Advocates must fight for parity in mental health coverage

This article is excerpted from ENVOY, April/May 1996

by James Jordan

In mid-April, the Senate passed an amendment to the Health Insurance Reform act of 1996 that would eliminate discriminatory health insurance practices against mental health consumers.  While the amendment, co-sponsored by Sens. Domenici (R-NM) and Wellstone (D-MN), won with bipartisan support (68-30) in a Republican-majority Senate, it now faces an uphill battle in order to become law – and a steep hill it is.

The Domenici-Wellstone amendment would make insurance companies treat mental health services in the same way that they treat other health care services, offering parallel coverage for mental and physical illnesses.  For example, if an insurance plan permitted unlimited outpatient visits to a physician, it would have to permit the same for outpatient visits to a psychiatrist.

Although medical data has demonstrated that mental illnesses (such as bipolar illness, depression, and schizophrenia) can be diagnosed and treated with the same or better levels of reliability and effectiveness has other illnesses (such as diabetes and heart disease), most plans currently place strict limits for mental health services.

The House of Representatives has a sister bill to the Health Insurance Reform Act, but it does not include anything regarding mental health parity.  It is now up to a house-Senate conference committee to work out the differences between the two bills and decide the fate of the mental health parity amendment.

Although members of the conference committee are not known at this time, advocates for people with disabilities are gearing up for a phone campaign to assure that the Domenici/Wellstone amendment is still attached to the Health Insurance Reform Act when it comes out of conference.

Sens. Kennedy (D-MA) and Kassebaum (R-KS), sponsors of the Health Insurance Reform Act, are not expected to fight in conference for the inclusion of the mental health parity amendment.  Kennedy said that, although he supports mental health parity, their strategy is to pass a “clean” act with no controversial amendments, in order to assure its final passage and the President’s signature.  How could an amendment that ends discrimination be controversial?  A look to the vehement opposition in the business community provides some answers.

The National Association of Manufacturers has stated that it will oppose the whole Insurance Reform bill if the mental health parity amendment is included.  Other organizations opposed to the amendment include the ERISA Industry Committee, the U.S. Chamber of Commerce, the Blue Cross-Blue Shield Association, the American Association of Health Plans, and the Health Insurance Association of America. 

Such resistance stems from a belief that America cannot afford mental health parity. For example, the opposition cites studies that claim health insurance premium costs will rise 8 to 11 percent if the amendment becomes law.   A Blue Shield executive estimated that insurance costs would go up nearly $8 per member per month.

However, the business community’s numbers are drastically refuted by a variety of sources.  The Congressional Budget Office, for example, estimated that mental health parity in health insurance would add only 1.6 to 3.9 percent to the average health insurance premium.  A heavily researched actuarial pricing report for the Washington State Health Services commission said that ending discrimination against mental health consumers would add only $4 to $5 per member per month, about half Blue Shield’s estimate.

Not all businesses are opposed to the Domenici/Wellstone amendment.  Many progressive businesses, realizing they are indirectly swallowing the costs when employees with untreated mental illness are less productive or absent, have signed on to coalitions in favor of the amendment.

It’s not just the businesses, though that will bear the weight if the Domenici/Wellstone amendment doesn’t make it.  The social and economic costs to society and individual taxpayers in not treating mental illnesses are too high already and increase every year. 

For example, depression costs the United States an estimated $43.7 billion every year.  The government (through Medicare, Medicaid, and other programs) currently pays for 57 percent of all mental health costs, as opposed to 42 percent of all other health care costs.  Apparently, because there is no parity required through the law, the insurance industry chooses to drop the costs of mental health onto the taxpayer.

The societal impact of not treating mental illness early and effectively is nearly as grip as the financial one.  People without adequate mental health insurance often end up either homeless or trapped in the criminal justice system.  Others are dependent on Social Security or Medicaid and can’t get out of these systems because of inadequate mental health insurance.  For 30,000 Americans last year, suicide was their final choice.

Our current health insurance system is not only irrational and inhumane, it also violates the Americans with Disabilities Act, which prohibits discrimination against people needing mental health services.  Such discrimination will continue unless the Domenici/Wellstone amendment is passed.  Everyone who advocates on disability issues should make parity in how mental health care and all other health care is insured a priority.

ENVOY Credits

ENVOY Editor:  Nicole Elger
ENVOY Editorial Assistant:  Annaliza Torres
ENVOY Staff Contributors:   Laura Allen, Elizabeth Ambrose, Randy Brown, Debbie Dorfman, Marie Jensen, James Jordan, Glenn Kearns, David Lord, Sandy Macdonald, Gillian Maguire, Betty Schwieterman,  Michael J. Smith, Mark Stroh, Thomaszine Weathersby
Other Contributors:  Elizabeth Gallagher

ENVOY is the newsletter of Disability Rights Washington, a private, nonprofit agency that has been protecting the rights of people with disabilities since 1972. DRW is a member of the National Disability Rights Network. Eligibility for DRW services is determined by federal law. Contact DRW if you would like more information about current priorities and available services.

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