APA President Harold Eist, M.D., told a House Government Reform and Oversight subcommittee last month that "fair and equal coverage for mental illness in the Federal Employees Health Benefits Program would simply once and for all end a fiscally unsupportable, publicly deplorable discrimination that denies FEHBP recipients the finest psychiatric care the world has ever known."

Eist told the House Subcommittee on Civil Service that "the cost of not providing parity is vastly higher than the price of this inexpensive care." For example, the indirect costs of untreated depression are in excess of $40 billion, he noted.

When challenged by Representative Jim Moran (D-Va.) about the affordability of mental illness parity, Eist responded, "How can we not afford to pay for fair and equitable treatment?" He referred to the Congressional Budget Office estimate of $600 million over five years to provide mental health parity to FEHBP beneficiaries, which translates to $12 a year.

APA's written testimony called on Congress to eliminate annual caps on mental illness coverage in the FEHBP. This step would then parallel the amendment by Senators Pete Domenici (R-N.Mex.) and Paul Wellstone (D-Minn.) requiring health care insurers that offer mental health policies to provide the same total dollar coverage as they do for physical-related claims. Last month conferees in the House and Senate approved this amendment, which was part of a spending bill for the departments of Veterans Affairs and Housing and Urban Development. The House subsequently passed the entire bill on September 24, and President Clinton signed it September 26.l

Domenici estimated that the provision would raise health insurance costs only one-sixteenth of a percent.

The APA testimony applauded the elimination of lifetime caps for mental illness last year in the FEHBP but pointed out that this action "regrettably resulted in unintended and harmful consequences for federal workers and their families, particularly in the event of a psychiatric illness requiring hospitalization."

For example, Blue Cross and Blue Shield "proclaimed proudly about having expanded such coverage to 100 days annually," while they implemented daily patient copayments up to $400 in a nonmember hospital under the standard option, stated APA's written testimony. The patient could incur up to $40,000 in out-of-pocket expenses with no ordinary and customary annual stop loss protection.

The Mail Handlers also dramatically increased out-of-pocket costs for enrollees for inpatient treatment and eliminated the catastrophic annual stop loss protection for mental illness and substance abuse.

"We remained concerned about potential harmful consequences for federal-worker retirees and their families when FEHBP plans are at liberty to ratchet down on mental illness coverage elsewhere in plan design or substantially raise beneficiary out-of-pocket costs. We strongly believe that the Administration can and should do more to correct this iniquity," stated APA's testimony.

Eist reminded members of Congress, "With the stroke of a pen, you can do more good for the American people than armies of physicians can do in their lifetimes. It is time to strike a blow for what is right, for what is fair for the American people."

(Psychiatric News, October 18, 1996)