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APA President Herbert Sacks, M.D., urged nondiscriminatory coverage of mental illness in testimony to a White House advisory commission at the University of Illinois in Chicago last month.
Sacks made his remarks September 9 at a hearing of the Subcommittee on Consumer Rights, Protections, and Responsibilities of the Advisory Commission on Consumer Protection and Quality in the Health Care Industry. An independent commission appointed by President Bill Clinton, it is cochaired by Secretary of Labor Alexis Herman and Secretary of Health and Human Services Donna Shalala. Peter Thomas, J.D., chairs the subcommittee.
The commission’s members represent business, labor, health care providers, insurers, managed care plans, state and local governments, and consumers. Former APA president Herbert Pardes, M.D., dean of the faculty of medicine at Columbia University in New York, and former APA secretary Steven Sharfstein, M.D., president and medical director of Sheppard Pratt Health System in Baltimore, are members.
Sacks addressed two questions raised by the commission. First, to what extent should consumers have a right to specific health care benefits? And, second, what approaches would best achieve greater access to needed benefits?
Based on "outdated notions of cost, and rooted in fear and ignorance, some insurance companies and businesses continue to argue that" APA’s advocacy of nondiscriminatory coverage of mental illness "constitutes advocacy for ‘mandated benefits,’" Sacks commented. This obscures APA’s stated position, which is that discrimination against one class of illnesses, mental illnesses, including substance abuse, must be eliminated.
APA supports federal legislation requiring that insurance cover mental illnesses, including substance abuse, the same as other illnesses. APA also supports the elimination of any statutory or regulatory limits on treatments of mental illness that are not applied to other medical and surgical treatments, Sacks explained. But APA also believes that the Association’s district branches, working at the state level, are "best able to determine how to achieve the specific objective of full parity for mental illnesses."
APA would prefer that there be a uniform standard establishing that no insurance plan could "discriminate by diagnosis" in its coverage, said Sacks. But until that goal is attained, "the political reality will compel us to lobby for the best possible specific coverage requirement at both the federal and state levels," he added.
In March President Clinton addressed the advisory commission in the East Room of the White House. He asked the commission to develop a "consumer bill of rights." The President enumerated five aims of this bill of rights.
First was to free health care professionals from constraints on providing full and accurate advice and information to patients. Second was to assure that providers "are not subject to inappropriate financial incentives to limit care." Third was that "the sickest and most vulnerable patients" receive "the best medical care for their unique needs." Fourth was that "consumers have access to simple and fair procedures for resolving health care coverage disputes with plans."
Finally, "and perhaps most important," said the President, consumers should have "basic information about their rights and responsibilities, about the plans - the benefits the plans offer, about how to access the health care they need, and about the quality of their providers and their health care plans."
APA’s push for parity is occurring within the context of this patient bill of rights.
In a letter to subcommittee chair Thomas, Jay Cutler, J.D., director of APA’s Division of Government Relations, reiterated some of the key points Sacks made to the subcommittee.
According to a variety of statistical analyses, full parity coverage for mental illness would result in only modest increases in health plan deductibles and premiums. The nonpartisan Congressional Budget Office, for example, estimated that full parity coverage would boost premiums only 4 percent. A study by the actuarial firm Milliman and Robertson estimated the cost of full parity as an additional 3.9 percent per member per month. And the National Institutes of Health, which Cutler described as "the nonpartisan scientific jewel of excellence," has also concluded that nondiscriminatory coverage of mental illness is affordable.
Higher figures cited by the business community rely on "outdated benefit designs that are more than seven years old - a lifetime" in the rapidly changing health care market, Cutler observed.
Further, the costs of parity cannot be seen in isolation, as the increased expenditures are certain to result in medical-cost offsets in such areas as better employee productivity and less lost work time, said Cutler. The National Mental Health Advisory Council estimated in 1993 that parity coverage would save businesses as much as $2.2 billion a year, he noted.
The subcommittee and the full advisory commission were scheduled to meet this month to draw up a draft report, according to the commission’s deputy director, Richard Sorian. A final report will be released next month, prior to Thanksgiving, after review by President Clinton.
Last September Clinton signed legislation that provided for conditional parity effective January 1998. Clinton remarked then that there should be "no more double standards; it’s time that law and insurance practices caught up with science."
The legislation requires group health plans in businesses that have 51 or more employees and offer any mental health coverage to apply equal annual and aggregate lifetime limits to coverage of all illnesses, including mental illness. Small businesses of 50 or fewer employees are exempted, and substance abuse services are excluded.
The new law does not require parity with respect to copays, day or visit limits, or managed care measures such as carveouts. And it does not require health plans to cover mental illness if they do not already do so.
Another provision protects businesses by allowing them to opt out of the mental health provisions if adhering to them increases the cost of their plan by 1 percent or more.