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NEWS
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Legislation: Mental Health
Mental disorders are very similar in nature to other medical ailments such as diabetes and asthma, requiring long-term treatment and resulting from biological imbalances or deficiencies. However, mental health care is not as vigorously addressed as medical health care. The Surgeon General has estimated that 20% of the U.S. population has a diagnosable mental disorder in any given year; only one in three receives treatment. Furthermore, a study conducted by the World Health Organization, the World Bank, and Harvard University on the most common causes of disability worldwide found major chronic depression to be in the lead. Other mental disorders that were in the top ten included alcohol abuse, bipolar disorder, schizophrenia, and obsessive compulsive disorder.
Many of those affected live for years with their illnesses because insurance companies do not cover psychiatric visits. When such visits are covered, a reported 74% of workers are subject to annual limits on outpatient mental health visits and 64% are subject to annual inpatient day limits. No comparable restrictions are imposed on medical or surgical coverage. Due to this disparity between mental and medical/surgical health care coverage, former Democratic Senator Paul Wellstone and Republican Senator Pete Domenici collaborated to lobby for parity. The result of their work was the 1996 Mental Health Parity Act, a bipartisan measure which prohibits insurers from imposing annual or lifetime dollar limits on mental health coverage. However, major insurance companies such as Kaiser Permanente and Etna still fail to comply. A recent study by the U.S. General Accounting Office (GAO) found that insurance companies have drastically increased premiums and co-payments, and have imposed new limits on inpatient psychiatric care. Some plans even restricted the number of covered office visits to six, barely allowing for the diagnosis of an illness.
In 2003, the Senator Paul Wellstone Mental Health Equitable Treatment Act (H.R. 953, S486) was introduced as an amendment to the 1996 Mental Health Parity Act and the Employee Retirement Income Security Act of 1974 (ERISA). This Act "provides for equal coverage of mental health benefits with respect to health insurance coverage unless comparable limitations are imposed on medical and surgical benefits (S486)." Currently, there are 243 House co-sponsors, 42 of whom are Republican, and 68 Senate co-sponsors for this bill, 20 of whom are Republicans. Former Presidents Clinton and Bush strongly support mental health parity legislation with the backing of over 270 organizations such as the American Medical Association, the American Medial Student Association, and the National League of Cities.
While striving for complete parity between behavioral and medical health care, the Equitable Treatment Act does have limitations. It only applies to group health plans that already provide mental health benefits. Out-of-network services, individual market plans, and small business (Less than 50 employees) are excluded. Only mental health conditions listed in the Diagnostic & Statistical Manual of Mental Disorders, Fourth Edition (DSM IV) are covered, and patients are subject to normal treatment authorization plans, accordance with standard protocols, and medical necessity determination criteria set by insurance companies. In order to achieve bipartisan status, both House and Senate Democrats compromised and did not include coverage for substance abuse services.
Opponents of this bill mainly consist of corporate businesses and insurance companies who fear increase in premiums. However, the Congressional Budget Office estimates that this legislation would only raise employers' premiums by only 0.36%, and overall mental health costs by 0.9%. American businesses already lose $70 billion each year in lost productivity and worker absenteeism due to untreated mental illness. While waiting for the bill to pass, thirty-four states have taken action to provide health care parity. Because each state issues its own parity statutes, the quality of mental health care coverage varies. Minnesota is considered to have one of the more comprehensive parity laws as reported by the Mental Health Services Administration. It covers chemical dependency and has broad definitions of mental illness. In contrast, Texas and California have statutes with limited regulating power and exclude substance abuse care.
The Equitable Treatment Act has much momentum due to its bipartisan status, large number of co-sponsors, and high volume of lobbying from almost 300 organizations. Senator Frist has pledged that the Senate will make this its first order of business, but it has yet to be placed on the 2004 calendar for voting.
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