Legislators Debate Expanding Mental Health Coverage
May 18, 2000 (Washington) -- With federal rules regulating insurance coverage of mental health treatments set to expire in September 2001, members of the Senate on Thursday took up the issue of whether more stringent standards are needed.
Since passage of the Mental Health Parity Act of 1996, the proportion of U.S. employers offering at least partial mental health benefits has grown from about 55% to 86%, according to the General Accounting Office (GAO). But the increase has been accompanied by complaints from health-care professionals about the limits insurance plans set on these benefits, and by complaints from insurers about the costs.
Denying coverage is tantamount to discrimination, say proponents of expanding the current limits. "For far too long, mental illness has been stigmatized or viewed as a character flaw, rather than as the serious disease that it is. Too often we try to push the problem away, deny health insurance coverage, or blame those with the illness for having the illness," says Sen. Paul Wellstone (D-Minn.), who along with Sen. Pete Domenici (R-N.M.), has introduced legislation aimed at ensuring greater coverage for mental illnesses.
Denying more coverage would be hypocritical, since mental illness is treatable, says Steven Hyman, MD, director of the National Institute of Mental Health. "We can make the diagnosis with certainty," he says. "We have found no reason, based on biomedical or behavioral science, why mental disorders should be treated differently from any other medical disorder."
But mental health benefits increase the cost of health insurance and as a result, such benefits increase the number of Americans who have no health insurance, insurers say. "We cannot vote on the one hand to expand insurance coverage and increase the cost of liability insurance, and then go out in an election year and point the finger elsewhere for the increase in insurance costs," says Dean Rosen, general counsel for Health Insurance Association of America (HIAA). HIAA is a trade association that represents the nation's largest insurers.
The costs could also be prohibitive for many employers, says Tara Wooldridge, manager of the benefit program at Delta Air Lines, which offers comprehensive mental health benefits. While Delta is an advocate of expanding access to mental health benefits, the company is not confident that the complex factors involved in providing these benefits can be addressed with federal legislation, she says.
Based on the experience of Vermont, where the nation's most comprehensive bill for mental health coverage was passed in 1997, the increase in premium costs could amount to about 3.4%, says Ken Libertoff, PhD, director of the Vermont Association for Mental Health. The costs might be even lower for managed care plans, he says. Estimates had reached as high as 12% before Vermont's legislation was passed.
Only about 3% of respondents to a GAO survey of 863 employers reported that complying with the current federal law had raised their claims costs, says Kathryn Allen, an associate director of the GAO. But about 86% of the employer plans had at least one restrictive provision, such as limits on the number of outpatient visits and on hospital stays, that may have helped cap the costs, she says.
Twenty-nine states have now enacted mental health laws that are more comprehensive that the federal law, according to the GAO. The premium increases in these states ranged from 2% to 4%, with the largest increases experienced by fee-for-service plans and the smallest by health maintenance organizations.