Mental Illnesses: Should insurance companies treat them the same as other diseases?

For years, our representatives and senators in the United States Congress have been talking, back talking, talking in circles about mental health insurance parity. The idea is simple: insurance companies would have to grant the same measure of treatment to someone suffering with chronic major depression as someone with diabetes, someone with schizophrenia as someone with sickle-cell anemia, someone with panic disorder as someone with pancreatic cancer.

But many people, including President Bush and certain lobbyists, are hesitant to make insurance companies do so, in part because of the costs associated with mental illness treatment. Others just believe mental illnesses are not “real” medical illnesses, despite years of scientific research, study and reports after reports after reports clearly indicating mental illnesses are just as real as other medical illnesses. I should note that I have suffered from mental illness, specifically major depression, panic disorder, social anxiety disorder and anorexia for more than 20 years. Last year, I was diagnosed with conversion disorder. I should also note that many of my friends, former colleagues and family members suffer daily with some form of mental illness.

It is absurd that in this day and age, that mental illness (also called brain disorders) would be considered anything less harmful than cancer, diabetes or high blood pressure. According to the National Alliance for the Mentally Ill, some 19 million to 20 million Americans suffer from some form of mental illness every day, that’s about one in four or five people. One likely never would consider limiting treatment to cancer patients, so why is it even conceivable that those who suffer severe mental illness should be restricted to, customarily, 28 days of treatment? I ask our legislators: If a cancer patient were to be denied chemotherapy after 28 days, would that sit well with you? If someone with diabetes were given only 28 days of insulin treatments, would that sit well with you?

Mental illness can be just as deadly as cancer or other life-threatening illnesses, particularly when one suffering with mental illness feels no hope for the future, believes there is no point in even trying to receive extra treatment because of insurance limitations, and starts considering suicide a real option.

Recently, the Senate passed legislation (S 558) -HR 1424) calling for equal treatment for the mentally ill. This important legislation, known as mental illness insurance parity, has been pending before Congress for years. It is critical, if not crucial, that Congress to come to a quick agreement on this legislation, that it be approved by President Bush and that it be signed into law in 2008. Many of us who live with mental illness have for so long resisted in-paitient and/or out-patient treatment, even psychiatric and psychological visits because of out-of-pocket cost issues, because insurance companies, legislators and the general public do not seem to take our illnesses seriously enough to consider them worthy of full and fair treatment and insurance coverage. That kind of thinking must stop.

Congress again has a chance to prove that people like me will not be left hanging, that we will not be considered lesser people than those suffering with other life-threatening illnesses, that we will not be denied the same level of medical treatment than others with severe illness. Congress absolutely must seize this historic opportunity to end insurance discrimination faced by people living with serious mental illness.

If treating fairly those who suffer with mental illness is not reason enough to pass this legislation, consider these facts offered by the National Alliance for the Mentally Ill:
• Untreated mental illness costs American businesses, government and families more than $80 billion annually in lost productivity and unemployment, broken lives and broken families, 30,000 suicides annually, emergency room visits and homelessness.
• Mental illnesses such as schizophrenia, bipolar disorder, major depression, obsessive-compulsive disorder and severe anxiety disorders are real medical illnesses that require intensive medical treatment. These are not illnesses people can just "snap out" of.
• Treatment for mental illness works for most people. If accessible, treatment success rates for most severe mental illnesses exceed those for heart disease and diabetes.
• There simply is no scientific or medical justification for insurance coverage of mental illness treatment to be on different terms and conditions than other diseases.
• Discriminatory insurance coverage of mental illness bankrupts families and places a tremendous burden on taxpayers through higher expenditures for public disability and health benefits, chronic homelessness and inappropriate and unnecessary “criminalization” of mental illness.

It is of paramount importance that Congress reach an agreement on mental illness parity legislation this year. This means an agreement that can get through the Senate and is acceptable to the President so that it can be signed into law and not pushed off to next year, or the year after or the year after. Mental illness insurance parity is long overdue. Congress must act in 2008. For some people, the wait is killing us.

But in a statement issued by the Bush Administration, “Despite the consensus on the need for parity, the path toward final agreement between the House and Senate will not be easy. There is likely to be stiff resistance in the Senate to any effort to require health plans to cover every diagnosis and condition in the DSM (the Diagnostic and Statistical Manual, which psychiatrists and psychologists use to diagnose mental illness) in order to maintain coverage for mental illness.”

The statement goes on to list multiple reasons why it likely it will be difficult to pass a mental health insurance parity bill this year. “Among the differences that the House and Senate will have to resolve to get a bill that can be enacted this year are:
“• DSM Mandate – The requirement in the House bill dictating that if a group health plan offers coverage for any mental health or substance abuse disorder, then the plan must cover every diagnosis and condition in the DSM.  The Senate contains no such mandate;
“• Preemption of State Mandates – The House bill contains a provision that would supersede state laws that require coverage of mental illness defined as less than the entire DSM;
“• Out of Network Coverage – Both bills require equity in treatment limits and financial limitations for out of network coverage. However, the House bill goes further in requiring out of network coverage for mental health and substance abuse if it exists on the medical-surgical side; and
“• Management of Benefits – The Senate bill contains language allowing group health plans to manage benefits through utilization review and medical necessity.  While the House bill allows such benefit management, it goes further by requiring disclosure of plan information regarding medical necessity determinations.”

The Bush Administration goes on, saying, “It is important to note that both bills exempt from parity [those] employers and group health plan sponsors with 50 or fewer workers, and that both plans authorize a cost increase exemption that would allow plans whose premiums rise more than 2 percent as a result of compliance to waive the parity requirement for one year (after which time the plan must come back into compliance).”

In English, that means “blah blah blah.” What our legislators, and no doubt Big Pharma, are concerned about is money. “Under recently revived budget rules Congress must ‘pay for’ any change in federal law that results in higher entitlement spending or lost revenue with an ‘offsetting’ cut in another program,” the Bush administration’s statement reads. “In the case of [mental health insurance] parity, tax revenue will be lost to the government as health spending that is now made by families with after-tax dollars shifts to before-tax dollars. For example, spending now excluded from health plan coverage (e.g. because of arbitrary limits on inpatient psychiatric care that would not be allowed under parity) would be covered by health plans with pre-tax dollars.”

Other issues include Medicaid rebates for mental health treatment, including those for prescribed medications. And to make it even more difficult for the mentally ill to be treated fairly by insurance companies, the House added a separate and completely unrelated piece of legislation to the parity bill, called the Genetic Information Nondiscrimination Act (GINA, HR 493), according to NAMI. This bill is designed to address the misuse of personal genetic information and has been floating around Congress for years. Without this addition, it is possibly mental health parity could become reality sooner. But, as many of us know, legislative add-ons often pop up after a bill has been passed and such add-ons can delay passage of the primary legislation for months, even years.

So, at what point will mental health parity become reality? Right now, no one knows. But with suicide rates climbing each year, one would hope that Congress takes action sooner rather than later to pass fair and meaningful legislation. According to the American Foundation for Suicide Prevention and the Centers for Disease Control and Prevention, in 2005 (the most recent data available), there were 32,637 reported suicide deaths in the United States. “Based on the 2005 data, suicide remains the 11th leading cause of death in the United States,” according to the AFSP/CDC report. “It remains the third leading cause among our nation's youth, the fourth leading cause of death among adults 18 to 65. Individuals aged 65 and older account for 16 percent of all suicides.”

The AFSP reports that every 16 minutes someone dies by suicide. Though suicide attempts are not reported, it is estimated that close to one million people make a suicide attempt each year. Research has shown that 90 percent of people who die by suicide have a diagnosable psychiatric disorder at the time of their death, most often unrecognized or untreated depression.

If that’s not a case for mental health parity insurance legislation that would help those who need any level of psychiatric or psychological care, I can’t imagine what is.

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