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Mental Health Reform Just a Taste of Battles Ahead

Posted May 10 2010 12:00am

Major controversy is now in play over new rules issued by the Obama administration related to enforcement of a 2008 law requiring equal insurance coverage for the treatment of mental and physical illnesses. Both health insurers and major employers are lobbying the White House to delay and rework the rules on what is termed “mental health parity.” These groups supported the 2008 law, but now say the rules go far beyond the intent of Congress.  They argue that the new rules would severely damage and hamper their cost-control techniques while raising out-of-pocket costs for some patients. Patient advocate groups support the rules, saying they will eliminate many forms of insurance discrimination against people with mental illness. The rules are also supported by the American Medical Association, the American Psychiatric Association and House Democrats.

Mental disorders are very common in the US and worldwide.Some 26+% of Americans ages 18 and older or about one in four adults, suffer from a diagnosable mental disorder in a given year.Using the 2004 U.S. Census residential population estimate for ages 18 and older, this translates to 57.7 million people.  Based on the expected increase in population we will see when the 2010 census is complete, we can safely assume that the number of affected Americans is well in excess of 60 million.Even though mental disorders are widespread in the population, a much smaller proportion about 6%, or 1 in 17 suffer from a serious mental illness.Mental disorders are the leading cause of disability in the U.S. and Canada for ages 15-44.  Many people suffer from more than one mental disorder at a given time. Nearly half (45%) of those with any mental disorder meet criteria for 2 or more disorders, with severity strongly related to co-morbidity.

One area which has insurers particularly upset is the provision that requires them to maintain a single deductible for all medical and mental health services combined.  Currently many if not most have separate benefit packages for mental health care with separate deductible levels.  This change would be a significant one based on current industry practice. Health insurers argue that many mental health patients will face higher out-of-pocket costs because the combined deductible will almost surely be higher than the current one for mental health services alone.  That argument may be somewhat bogus, since many health plans limit mental health benefits overall.

Suffice it to say that mental health conditions are a major source of not only morbidity and illness, but lost work and wages for the nation. The failure of our system to adequately address these illnesses in the same manner as physical illness has been lamented for decades.  In fact, in may well be a gross injustice to refer to mental health problems and “physical illness” as if the two were separate entities, unrelated and without connection.  In fact, we now know that many forms of mental illness are in fact physical, based on brain chemistry and other factors which alter the brains response to stimuli and the environment.  Thus, mental illness is in fact, a physical ailment with real consequences that effect not only outward behavior and inner peace of mind, but also bodily functions and body maintenance.

We feel that insurers can make mental health parity work within the confines of their traditional policy structures, including single deductibles and uniform co-pay rules for ALL medical care, regardless of identity.  Just as their is no distinction between coverage of cardiac conditions and urological conditions, there should be no distinction for coverage of mental health conditions (psychiatric and psychological).  Real health reform means addressing real needs and mental health coverage, allowing for appropriate access to professional care is an unmet need.  The time has come for mental health coverage parity.  Health insurers need to adjust to this reality . . . obi jo and jomaxx

Fight Erupts Over Rules Issued for ‘Mental Health Parity’ Insurance Law – http://www.nytimes.com/2010/05/10/health/policy/10health.html?emc=tnt&tntemail0=y

The Devil is in the Details on Mental Health Parity Law – http://blogs.wsj.com/health/2010/05/10/the-devil-is-in-the-details-on-mental-health-parity-law/

Obama Administration Issues Rules Requiring Parity in Treatment of Mental, Substance Use Disorders – http://www.hhs.gov/news/press/2010pres/01/20100129a.html

The Mental Health Parity and Addiction Equity Act – http://www.cms.gov/HealthInsReformforConsume/04_TheMentalHealthParityAct.asp

45 CFR Part 146 Interim Final Rules Under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008; Final Rule -

http://edocket.access.gpo.gov/2010/pdf/2010-2167.pdf

Fact Sheet: The Mental Health Parity Act – http://www.dol.gov/ebsa/newsroom/fsmhparity.html

The Impact of Mental Illness on Society – http://www.nimh.nih.gov/health/topics/statistics/index.shtml

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