WASHINGTON — Americans struggling with mental illness, depression or addiction often face an added burden: limited insurance coverage compared with people suffering physical ills.
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Those days may be numbered, but changing the situation will take approval of the massive economic bailout bill heading for consideration in the U.S. House of Representatives.
Currently, insurance plans routinely require mental health patients to pick up more of the initial costs of their care through higher deductibles and co-payments. Other times, insurance plans have stricter limits on how often patients with mental problems can seek medical care. Unlike in many developed countries, where health insurance is bought through the government, U.S. health insurance normally is provided by employers as benefits.
Changing that has widespread support in Congress, but time is running out for this year. The only vehicle left is the economic rescue package coming before the House as early as Friday.
Could reach 113 million Americans
The requirement for equal treatment would apply to health plans that cover more than 50 employees, potentially reaching 113 million people across the United States.
Health officials argue that equal protection for mental health conditions would lead to a healthier, more productive work force.
"There's a phenomenon ... where you've got a psychiatric illness and you're able to get around but you can't do your work at the same quality you did before," said Dr. Nada Stotland, president of the American Psychiatric Association.
"Many workers today are in the service industry. If a person on the other end of the line is depressed, they may have shown up to work and they may be present, but they will not necessarily make us happy about the company that we're calling. They'll be slow, unhappy and maybe irritable, and their powers of concentration won't be good. So, more and more companies want to see their employees treated."
For Republican Sen. Pete Domenici, passage of the legislation would be a highlight of a six-term career that is nearing its end. He got involved in the parity issue after joining a National Alliance on Mental Illness support group. On his way home from work, he and his wife, Nancy, would meet with other parents of children with mental health problems. The Domenicis have a daughter diagnosed with atypical schizophrenia.
"The first real understanding of how broad the problem was came from those meetings where I met with mothers and fathers who had children who were mentally ill and they were going bankrupt because they couldn't pay the health bills, or their children were in jails instead of hospitals," Domenici said.
Employers' expense issues
Domenici said perceptions about the ability to treat mental health problems have changed greatly over the years, but coverage also has become an expensive proposition. So he and others, such as the late Democratic Sen. Paul Wellstone, began pushing for health insurance parity. Those who would have to bear most of the expenses resisted.
"Those who stood to lose fought hard, and that was principally insurance companies and businesses," Domenici said.
To deal with employers' problems, the legislation does not mandate that group health plans cover mental health or addiction treatment. But if they do, under the new stipulation the coverage must be equitable to other medical coverage.
Employers and insurers were worried that legislation would have required plans to cover a "telephone book" of conditions, raising costs beyond what companies and their workers could afford and potentially negating companies' ability to offer any health coverage at all. The insurance industry is now a strong supporter of the parity legislation before the House.
In 1996, Sens. Wellstone and Domenici won passage of a law prohibiting insurance plans that offer mental health coverage from setting lower annual and lifetime spending limits for mental treatments than for physical ailments.
The pair again teamed up in 2001 on a predecessor to the legislation now before the House. After Wellstone was killed in a plane crash in 2002, Sens. Edward Kennedy, a Democrat, and Republican Mike Enzi took on larger roles in getting a bill passed.
On the House side, the effort for "mental health parity" was led by Democratic Rep. Patrick Kennedy, the senator's son, and Jim Ramstad, a Republican. Both had battled problems with addiction.
The mental health parity bill, while widely popular, stalled after becoming part of a package of tax breaks and the ensuing controversy over how to pay for them. Supporters were afraid Congress might adjourn without dealing with the issue. By attaching the mental health legislation to the bailout, Senate Democrats saw it as a way to make the package a little more palatable to some Republicans, particularly for Ramstad. Ramstad voted against the financial rescue package on Monday.
Republican Rep. Tim Murphy, a child psychologist, said Friday's vote will be difficult for him because he has long worked on the mental health parity legislation but opposed Monday's bill on the bailout.
"A person can save money on their car if they never change the oil, if they never replace the brakes, but eventually it's going to cost them a heck of a lot more to do an overhaul on the engine," Murphy said. "What happens on mental health care is on policies: the businesses who have parity as part of their policies have found they actually save money in the long run."
Overall, the parity legislation is expected to cost the federal government about $3.4 billion over 10 years. That is because employers will have more health expenses that they can deduct from their income taxes.
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