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A bipartisan group of legislators in the House of Representatives introduced a comprehensive version of mental health parity legislation last month that would fill many of the loopholes left in the version approved in 1996.
The earlier version required that businesses with 51 or more employees that offered any mental health benefits had to provide aggregate annual and lifetime coverage for mental health services equal to that for other medical and surgical benefits. But the earlier version excluded coverage for substance abuse disorders; allowed unequal limits on frequency of treatment, number of visits, and copayments for mental health coverage versus other medical coverage; and permitted businesses to opt out if providing mental health coverage increased the cost of their health plans by 1 percent or more.
The version introduced last month would still exempt businesses with 50 or fewer employees, but would extend coverage to substance abuse disorders, eliminate the 1 percent opt-out provision, and broaden the legal definition of parity to require mental health services be equal to other medical services regarding limits on frequency of treatment, number of visits, and copay-ments. The new bill also eliminates a sunset provision that would end the parity mandate in 2001.
The bill was sponsored by Republicans Marge Roukema (N.J.), Christopher Shays (Conn.), and Connie Morella (Md.) and Democrats Peter Defazio (Oreg.), Bob Wise (W. Va.), and Ted Strickland (Ohio).
At a press conference announcing the bill's introduction, several of the cosponsors were joined by supporters of the measure, including immediate past APA president Harold Eist, M.D.
Eist, speaking for the APA-led Coalition for Fairness in Mental Illness Coverage, thanked the legislators for "sponsoring this new, true parity legislation." He observed that "diagnosis-based insurance discrimination is abhorrent to the people of this nation." By sponsoring the new bill, legislators have affirmed their opposition to the insurance industry's "blight of exploitation and profiteering," he added.
The 1996 parity act was an important "first step," said Eist. But recent studies, including one released by the Substance Abuse and Mental Health Services Administration (SAMHSA), have shown that full parity for coverage of mental illness and substance abuse disorders is affordable and would produce an average premium increase of only 3.6 percent, he added.
Parity is "not only affordable; we cannot afford not to provide it," said Eist. "Failing to do so will unreasonably increase human misery while actually massively increasing costs, and it will drive a wedge between the people and the representatives who have let them down." Mental illnesses "are real, are horrible, but are eminently treatable at a reasonable price."
The new parity legislation "makes sense not only for those afflicted with mental illness, their families, their loved ones, their employers, but for us as a society as a whole," remarked Defazio. Although passage of the legislation could result in modest premium increases, "for that cost we would insure that every person who has health insurance would have full access to the best professional services for mental health and substance abuse." This could ultimately save "tens of billions of dollars" in enhanced employee productivity and lower health care costs, Defazio said.
"If we put this out for a plebiscite in America, we'd win hands down," he remarked. It will, however, be necessary to get through "the legislative funnel, where there will be many forces arrayed on the other side, powerful and wealthy forces, who are slightly less enlightened," he noted.
The movement for parity ultimately "cannot be stopped," he asserted. "It may not happen in this very short legislative session, but in the not-too-distant future we will be holding a press conference to celebrate full parity in coverage for all people. . . ."
The parity bill "meets my community-meeting test," said Shays. "I'm tired of going to community meetings where I have to defend a process" that treats mental and physical disabilities differently for insurance purposes. As someone generally suspicious of mandates, said Shays, he has often found himself justifying the need to move slowly to correct this disparity. "But the bottom line is [mental disorders] just can't be treated differently. People with mental illnesses can be helped and be maintained, in some cases healed."
The additional costs "will be absorbable and affordable" and will not harm small businesses since businesses with 50 employees or fewer will still be exempted, he noted.
"I don't know how successful we will be this year, . . .but we will be working very hard to see that it does become law."
The bill "just makes sense, and it is consistent," observed Wise. "We're not asking anything different for mental health-just what people already receive in medical and surgical benefits under existing policies."
The recent SAMHSA study estimates that full parity would cause only a 1 percent increase under managed care plans and 3.6 percent, on average, for the spectrum of health plans.
"Now we have to keep moving this forward," said Wise. "It's a rock that has to be pushed up the Hill, and it's going to take a lot of pushing. Happily we've got some momentum already, and I think we're going to build more, particularly because of the people that are in this room."
Strickland, who is a psychologist, cited his own experience as shaping his decision to back the bill. "As someone who has spent most of his adult life working with folks who have mental and emotional disorders, I have been troubled at the discrimination that has existed and continues to exist in our society," he said. "The fact is that as we know more and more about the causes of mental and emotional disorders, the more we understand that these are very treatable disorders and that we can actually save money if we provide appropriate, timely treatment. But we've got to convince our colleagues that this is the case in order to move this forward."
Laurie Flynn, executive director of the National Alliance on Mental Illness (NAMI), pointed out that mental illness affects "families and individuals in huge numbers across the country." Although there are increasingly effective treatments, they can be effective only if people who need them have access to them.
"My own daughter is a person with a serious mental illness, and she has been diagnosed now for more than 12 years," said Flynn. "She is one who has been fortunate. She has had the latest and best psychiatric treatment available. She has learned to accept, understand, and manage her own illness. And she has been able to reclaim her life, a life that [for others] is still too often confined to the margins of our society."
Her daughter was able to achieve this recovery because she had access to "lifesaving and life-giving treatment and the strength and support she has from her friends and family, combined with her own courage and strength," Flynn added. "This is a picture that we should see more of."
Irene Wasney, J.D., a Maryland attorney and board member of the Mental Health America, described her own struggle with chronic depression. By taking medication daily and periodically consulting her psychiatrist, she has been able to function normally, she told legislators.
When she was recently diagnosed with a low blood pressure disorder called neurally mediated hypotension, said Wasney, it became clear to her how arbitrary are the distinctions drawn by insurance companies between physical and mental disorders.
The blood pressure disorder manifests itself in "a sudden drop in blood pressure, decreased blood flow to the brain, a lengthy adrenaline response, heart palpitations, dizziness, nausea, and occasionally fainting," explained Wasney. "It is caused by a miscommunication between the brain and the heart. As a result of the compromised blood flow to the brain, this physical disorder causes my depression."
Her insurance has covered virtually all of the considerable cost of treatment for her illness, except for a $20 per visit copay, she said. But when she visits her psychiatrist for treatment for the depression caused by the blood pressure disorder, she must pay an $88 copay per visit, she noted.
"How does this make any sense? Why is it that a symptom of my physical illness is treated discriminatorily by my insurer? Where do you draw the line between this symptom of my blood pressure disorder and the symptoms of dizziness, which are treated by my neurologist?
"My mental illness over the years has cost me enough to make a down payment on a house. I don't regret seeking these services because they have restored me to health. However, I wish I did not need to be so financially strapped because of a meaningless distinction. I am quite certain that my brain is just as important to me as my heart, if not more. This is a wonderful bill, which, in health insurance terms, will make the brain equal to any other organ of the body."
-R.B.K.