Mental Health Parity Likely
Mental health parity law likely
By Marina Pisano San Antonio Express-News 07/01/2002
For years, mental health care professionals, grass-roots advocates and
organizations have pushed for parity in health insurance coverage for mental
illnesses, coverage beyond the limited amount provided by the federal parity
legislation of 1996. Hopes are high that this year it just might happen.
A large majority in both houses of Congress formally supports S 543, the Mental
Health Equitable Treatment Act sponsored by Sens. Pete Domenici, R-N.M., and
Paul Wellstone, D-Minn., and the comparable companion bill HR 4066, sponsored by
Reps. Marge Roukema, R-N.J., and Patrick Kennedy, D-R.I.
The proposal got a big boost in April when President Bush spoke in support of
mental health parity.
"It has a ton of momentum," said Michael Strazzella, an American Psychiatric
Association lobbyist. "I'm confident that the leaders of the House and Senate
will all come to the table, work out any disagreements and bring this
legislation to the president to sign."
Many insurance companies and businesses oppose the idea, arguing parity would
cost too much and take away employers' flexibility in designing affordable
health plans.
Right now, plans often restrict mental health coverage through higher
co-payments and deductibles, limits on doctor visits and hospital days and low
annual and lifetime benefit caps.
About 44 million Americans have a diagnosable mental disorder, according to the
National Institute of Mental Health. The proposed legislation would essentially
put mental illnesses on an equal footing for coverage with other medical and
surgical problems, a step that many say is supported by science.
"There is overwhelming evidence that severe mental illnesses have demonstrable
biological abnormalities and genetic contributions, even though the precise
nature of the biological cause and genetic alteration may not be understood,"
said Alexander L. Miller, a professor of psychiatry at the University of Texas
Health Science Center who testified before the Texas Legislature on parity.
"This puts them in the same boat as medical illnesses such as hypertension and
coronary heart disease."
The proposed federal parity law would expand the Texas parity law of 1997. The
federal law would not apply to employers with from two to 50 employees. Among
its provisions:
If a plan chooses to offer mental health benefits, then it must provide parity
with the medical and surgical benefits offered. But plans are not required to
provide mental health benefits.
Mental health parity would apply to deductibles, co-payments and other
cost-sharing and limitations on the total amount paid by a participant or
beneficiary.
Parity applies to lifetime limits, frequency of treatment, number of visits or
days of coverage and other limits on duration or scope of treatment.
If a plan offers mental health benefits, then it must cover the diagnosis of all
the disorders listed in the Diagnostic and Statistical Manual of Mental
Disorders, except for illnesses related to substance abuse and chemical
dependency. Treatment isn't necessarily covered. The health plan has management
over what is medically treatable.
Strazzella dismissed claims that things like "jet lag" would be covered. "That
wouldn't be considered medically necessary. It's very rare that somebody's jet
lag causes clinically significant impairment to their lives that's going to
require psychiatric treatment."
With no insurance coverage or limited mental health benefits, people often must
turn to the public sector for care. That's what Joe Lovelace, a consultant for
the National Alliance for the Mentally Ill in Texas, did a few years ago when
his son, then 16 and diagnosed with schizophrenia, was admitted to a private
hospital in Dallas.
Lovelace's insurance had provided $1 million in benefits for his wife in a
yearlong, losing battle with cancer. But benefits for his son ran out at
$10,000, and he had to commit him to Terrell State Hospital.
Last year, parity legislation passed in the Senate but died in the House. This
year, opposition again centers on the cost of covering mental disorders.
"The definitions that this bill uses are far too broad, encompassing a lot of
conditions that really there's no treatment for or clear diagnosis of," said
Joseph Luchok, a spokesman for the Health Insurance Association of America,
whose 300 member companies insure about 100 million Americans.
"What is obsessive-compulsive disorder? What is oppositional defiant disorder?
These are things there are no clear definitions for," Luchok said. "We have
grave concerns that a bill like this would end up pushing more people off health
insurance completely."
Luchok estimates premiums could rise 5 percent with parity. "That's where the
plan could end up defeating itself. Employers might say, 'We can't afford this.
We're not going to offer any mental health benefits.'"
In May, the Congressional Budget Office projected that parity would increase
insurance premiums by less than 1 percent. Advocates argue that about 34 states
currently have some form of mental health parity, and premiums have not soared.
Supporters point out that not adequately covering mental illnesses carries costs
too. The U.S. Surgeon General's Report in 1999 estimated that lost productivity
and absenteeism due to untreated mental disorders cost the nation's businesses
about $70 billion, annually.
While opposed to a new law, Paul Dennett, vice president for health policy for
the American Benefits Council, which represents about 300 companies, mostly
Fortune 500 firms, says his organization favors continuation of the 1996 parity
law, set to expire Dec. 31. That legislation mainly prohibits limits on annual
or lifetime benefits.
By going much further, Dennett said, the proposed legislation limits employer
flexibility. "There needs to be flexibility in the (health plan) design, or it
can rapidly become unaffordable to provide it at all."
But in a written statement, Richard Harding, president of the American
Psychiatric Association, calls parity an idea whose time has come.
"This is a struggle for basic human rights, a triumph of science over stigma,"
Harding said. "Mental illnesses are real and can be successfully diagnosed and
treated."
Source:
http://news.mysanantonio.com/story.cfm?xla=saen&xlb=360&xlc=746843&xld=360
This "Mental Health E-News" posting is a service of the New
York Ass'n of Psychiatric Rehabilitation Services, a statewide coalition of
people who use and/or provide community mental health services dedicated to
improving services and social conditions for people with psychiatric
disabilities by promoting their recovery, rehabilitation and rights.
To join our list, e-mail us your request and, where appropriate, the name of
your organization to NYAPRS@aol.com.
Save these dates!
September 10 - 13, 2002
NYAPRS 20th Annual Conference Celebration
'Now More Than Ever: Hope, Healing and Recovery'
at the Nevele Grande Resort, Ellenville New York
contact: Mary McLaughlin, NYAPRS
1 Columbia Place Albany, NY 12207
(518) 436-0008; fax: (518) 436-0044
