Suppose the typical U.S. health insurance plan didn’t cover treatment for cancer.
Or suppose most American insurance companies put annual and lifetime benefit limits on cardiac care, limits that didn’t apply to other ailments.
Imagine that the health plans still covering heart care applied higher deductibles to that treatment than to other health care bills.
These ideas are outrageous, yet they are reality for American families living with mental illnesses.
Federal legislation enacted in 2008 aimed to encourage “parity” between coverage for mental illnesses, chemical dependencies and other medical conditions. The legislation, known as the Paul Wellstone and Peter Domenici Mental Health Parity Act, was a step forward in recognizing that people with brain disorders need and deserve the same access to care as other patients. However, the law that passed was significantly weaker than what mental health advocates, including Wellstone and Domenici, have championed for many years. The law only applies to employer group plans with more than 50 employees. Larger employers still aren’t required to cover mental illnesses. The law just says that if they choose to cover mental illnesses, the coverage has to be equal to what is provided for other illnesses. State and local government plans can simply opt out of mental health parity.
The size of the parity law loophole shocked participants at the Montana State Conference on Mental Illness in Billings last week when Angela Kimball, director of state policy for the National Alliance on Mental Illness, ticked off a list of entities that opted out of parity: Montana state employee plan, Montana University System, Billings Public Schools and the city of Billings.
It’s been estimated that half of U.S. adults who have mental illnesses have insurance, Kimball said. But they may not have adequate coverage for their mental health needs.
Small wonder that mental health advocates are keenly interested in the Affordable Care Act that squeaked through Congress earlier this year. That law designates mental health care as an “essential benefit” that all health plans must cover in 2014. Kimball urged her audience at the Billings Crowne Plaza Hotel to speak up for mental health care as new rules and state laws are being considered.
The desire to work was a recurring theme in questions for Kimball at the Billings conference. As one Helena man told Kimball: “People want to work without having their benefits knocked down like dominoes.”
If people have Medicaid or other public health care services, they are limited in how much they can work. The system often gives them two bad choices: being totally dependent so they can get needed care or being totally cut off from services.
“We want people working and we want mental health covered,” Kimball said.
Considering how limited mental health coverage can be in private insurance plans, it’s not surprising so many seriously mentally ill people — adults and children — wind up in public programs to get services. Lacking the insurance that could help them stay healthy, people lose jobs. However, with income below poverty level and a disability designation from Social Security, adults may qualify for Montana Medicaid.
For the new federal health care law to truly cover the uninsured, it will have to ensure mental health parity. That ought to be a bipartisan goal in Congress and in the Montana Legislature. If every plan covered mental illnesses like other illnesses, fewer Americans would be forced into poverty and public programs. Meanwhile, more people could get the right care at the right time — and keep working.