THURSDAY, May 15, 2003 (HealthDayNews) -- If you suffer from health problems such as heart disease, diabetes or chronic back pain, your insurance company will likely pick up much of the treatment costs.
If, however, you're among the one in five Americans who struggles with a mental illness each year, the chances of getting insurance to pick up a substantial amount of the treatment costs decline considerably.
Mental health advocates say insurers limit the number of therapy visits and sharply restrict in-patient treatment, while imposing higher co-payments and deductibles and lower patient spending caps than for any other medical condition.
"Employer-provided health insurance routinely treats mental illness very differently than other medical conditions and imposes barriers to treatment and imposes higher costs," says Ralph Ibson, vice president of government affairs for the National Mental Health Association (NMHA).
Now, a broad coalition of mental health advocates, including 255 national organizations, have lined up in support of federal legislation designed to require insurance companies offering mental health coverage to make the benefits on par with those for other medical conditions. The federal mental health "parity" measure failed during a congressional logjam last session, but drew support from some 300 members of Congress, most of whom still hold their seats.
Backers hope to refocus attention on the bill during May, which is Mental Health Awareness Month.
Nationwide, some three dozen states have mental health parity laws, but advocates say major loopholes still exist, including exemptions for companies that are self-insured.
A survey by the NMHA last fall showed 83 percent of Americans believe existing limits on mental health benefits and the resulting high out-of-pocket costs are unfair. Nearly 80 percent supported "parity" between coverage for mental illnesses and other conditions, even if that means paying higher premiums.
"I would analogize mental health parity to civil rights legislation," Ibson says. "There is something fundamentally unfair about arbitrary discrimination tied to a particular kind of illness."
A trade group representing health insurance companies, however, presents a decidedly different view.
Dr. Donald Young, president of the Health Insurance Association of America, says in a prepared statement that the federal measure is "a misguided effort to provide additional treatment resources for a wide variety of ill-defined and difficult-to-diagnose mental disorders."
The parity legislation, he says, would create a "blank check for mental health advocates" and drive up health insurance premiums, causing hundreds of thousands of Americans to lose their health insurance.
"At a time when health-care costs are soaring, the last thing employers and workers need is a new mandate that will make health insurance even more expensive," Young says, calling federally mandated parity a "hidden tax" on businesses and workers.
More than 90 percent of employers already provide mental health coverage for "significant conditions that cause functional impairment," Young says, and many offer help beyond traditional health insurance, such as employee-assistance programs.
Mental health advocates retort that huge gaps remain: Today, fewer than one in five Americans with mental illnesses get treatment any given year, the American Psychiatric Association (APA) says. That's true despite dramatic, well-documented improvements in treatment and recovery rates in recent years.
"Parity legislation for mental health coverage would be an important step forward," says Dr. Paul Appelbaum, president of the APA.
Appelbaum points to limits on the number of therapy appointments often imposed by health insurance companies. These limits, he says, result from insurance companies "abusing statistics" by basing therapy restrictions on how many sessions most patients attend.
"When that statistical model is applied as a straitjacket, to say everybody has to complete treatment within the typical number of sessions, then you end up with a rigidity that drives patients and mental health professionals alike to distraction," Appelbaum says.
Over-reliance on medications gives short shrift to the importance of therapy and reflects an ineffective, quick-fix approach, says James P. McCullough Jr., a psychologist who specializes in treating chronic depression.
This approach ultimately costs insurance companies more because patients who don't receive necessary therapy return for further treatment later, adds McCullough, a professor of psychology and psychiatry at Virginia Commonwealth University.
"This is America. We like french fries and fast food and instant healing," he says. "The repercussion is the patients don't get treated well."
Supporters of the federal measure say savings from successful treatment would more than offset costs of parity, which the Congressional Budget Office estimated last year would increase premiums less than 1 percent.
That's a small price, mental health advocates say. They point to figures from the U.S. Surgeon General showing mental illness costs U.S. businesses more than $70 billion annually in lost productivity.
Some business executives, too, say mental health parity makes sense economically. James Hackett, chairman, chief executive officer and president of Ocean Energy Inc., an independent gas exploration and production company in Houston, brought his case for parity to congressional lawmakers.
Testifying at a hearing on parity, Hackett said Ocean Energy and a few other Houston companies insisted on mental health parity in insurance plans.
"I do believe that in time, most business leaders will realize, as I have, that providing mental health benefits on par with medical and surgical care is good for the bottom line," he testified. "But quite frankly, we cannot afford to wait for that time. Mental health parity is good for American workers and good for the American economy."
More information
For more on mental health insurance parity, visit the National Mental Health Association. To learn more about President Bush's pledge to improve mental health coverage, check the President's New Freedom Commission on Mental Health.
