threatening? The fact of the matter is, this depressed suicidal patient has a higher mortality [risk] than the patient with appendicitis, and yet this is the one that we delay and make wait, and I believe illustrates disparity." And from Trudy Avery, who fought to get her insurance carrier to pay for her son's addiction treatment: "What is written on paper and what actually occurs are two different things," she said. Therein lies the rub. Though mental health parity is the law of the land, the federal government has not yet issued its final regulations translating the law into practice, so it cannot be actively enforced. In the wake of the Newtown shooting, the Obama administration pledged to issue those final rules, but they are still not out. Some can wait no longer. Class action lawsuits alleging violations of the parity law have been filed in California and, just this month, in New York. The New York State Psychiatric Association accuses insurer UnitedHealth Group of limiting actively suicidal patients to just one psychotherapy session a week, among other denials, Psychiatry News reports. Former Congressman Patrick Kennedy (YouTube/NAMI) Meanwhile, around the country, many states have been moving forward to decide for themselves how to enforce parity — hence the Massachusetts hearing, and Kennedy's presence. (Listen to an excerpt of Kennedy speaking in the sound file at the bottom of this post.)Massachusetts is gathering public comment on proposed parity rules through April 5, and Kennedy says that given the state's leadership in health reform, what it decides will serve as an important bellwether for other states. "You are where the rubber hits the road," Kennedy told the commissioners presiding at the hearing. If Massachusetts is any indication, several points of contention on parity rules arise: • Is there a problem? How can you know? Talk to psychiatrists who deal daily with insurers, and they'll likely tell you that parity is a fiction. ("It's not even good fiction," notes Dr. Steve Schlozman, a psychiatrist at Massachusetts General Hospital. "Good fiction has an arc and a satisfying resolution. This is more like a lousy 70's sit com, over-using the same tired themes and hijinks. The problem is, we're powerless to change the station.") But health insurers question whether there's a problem. Lora Pellegrini, president of the Massachusetts Association of Health Plans, said in a phone interview: "Our plans set a high priority on ensuring access to high quality and appropriate behavioral health care, and I think we demonstrate that through our national quality scores." Patient satisfaction ratings are high as well, she said. The association also pointed to state statistics that show that mental health care visits have been rising for the last several years, and that the existing Office of Patient Protection gets few formal complaints about denials of mental health coverage. Those mental health complaints, however, are the most common sort of complaint the patient-protection office receives, emphasized Matt Selig, executive director of Health Law Advocates, a non-profit law firm that helps low-income consumers denied access to health care.

We don’t want any more than physical health care, but we demand no less.