Former first lady Rosalynn Carter's interest in improving mental health care began when her husband ran for governor of Georgia in the 1960s.

Soon, one of her main objectives may be realized. The U.S. House in March passed a broad bill that requires insurance "parity" —- comparable coverage —- for mental and physical illnesses.

But there are still hurdles. A bill passed earlier by the Senate that requires parity is not as far-reaching.

A committee made up of senators and representatives now must iron out the differences.

Carter, who is writing her second book on mental health, spoke with The Atlanta Journal-Constitution a few days after the House vote.

Q: Why has parity become an issue, and why is it so important to you?

A: When I started, and even when Jimmy was president, we never dreamed mental illnesses could be controlled. When I first started, there was very little knowledge about how to treat mental illness. Most people were just kept sedated. It was hard to get anybody to work on it because of the stigma.

Today, mental illnesses can be diagnosed and treated effectively. An overwhelming majority of people can become contributing members of society. It's morally wrong not to treat people and give them a chance to develop to their fullest potential.

Q: What do you see as the pluses and minuses of the two bills?

A: There are some differences. The House bill covers all mental illness diagnoses in the DSM (Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association). The Senate bill lets insurance companies and managed care companies decide which illnesses to cover. That's a huge difference. It's the main point of contention. The Senate bill will cover only severe illnesses —- depression, schizophrenia, bipolar disorder and maybe one or two more. The House bill has the same coverage that Congress has.

Q: The House bill covers addiction, right?

A: Both cover addiction. That's really exciting. The ones in the past that we've tried and failed to get passed have not covered addiction.

Q: What would you like to see in the law?

A: We need everybody to be covered. What we have learned over the years is that total coverage does not increase insurance costs significantly at all. When people have mental health coverage, they don't go so much to their primary physicians to try to find out what the problem is. They don't go to their doctor as much for symptoms of depression like headache, stomach ache, not feeling good. Overall health care cost does not go up appreciably.

Q: Critics are saying that the House bill, by requiring coverage of all mental diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, would require coverage for things like jet lag and caffeine intoxication. What do you say to that?

A: In order to get insurance coverage, it has to be a medical necessity. Suppose somebody was sick from jet lag and went to a primary care doctor —- which they would probably do before going to a mental health professional. Would that doctor say it was a medical necessity?

Q: What's changed that makes parity viable in some form this year when it's failed in the past?

A: The mental health community has been working long and hard. Finally we had some people who listened to us and wanted to do something about it. ... The way Congress works, you get what you can. You have to give something up. I hope we don't have to give up too much.

I'm hoping they will go ahead and not wait too long before they have a conference committee meet and do the negotiating so they can get the bill to the floor so it can pass this Congress.

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HR-1424 vs. S 558

Both the House and Senate bills require insurers to provide the same benefits at the same costs and with the same restrictions for mental illnesses that they do for physical illnesses. Both cover addiction. And both exempt health plans with 50 or fewer workers. But there are differences.

The House requires insurers to cover all diagnoses in the Diagnostic and Statistical Manual of Mental Disorders.

The Senate does not specify what conditions must be covered.

The House leaves in place any state laws that provide greater benefits than the federal government requires.

The Senate makes states conform to federal standards, even if state standards have been higher.

The House requires any insurer offering out-of-network coverage for medical or surgical procedures to also offer the coverage for mental health care.

The Senate has no such provision.

The House requires insurance companies explain any denial of coverage.

The Senate allows for less transparency.