Mental health parity: Cover all conditions the same way
Mental illness is no less real than any other medical condition, but health
plans typically don't give it equal coverage. Congress could change that.
Editorial. April 22/29, 2002. American Medical News
Among the most blatant inequities in health care is one that could quickly be made right and at very little cost. Most Americans would recognize an irresistible combination here. Will Congress?
This particular problem is the gross discrimination by health plans against treatment for mental illness. The remedy is legislation that has a proven track record in the Senate and is now before the House. The measure would replace a mental health parity law already in place but that is riddled with loopholes.
The AMA is a long-time advocate for mental health parity and recently provided subcommittee testimony at a hearing that preceded formal introduction of the Mental Health Equitable Treatment Act (HR 4066). A nearly identical bill, introduced by Sens. Pete Domenici (R, N.M.) and Paul Wellstone (D, Minn.), passed in the Senate last year (it must come up again in the Senate due to a procedural issue). The AMA strongly supports this legislation.
The unequal status of mental health treatment is one of the crueler twists in American health care. The patient is fortunate enough to be among the insured, but the coverage for mental health care may be a fraction of what would be paid for other types of medical care. Often, health plans require high co-pays and deductibles while slashing lifetime and annual coverage limits.
As the AMA testimony pointed out, about 15% of American adults use mental health services each year, and the coverage shortfall gets even more disturbing when the focus is on young people. Parents slave to provide insurance for their children, then come up against the startling realization that the coverage will fall far short at the very moment that help is most needed. Overall, about one in 10 children and adolescents have mental health problems that rise to the level of impairment. Less than one in five get the necessary care.
Compounding the tragedy is that treatments for mental illness are proven to be quite effective. The National Institute of Mental Health reports better-than-even treatment success for patients with schizophrenia, and the numbers are even higher for patients with clinical depression or panic disorder. The treatment success rate for these examples is actually better than for heart disease.
Yet this common-sense reform is facing stiff resistance from health plans and employers. Their dire warnings are that mental health parity will prompt premium increases of up to 15%. Sponsors of the House bill, however, testified that a Congressional Budget Office analysis put the increase at about 1%. The National Advisory Mental Health Council earlier pegged the rise at 1.4%, and experience among states that have their own parity laws confirms that the cost is very low.
There is even more good news on the money issue -- good mental health benefits are a corporate money saver. Getting workers the help that they need, logically enough, cuts down on expensive absenteeism, lost productivity and other problems. Even so, neither the House or Senate version -- bowing to political reality -- forces employers to offer the coverage. But what the legislation does say is that when they do, it can't be coverage that fools enrollees with a false sense of security.
The bills require that mental health treatments in federally regulated health plans be covered the same way as any other medical condition -- the same co-pays, deductibles and limits. In contrast, the law that it would replace (which itself is scheduled to sunset in December) mandates parity for annual and lifetime caps but then provides ways for employers to cop out.
The improved measure passed in the Senate last year as a rider to other legislation (it was dropped in conference committee) but now faces an uncertain future in the House. But the fact that the issue saw the light of day at the subcommittee is a hopeful sign -- it was the first such hearing in the House.
No modern society accepts that mental illness is less real than any other medical condition. It's time to ensure that mental illness is treated the same way when it comes to paying for care.
Source: http://www.ama-assn.org/sci-pubs/amnews/amn_02/edsa0422.htm
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