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serious physical disorders. The cost of paying for health insurance parity for mental illness has been one of the most hotly debated issues at the national and state levels. Despite vehement opposition by special interests who claimed that parity would be too costly for businesses, multiple studies show that the cost impact is minimal and that businesses are instigating policies to provide parity for their employees:62
* The introduction of parity in combination with managed care results in, at worst, very modest cost increases. In fact, lowered costs and lowered premiums were reported within the first year of parity.
* Maryland reported a 0.2% decrease after the implementation of full parity at the state level.
* Rhode Island reported a less than 1% increase of total plan costs under state parity; Texas experienced a 47.9% percent decrease in costs for state employees enrolled in its managed care plan under parity.
* In a survey of New Hampshire insurance providers, no cost increases were reported as a result of a state law requiring health insurance parity for severe mental illnesses.
* A Congressional Budget Office federal cost estimate projected a 0.4% increase in premiums and a 0.16% increase in employer contributions for parity in annual and lifetime limits.
* A study conducted for NAMI by William Mercer Inc., one of the nation's leading human resources consulting organizations found that of the 300 American businesses polled, 85% were either in compliance or planned to make changes to comply with the Mental Health Parity Act by January 1, 1998.
* Seven out of ten of those same employers agreed that mental health parity is a reasonable national policy goal and that parity is important to their employees.
What is managed care?
Managed care began in the United States in the form of pre-paid group practices. These were developed to provide coordinated health care in a cost-effective way. The passage of the federal Health Maintenance Organization Act in 1973 spurred the growth of managed care. As health care costs escalated, employers and the public insurance programs increasingly considered managed care as a means of containing health care costs. By early 1998, 74% of those receiving their health insurance through their employers were enrolled in a managed care plan.63
The concept of managed care is to combine the delivery of health care services with the financing of that care. By enrolling in a managed care plan, the consumer agrees to receive health care from a selected group of physicians, hospitals, and other service providers in exchange for paying a set fee each month for the services received. Managed care plans range in type from more restrictive to less restrictive models in terms of choice of medical providers, medical care, and services.64 Managed care plans can dictate not only which procedures are covered but also how much insurance companies will pay for the procedures. While it is widely agreed that managed care has been cost effective, it has also been very controversial. According to Health news,65 overall consumer dissatisfaction with managed care plans rose from 17% in 1997 to 22% in 1998. Consumer dissatisfaction was mainly related to poor customer service in terms of resolving problems, timeliness, and accuracy. Consumers are often caught in the middle of 
