When Congress approved the $700 billion rescue plan, it also passed one of the most significant mental-health bills in U.S. history the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. It requires group insurance plans to cover mental illnesses the same way as physical ones (no more higher co-pays, deductibles and limits on hospital stays). For more than a decade, Senator Peter Domenici pioneered the fight for such legislation. Last year, the 76-year-old Republican announced he suffers from a degenerative brain disease and would not seek another term. One of his final votes led to the bill's long-awaited passing. TIME spoke with Senator Domenici about the legislation's history, the state of mental health care in the U.S. and his hopes for the future.Why do you think there is such a difference in the way insurance companies cover physical illnesses like heart disease and mental illnesses like schizophrenia?
First of all, it's pretty easy to see that people kind of frown on mental illness. If your neighbor has a heart condition, it's, "Gee, poor Jane, she has to take care of her husband." But if the neighbor has a manic-depressive son, you're kind of mad at them because the kid misbehaves. Unless you're a very, very considerate neighbor that's gotten close to the family, you can't quite understand why Johnny can be such a mean little child, why he does dangerous things. Well, the mom next door gets pretty frustrated, she doesn't know what to do and pretty soon, Johnny's in jail.
Parity of insurance is almost a civil-rights issue. We take care of people with heart trouble, we operate on them, we have great learning centers where we study all there is to know about the heart. And insurance companies have paid for all those surgeries. And yet, if you have schizophrenia, which is an illness of the brain instead of the heart, because we started off early on saying it wasn't an illness, we kept it and they wouldn't let us change it.How did you feel when you found out the bill had finally passed?
You know, I'm going to be dead-honest with you, it dragged on so long that I didn't act like I normally would have. I wasn't like me. I [usually] get excited, passionate, but I didn't have any of those feelings because I was thinking it can't be real. It was more like, "It's finally over." It got so close and yet so far so many times. It's amazing, not only because we got it done, but because, for a nation, it has taken us so long.
Even in America in 2008, there are more people who are housed in jails that have a mental illness than there are facilities with trained help that were built to take care of them. By virtue of the fact that nobody else is going to do it, most police departments know that they're going to have them in their custody so they now train police in how to deal with the mentally ill. But it's all makeshift compared with what was intended when the Kennedy commitment was made way back yonder when he said let's open up these dungeons, where we had the mentally ill housed like beasts, and let the country build local facilities to treat them. America still hasn't faced up to it.
One of your major allies has been the advocacy group The National Alliance on Mental Illness (NAMI). Tell me about how you first got involved with them.
The Alliance has been the instrument of many, many good things. Our daughter was 17, going on 18, when she began showing symptoms of [schizophrenia]. We started stopping by their meetings after work and we quickly found out that, in spite of us having a child who had problems, there were so much more serious ones than ours. We ran into parents with two children who are schizophrenic, and they tried desperately to keep them at home and take care of them, and they went broke and the kids are in jail. That's when I first started finding out about the issue, how parents were losing control of their children physically, and they were in jails because there wasn't any place to put them ultimately. If it's some average worker trying to find a place for their kid to spend a week or something for treatment and medicine, it's pretty damn expensive.
This bill targets insurance plans that cover more than 50 employees. About 113 million people, we figure, are in group insurance plans that have, as part of their health care, mental health coverage. All of those, now, will have imposed on their insurance policy by operation of law that the insurance company will pay for mental health treatment in exactly the same way they cover physical ailments the same amount of days in the hospital, the same amount of co-pay, and all the other technical words will be equal. And that's not what it used to be, and not what it is today. Insurance companies were already moving in that direction, but now we've made it so they can't slide backwards.
How do you think perceptions, both in Congress and among your constituents, have changed since you first introduced this issue in 1996?
Now when I'm finished with a speech and I'm mingling around even if the meeting were oil and gas operators in Dallas, Texas almost always somebody will come up and say, "Hey, keep with it, Pete, I've got a nephew..." Or, "My uncle Billy had this..." In other words, it is more prevalent than you think. Out of almost any crowd somebody will tell you a story about their family. Those kinds of things are always coming up. Even President Bush spoke to me personally and very eloquently about it. He said, "You don't have to convince me, I'm over that hurdle." Every time we got close [to passing the bill], he'd ask about it.
Strangely enough, when I would speak to this among a group of Senators, it took more time than I thought to get some of them to come up and join me and say, "I want to work on this because I have a relative or a friend." But eventually, four or five Senators came up to me and said, "We got to work on this, Pete, because it's real." It took many a month until that first bill got to the floor. Then we just rolled it through the Senate. That was the first bill in 1996. And that's when it died in the House the first time.
How did you react when you found out the House had killed it?
Well, it wasn't like they killed it overnight. It was a lingering death. Until recently, we had a lot of trouble in the House at the top level under the Republican leadership, and as a Republican, I acknowledge that. And I was upset.
How did the vote on the $700 billion rescue plan affect the bill's passage? Were you worried it would get sidelined?
I had no concern. The economy is in bad shape in a number of ways, and it may be that we're going to have trouble finding out how to solve it, but at the same time life goes on, you know. Businesses are beginning to know that they have in their employment people who are mentally ill, people who have manic-depression, who have depression, who have schizophrenia, who suffer from alcoholism. And businesses are finding out that they are better off giving them treatment and buying insurance that covers their treatment because if you can keep them well and get them their medicine, you add to their productivity and to your workforce productivity.
There are many things that I would still love to be doing, which makes my departure so hard. I would think the next thing to do is to introduce national legislation to start a program for a 50-50 match, where the federal government matches the local government in the construction of facilities that would be a local place for the mentally ill to be taken care of. We're a nation that is really hell-bent on trying to do more and more for humankind all the time. I went to a clinic that handles little tiny babies that are born premature and they showed us what new equipment they have and how the baby can be saved and nourished at even a pound and a half. We spend hundreds and hundreds of thousands of dollars to save little premature babies and that shows a real commitment on our part. And then we turn right around and, for the mentally ill, we have made it so difficult for so long to even say it's an illness that you just can't quite figure it out. We can do better.