Call for Parity

An editorial published in a recent edition of the AMA News calls for mental health parity. This issue is a crucial component in our struggle for recognition of substance abuse and dependence as a disease that requires equal attention in treatment as any other diseases (Diabetes, Heart Disease) do. Unfortunately, the proponents of mental health parity often forget that substance abuse and dependence is part of mental health care. We need to remind them and lobby for our interests and those of our patients.
Yours truly,
Bernd


OPINION
Time to pass mental health parity
The AMA is part of a coalition that supports new Senate legislation to close some gaps in the law requiring equal insurance coverage for mental illness.
Editorial. March 12, 2007.

Cancer. High blood pressure. Depression. Heart disease. All are serious medical conditions that affect millions of Americans. All are treatable. So shouldn't they all be covered equally by health plans?
The sad fact is that insurers have long singled out one of those diseases -- depression -- for lesser coverage. Benefits for mental illness in general often come up short in comparison with those for physical conditions.
Even with passage of the 1996 mental health parity act, barring different dollar limits on annual and life-time benefits, discrimination remained. Higher patient cost-sharing, limits on the number of days in the hospital, and caps on the number of outpatient mental health visits are still common.
That double standard would end if new mental health parity legislation introduced in the Senate passes Congress and is signed into law.
The bipartisan bill is the culmination of more than a year of negotiations between lawmakers, mental health organizations and the traditional foes of such measures: insurers and the business industry.
It has the strong support of the Coalition for Fairness in Mental Illness Coverage, which includes the American Medical Association, the American Psychiatric Assn. and several other health care and patient advocacy groups.
Under this legislation, group health plans no longer would be able to charge higher deductibles, co-payments or other out-of-pocket costs for mental health care. Patients no longer would face tighter restrictions on the number of days in the hospital or outpatient visits. Substance abuse is included in its protections.
Compromises were involved. The measure acknowledges the concerns of insurers and the business community. These groups have long argued that mandating equal benefits for mental illness would make health insurance prohibitively expensive.
The legislation includes one-year exemptions for health plans that experience an increase in actual total plan costs of more than 2% in the first plan year after the measure's implementation or 1% in years thereafter. It also exempts employers with fewer than 50 workers. The legislation would override state laws that differ from it on financial and treatment requirements, physician reimbursement, management of benefits, in- and out-of-network coverage, and cost exemptions.
An estimated 26% of Americans 18 and older -- about one in four adults -- have a diagnosable mental disorder in any given year, according to the National Institute of Mental Health. When applied to Census Bureau figures, that translates into 57.7 million adults.
The stigma historically associated with mental illness and exacerbated by insurance coverage policies has prevented many people from seeking help. This carries a huge economic toll. The combined indirect and related costs of mental illness, including lost productivity, lost earnings due to illness and social costs, are estimated to total at least $113 billion annually, says Mental Health America, an advocacy group.
By putting mental health benefits more on par with medical and surgical coverage, the Senate bill could help end the stigma and would encourage people to get medical care.
Mental illness is very treatable. Between 70% and 90% of people with serious mental illnesses have a significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatment, according to the National Alliance on Mental Illness.
More than a decade has passed since the first mental health parity law was adopted. The Senate consensus legislation, sponsored by Sens. Edward Kennedy (D, Mass.), Pete Domenici (R, N.M.) and Mike Enzi (R, Wyo.), finally could fill many loopholes left by that measure.
There is action on the House side as well. Reps. Patrick Kennedy (D, R.I.) and Jim Ramstad (R, Minn.) are crafting a bill they plan to introduce this spring. President Bush has voiced support for mental health parity in the past.
All this bodes well for success this year. It is time for Congress to finish the job.