June 21, 2018
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A measure that ensures treatment

By David S. Proffitt, Special to the BDN

People affected by persistent mental illness, although challenged, can and do live lives of great value and purpose. Denying them access to necessary services is biased, unnecessary and wrong.

Two exciting developments related to health care reform in the mental health arena are occurring. One is the implementation of insurance parity. The other is a bill being introduced in Congress by Sen. John Kerry, D-Mass., and Sen. Olympia Snowe, R-Maine. Both are aimed at treating people with mental health conditions with respect, dignity and equality.

Several weeks ago the Obama administration issued 154 pages of regulations governing implementation of a sweeping new federal law designed to guarantee parity in insurance coverage. The law, passed with broad bipartisan support and signed into law by President George W. Bush in 2008, is called the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. This measure is widely regarded as the last major piece of health legislation passed by Congress. The rules, which are subject to a comment period, are scheduled to take effect July 1.

An estimated 140 million Americans, most of them covered by group insurance plans provided by employers, are the beneficiaries.

No longer can insurance companies have higher deductibles, steeper co-pays and service limits for mental health and substance use conditions as opposed to other health conditions. The law applies to groups of more than 50 employees and is designed to end what Health and Human Services Secretary Kathleen Sebelius called “needless and arbitrary limits on care.”

The law does not apply to individual insurance policies, nor does it require group plans to provide mental health and substance abuse treatment, although most do.

On the cost side, the equality in mental health coverage is expected to have a minimal effect on health insurance costs. Many employers now recognize that managing chronic diseases, including mental illnesses, makes economic sense because employees are more productive.

Mental health advocates applauded the rules, which will help ensure that Americans living with schizophrenia, bipolar disorder, alcoholism and other conditions receive the same intensity of care that a person with diabetes can access.

These are serious conditions from which people do recover. Limiting their treatment options only makes that recovery more difficult.

This law reduces the likelihood that Americans will have to endure a bankruptcy trying to pay for treatment for themselves or their child.

A second reform was initiated on Feb. 24. Sens. Kerry and Snowe, both important members of the Senate Finance Committee, introduced the Medicare Mental Health Inpatient Equity Act (S 3028).

This important legislation seeks to end a barrier imposed to those who are affected by chronic mental illness.

Currently, unlike people with potentially chronic health care conditions, people with Medicare are limited to 190 days of inpatient psychiatric care during their lifetime. Although many people with Medicare are those under 21 or over 65, about 8 million are people in between and are considered disabled.

Many people who are facing complex, persistent, challenging mental illnesses are hitting this Medicare limit and losing essential crisis hospital stabilization services just when they need them the most. Just like many health conditions, persistent mental illness may necessitate short, recurring hospitalizations over the course of a lifetime.

Recently, Sens. Snowe and Kerry wrote, “This arbitrary cap on benefits is discriminatory to the mentally ill as there is no other lifetime limit for any other Medicare specialty inpatient hospital service.”

Clearly ending bias and enhancing equality is always the right public policy.

David S. Proffitt is president and CEO of The Acadia Hospital in Bangor.

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