Mental Health Parity and Health Insurance
Before I was diagnosed with depression and realized that I suffered from a mental illness, in my mind the most vital issue in terms of health insurance was whether I had it or not. I think you'd find that's the case for nearly everyone in America. If you have good health insurance, for the most part it's not something you think about, and you're pretty darn thankful that's the case.
However, once I started treatment for depression I became aware of one of the ugly aspects of the health insurance coverage I had thought was so complete. Not only were there limits on my mental health care in terms of number of visits allowed, both annually and for my lifetime, but my co-pay was higher for mental health visits than for other types of care. And I'm not just referring to talk therapy, which is always a 50 minute long appointment. Even a 5 minute medication check with my psychiatrist cost me more than a 45 minute long appointment with my gynecologist.
This type of inequity led to the Mental Health Parity Act, which was passed by Congress in 1996. The aim of the act was to ensure that mental illnesses were accorded the same treatment as physical illnesses. Here's an example of how this was supposed to work: if your insurer placed a $1 million lifetime limit on medical and surgical benefits, it couldn't place a $100,000 lifetime limit on mental illness benefits.
However, probably due to lobbying by the powerful health insurance industry associations, the act falls short in several ways, including an exemption for employers who employ fewer than 50 employees, and an exemption for any group health plan whose costs would increase by more than one percent. The act also doesn't apply to benefits for substance abuse or chemical dependency. These exemptions weakened the act and left loopholes that many employers could, and did, exploit.
Now two more bills are making their way through Congress that aim to plug these loopholes. The Paul Wellstone Mental Health and Addiction Equity Act of 2007 H.R.1424 and the Mental Health Parity Act of 2007 S.558 both have widespread support, even among major insurers. Because of this new attitude, I was hoping to hear some input from the presidential candidates on mental health parity reform. But so far things have been very, very quiet.
Over the years we've come close to having an administration that might have been proactive about mental health parity reform. The wives of Colin Powell, Al Gore and Michael Dukakis all have suffered from depression. Tipper Gore in particular was very outspoken about it and worked for mental health reform during the Clinton years.
Close, but no cigar. A presidential candidate has never made mental health parity a campaign issue. Realistically, I'm not surprised. The lineup of the usual suspects of campaign issues rarely changes substantially, especially when old favorites like the economy, "cleaning up" Washington and taxes are joined by a current war.
If the only explanation for the lack of interest presidential candidates show for mental health parity was too many other, more general, issues to deal with, I wouldn't mind. But I suspect that our country's attitude toward mental illness has something to do with it. Most people are uncomfortable talking about mental illness at all, and certainly it's a potential minefield topic for a presidential candidate. Why support a group of people who are thought of by the rest as nuts, whiners and malingerers?
I"ll try putting this in terms that many of the presidential candidates should understand. It's bad for America and bad for business to treat mental and physical health differently and unequally. Untreated mental illness is one of the highest causes of absenteeism, lost productivity and unemployment. Ironically, it is a chronic illness that is treatable. So if you ensure that mental health care is not limited, you increase productivity among American workers. Simple, right?
And here's another thing - a group that any presidential candidate will support and praise in a heartbeat is our military. Many of them are returning from Iraq and Afghanistan with mental and emotional disorders that they didn't have before they shipped out. Seems reasonable to assume that serving in a warzone contributed to a great extent, yet the military is discriminating against them in terms of their treatment and disability rights (I plan to expand upon this topic in the near future). After serving our country, don't these men and women deserve to get equal treatment for both their physical and mental illnesses? Or should they suffer because mental health parity is uneven?
Time will tell. We still have almost a year until the presidential election, and mental illness may become a popular issue. I think it's extremely unlikely, but stranger things have happened in election years.
Published On: December 19, 2007