What's next?

That's the question a lot of readers want answered in the aftermath of the historic vote by Congress to expand insurance coverage for treatment of addiction and mental illness.

That's ironic because until now, few people gave any thought as to how, much less whether, their health plans covered depression, bulimia or alcoholism. All too often, it was only when they were in a crisis that they discovered that what they or their loved ones needed and deserved was not what they got.

But with news that President Bush signed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act into law Oct. 3, just hours after Congress gave it the thumbs up as part of the $700 billion bailout, suddenly it seems everybody wants to know.

Dear Mr. Moyers: I'm sure you'll think this a lame excuse, but I never wanted treatment because I was afraid it wouldn't get paid for or I couldn't afford the cost. I'm a pretty reliable worker. My boss has no idea I've got a drinking problem; only a few co-workers know when we go out Fridays, I'm the one who drinks too much. Even they are clueless as to how bad it is for me. I read about the insurance coverage being expanded, and I am at a point where I not only need help but also want it. Is now the time to seek that treatment? — Ellen D. in Rochester, N.Y.

Dear Ellen: Yours is a lame excuse, indeed. Your reasoning wouldn't fly if you had breast cancer or heart disease, would it? Get help if you know you're sick. But I can understand your fear that insurance won't pay for it. The good news is that the new legislation will require company plans to cover addiction and mental illness the same way they cover other health problems, but only if those illnesses were covered already. The bad news is that the requirement won't kick in for about a year. By then, it may be too late for you, so I urge you to go ahead and ask for help, whether your treatment is paid for by insurance or not. Otherwise, you risk losing your job, your sanity, your family and maybe even your life.

Even companies that already cover mental illness and addiction are eager to understand the implications of the new legislation.

Dear Mr. Moyers: We're a small business, a trucking company of 80 employees. I know the value of treatment; it's better to offer help to our "problem" employees to give them a chance first before firing them and training someone new. Our existing plan has covered that treatment on a limited level. Like everyone, I'm worried about rising health care premiums and costs for my employees and my bottom line. Is there any estimate about what this new requirement will cost? — Neill T. in Seattle

Dear Neill: Kudos for recognizing that treatment works and people with mental illness and addiction can recover. In fact, often the most productive and predictable employees on the job are those who have gotten help and are healthy again. The new legislation exempts employers with fewer than 50 workers. For companies such as yours, the Congressional Budget Office estimates that parity will increase premiums by about 0.4 percent, or about $1.35 per member per month. A couple of tall lattes at Starbucks cost more.

Not everyone, however, welcomes the expanded coverage.

Dear Mr. Moyers: Say what you want, but being a drug addict isn't like having cancer or even depression. It's a choice. People who make it their choice should make it their consequence. Treatment only lets them off the hook. What the politicians did shows just how crazy Washington is these days. — Michael M. in Hoboken, N.J.

Dear Michael: Your perspective underscores just how much work remains to unmask the stigma and educate people such as you about the realities of addiction. The new parity legislation is a step in that direction. You are right about one thing: Washington is a crazy place.

William C. Moyers is the vice president of external affairs for the Hazelden Foundation and the author of "Broken," a best-selling memoir. The paperback edition was released in August 2007. Please send your questions to William Moyers at William@WilliamMoyers.com. To find out more about William Moyers and read his past columns, visit the Creators Syndicate Web page at www.creators.com.

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