The biggest wrinkle in reconciling House and Senate differences over insurance parity can be summed up in the question, "who defines the terms of coverage?" The issue has become so heated that negotiations will bypass traditional committees for closed-door discussions, according to CQ Healthbeat.

Can private discussions, presumably including Sen. Edward Kennedy, sponsor of one measure, and his son, Rep. Patrick Kennedy, resolve such fundamental differences? Many in the mental health community certainly hope so. With the exception of the National Alliance on Mental Illness (NAMI), which has gone on record supporting the Senate's bill, most mental health advocates have been careful to support parity in general without taking sides.

There is no disagreement that the Senate’s Mental Health Parity Act (S. 558) tips power to the insurance industry to define which mental health and addictive disorders will be covered. In contrast, the the Paul Wellstone Mental Health and Addictions Equity Act (HR 1424) uses the APA’s Diagnostic and Statistical Manual (DSM) for definitions. In a letter to Rep. John Dingell, BlueCross BlueShield, Aetna, and several groups of retail businesses explained their opposition to the Wellstone Equity Act based on “protecting only medical management techniques ‘which are based on valid medical evidence.’” They promised to “continue to work to defeat HR 1424.”

MAPlight.org, a public interest group tracking campaign contributions, notes that roughly one-third of the $10.6 million spent in support of the Senate's measure came from the insurance industry in the year leading up to the vote. This averages $30,318 for every senator who voted yes.

The insurance industry also worked hard, but with less success, to defeat the Wellstone Equity Act. According to information on MAPLight, they spent $15,819,804, which amounted to $36,876 for every representative, of whom 148 voted “nay.” It passed, however, with 268 votes in favor, and 13 not voting.

For two Republican lawmakers nearing the end of their terms, parity is a passion. Sen. Pete Dominici (R-NM), who will not seek re-election, was an early supporter of mental health initiatives, and a sponsor of the 1996 mental health parity law. In the House, Rep. Jim Ramstad (R-MN) also announced he will not seek reelection, but there have been rumors that he might reconsider depending on the outcome of the Wellstone Equity Act. Until the 2006 election ousted Republican control, this bill had languished.

Now that both chambers have acted, and with frequent medical and therapeutic advancements bringing successful treatments into focus, there is no justification for a delay. An embargo on prompt and unabbreviated medical attention treating cancer or heart disease would not be permitted. Nor should one be permitted on speeding treatment for mental illnesses or addictive disorders.