A chance encounter on a New Hampshire public-radio station helped pave the way for a successful alliance between addiction and mental health advocates, resulting in a new health-insurance parity law.
In the face of major political opposition, advocates for addiction treatment in New Hampshire recently succeeded in passing a bill that calls for limited parity for treatment of alcohol and other drug addictions. New Hampshire Gov. Jeanne Shaheen — herself a supporter of mental-health parity when she served in the state Senate — signed the bill last week.
The measure requires insurers to offer inpatient and outpatient addiction care, but allows caps to be set on the number of visits and annual costs of treatment. It also requires parity for a full range of mental-health conditions, closing gaps in a previous mental-health parity law.
Even limited parity for addiction was a distant dream when John Bunker, president of the New Hampshire treatment and prevention advocacy group New Futures, sat down in 2000 for a radio talk-show appearance with psychologist John Phillips, Ph.D., a board member of the New Hampshire Psychological Association (NHPA). “That's when we were introduced to New Futures, and we later met with them to discuss common issues,” recalled Kirsten Singleton, executive director of NHPA.
One of those common interests was parity coverage for mental health and addiction. Mental health advocates in New Hampshire had previously succeeded in getting a partial mental-health parity bill signed into law, but wanted to go back to the legislature with a measure that would ensure that eating disorders and post-traumatic stress disorder were covered. To the surprise of some, advocates found themselves in agreement that addiction treatment also should be included in the follow-up legislation.
“We had a lot of therapists say that their patients are co-morbid, with both addiction and mental health conditions,” recalled Singleton. “There were some people who said let's just get the bill passed, but a majority of the coalition were true supporters of substance abuse.”
“When we introduced the bill in January 2001 a lot of lawmakers wanted substance abuse out, but the mental-health community was adamant about keeping it in,” Singleton continued. Working together under the banner of Partners for Parity, addiction and mental-health advocates contacted lawmakers, mobilized their grassroots supporters, and together raised $30,000 for a study to refute claims that parity would be too expensive for employers and insurers.
“This was the first time we came together and worked together,” said Joe Harding, executive director of Friends of Recovery New Hampshire (FOR-NH), an advocacy group comprised of people in recovery from addiction. “They couldn't have done it without us, and we couldn't have done it without them … We had some significant connections in the legislature and they did too; they have memberships and we also had that. The combined force of those connections and advocates meant that we got the legislation passed.”
The Power of Grassroots Advocacy
Singleton credited FOR-NH and New Futures for their strong grassroots advocacy, making hundreds of phone calls to lawmakers and appearing before legislative committees to give personal testimony. Meanwhile, mental-health clinicians put their professional authority behind addiction research, driving home the message that addiction is a brain disease and a “real” diagnosis.
Even a trimmed-down measure might not have passed without the efforts of the grassroots addiction-treatment supporters, acknowledged Singleton. “They were really there at the hearings, especially when clinicians had a hard time getting out of work on short notice,” she said.
One of the addiction community's key allies in the New Hampshire legislature was Sen. Lou D'Allesandro, a Manchester-area lawmaker and past director of the National Council on Alcoholism and Drug Dependence's New Hampshire chapter. “Joe and his group were very influential,” said D'Allesandro. “They were able to get people here and talking to [policymakers],” he added, saying that treatment advocates gave “compelling testimony” about the need for parity.
“It's an issue you need to get high visibility on, work the individual legislators, say it's cost-effective, and that treatment works,” said D'Allesandro.
With insurers like Cigna claiming that addiction parity would cause premiums to balloon, advocates attacked the cost issue on a number of fronts. First, Partners for Parity spent $30,000 on a PriceWaterhouseCoopers report that showed the cost of full parity would only amount to 50 cents per plan member per month. Parity backers also pointed out the numerous cost savings associated with addiction treatment, such as reduced hospital and prison expenditures.
“If there isn't any treatment, then the result is prison, and our prisons are bulging at the seams,” said D'Allesandro. “If you get someone into treatment, even if there's only a 50-percent success rate, those that go the other way are saving the state $25,000 a year in prison costs.”
That message reached not only legislators, but the ears of the governor, as well. “National studies show that each dollar invested in treatment saves $4 to $7 in social costs,” said Pamela Walsh, press secretary for Shaheen. “Eighty percent of people in New Hampshire prisons have a substance-abuse problem, and investing in treatment and prevention can save on prison costs. The insurance costs are minimal, especially when compared to the savings.”
Still, the Republican leadership in the New Hampshire legislature opposed the bill when it was introduced, and sent it to the conservative Finance Committee, headed by Rep. Neal Kurk. “The bill was referred to the committee by the House leadership thinking it wouldn't be very receptive, but a year later they passed it on a 17-0 vote,” said D'Allesandro. “The reason was they heard from grassroots constituents about the impact of the problem, that there are solutions, and that they need insurance coverage to address their problems.”
A Partial Victory, But Promise for the Future
The victory was also the result of compromise: full addiction parity became partial parity, with few guarantees about coverage limits. “The bill leaves it up to insurers to define the level of benefits, but legislators said the benefit has to be something substantive or they will readdress the issue,” said Harding.
In the end, the parity bill passed relatively easily in the House, which approved the Senate version of the legislation in a 187-140 vote. Support was bipartisan in both the House and Senate. “Legislators voted against their own leaders, and that's pretty impressive,” said Singleton.
Still, addiction advocates are not entirely satisfied. “I see the impact being the removal of one more obstacle to treatment,” said Tess Gomes, project director for Manchester's Demand Treatment! project, a Join Together supported effort to increase demand for addiction services in communities.
“We're cautious because we know that this isn't the golden ring,” said Gomes, whose project goals include making employers and employees more aware of the need for addiction treatment. “We realize that this is partial parity and there are no minimums required of insurers or employers. They can negotiate $500 in benefits if they want.”
Added Gomes: “It's a step in the right direction, but unless we have fuller parity, we still need to work on education of employers and getting the support of the community to say this is an issue and we want this, just like we want two weeks' vacation. We'd like to build on this law to work with employers and chambers of commerce, to talk to them about how parity affects them, to hear their viewpoints and open a dialogue, and educate them about the benefits of addiction treatment.”
As they work on future strategy, both addiction and mental-health advocates agree that the parity battle has forged some important new partnerships that should benefit constituents in both communities. “Even if we're not completely satisfied, the root system just got expanded,” said Gomes.