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| | Congress considers relief for mentally ill
Sunday, Jul 4, 2004 By Alison Vekshin Stephens Washington Bureau WASHINGTON -- As a psychologist working in Fort Smith, Anitra Fay says she has watched with distress as mental health service has deteriorated in Arkansas, with doctors leaving their practices, psychiatric departments closing and patients having to travel outside the state for treatment. To Fay, the reason is clear: Businesses are failing to provide their employees with adequate insurance benefits for mental health care. "I see people who can't get treatment because they can't afford it because their insurance won't cover it," said Fay, president of the Arkansas Psychological Association. "It will cover them to get their appendix removed, but it won't treat them for an anxiety disorder." Fay left the Fort Smith-based Sparks Health System, the second largest hospital in Arkansas, on July 1 for private practice. As evidence of a larger trend, Fay noted, Sparks closed its adult psychiatry department last year, leaving it with a geriatric mental health program that will staff two psychiatrists and two psychologists. The issue has spurred a national debate, pitting mental health groups against the business community. Both sides have been aggressively lobbying Congress over legislation that calls for parity in insurance coverage. The "Senator Paul Wellstone Mental Health Equitable Treatment Act" bars group health plans that provide mental health benefits from imposing treatment limitations or financial requirements not imposed on coverage for physical illness. Jeanne Parham, senior vice president of the Sparks Health System, said the insurance gap is only part of the reason for changes in mental health services. The advent of managed care has limited choices for patients and made it more difficult for providers to gain adequate payments generally from insurance companies. A growing number of uninsured patients and a shortage of beds for mentally ill patients also have been discouraging trends, she said. Vista Health in Fayetteville is the only psychiatric hospital remaining in western Arkansas, said Don Adams, vice president of the Arkansas Hospital Association. The Sparks system and the Northwest Medical Center in Springdale closed their psychiatric units in recent years. "These units close because they can't get reimbursed for the adult population that has no means of payment," Adams said. Nationwide, an estimated 22.1 percent of Americans ages 18 and older -- about 1 in 5 adults -- suffer from a diagnosable mental disorder, according to the National Institute of Mental Health. Untreated mental illness costs $300 billion a year in health care and lost productivity, the institute says. The numbers have underscored the debate in Congress on the Wellstone bill, which is sponsored by Sen. Pete Domenici, R-N.M. The bill was named after the late Minnesota Democrat who championed the legislation for years before he perished in a plane crash in 2002. The measure calls for deductibles, co-payments and other cost-sharing requirements to be equally applied to mental and physical health insurance coverage. In addition, the bill says treatment limitations applied to the number of visits or days of coverage and treatment frequency should also be comparably applied. Small businesses with fewer than 50 employees who offer a group health plan would be exempted. But the measure has drawn fierce opposition from business and insurance groups, who call it an unfunded government mandate. They fear it could raise insurance costs to the point where it would be cost-prohibitive for some employers to offer insurance coverage. They cite a 2002 Congressional Budget Office memorandum estimating parity would increase mental health costs between 30 percent and 70 percent. Insurers oppose the idea of the government dictating what benefits they offer to their customers. "The bill will raise health care costs for an employer, and that is likely to affect employees if not in terms of paying more for health care, they would get less of a salary increase," said Kate Sullivan Hare, executive director of health care policy at the U.S. Chamber of Commerce. Nicholas Meyers, director of government relations at the American Psychiatric Association, said the difference in coverage is "blatantly discriminatory." As for cost, "we are talking pennies per employee per day," Meyers said. The bill's supporters point to a 2001 Congressional Budget Office report that said parity would increase premiums for group health insurance by an average of less than 1 percent. In Arkansas, the discrepancy in coverage has contributed to a slow decline in the number of new psychologists registering each year, said Janet Welsh, executive secretary of the Arkansas Psychology Board. The state licensed 31 new psychologists in 1995, compared with 19 licensed in 2003, Welsh said. "There's a decline, definitely," she said. "Mental health parity is a factor. It stands to reason." Dr. G. Richard Smith, chairman of the psychiatry department at the University of Arkansas for Medical Sciences, said Arkansans do not have access to many specialized mental health services. "Because of the low rate of insurance in Arkansas and the lack of parity, it's very hard to build out those services in the state," Smith said. "So people who can afford the services go some place else." The consequences can be debilitating and even deadly, he said. Illnesses like depression can lead to suicide attempts, days missed at work, homelessness, and alcohol and drug abuse. Arkansas is one of 26 states that already has a mental health parity law on its books, although its effectiveness has been spotty, officials said. The Arkansas law was enacted in 1997. But it was written with a caveat that has limited its reach. An amendment allowed parity between coverage for mental health and physical ailments only if the added benefits increased costs less than 1.5 percent. That provision gave companies a loophole, said Robbie Thomas-Knight, a Little Rock psychologist in private practice who led a committee that helped craft the bill. Thomas-Knight also is the director of professional affairs at the Arkansas Psychological Association. "The way it's been interpreted is all they have to do is say to the Insurance Department is 'Our experts say it will cost more than that so we're not going to do it,'" Thomas-Knight said. "Even though we've got the law in the books, we're going to have to go back and put teeth in it to require participation," she said. "In effect, it hasn't been implemented." Ron Russell, president and chief executive officer of the Arkansas State Chamber of Commerce and Associated Industries of Arkansas, called insurance parity "another mandate," noting that Arkansas is one of five states with mandates on health insurance. Russell said requiring mental health insurance parity would drive up health care costs from 4.5 percent to 7 percent. "Our theory is that a lot of good companies that want to try to provide health care coverage would be forced not to offer it," Russell said. State Rep. Jay Bradford, D-Pine Bluff, who sponsored the parity legislation while he was in the state Senate, said the state legislature may revisit the issue if the federal bill is not enacted. Despite apparent strong support in both the U.S. House and the Senate, the Domenici bill has failed to reach the floor of either chamber. The bill has 68 co-sponsors in the Senate, including Sens. Mark Pryor and Blanche Lincoln, both D-Ark. Introduced in the House by Rep. Patrick Kennedy, D-R.I., the bill has the support of 246 co-sponsors, including Arkansas Reps. Mike Ross, D-Prescott, Marion Berry, D-Gillett, and Vic Snyder, D-Little Rock. Rep. John Boozman, R-Rogers, opposes the measure because of its cost, spokesman Patrick Creamer said. President Bush endorsed mental health parity in a 2002 speech in New Mexico, saying "our health insurance system must treat serious mental illness like any other disease." Its supporters say House Speaker Dennis Hastert and others in the Republican leadership have stood in the way of the bill's enactment. "The speaker has some very real concerns about the cost to consumers, to the industry and to people who are trying to provide health insurance," said Hastert spokesman John Feehery. "He needs to be satisfied this is not going to put terrible burdens on consumers and make it more difficult to get the uninsured insured." A mental health parity bill passed Congress in 1996, and went into effect in 1998. The law equalized lifetime limits and annual limits in mental and physical health benefits for plans that offer both. But mental health advocates criticized it for not addressing the loophole in out-of-pocket payment limits such as co-payments and deductibles. Supporters say the bill's future remains uncertain this year. "It's hard to get legislation that has any degree of controversy attached to it passed in an election year," said Ron Honberg, legal director for the National Alliance for the Mentally Ill. Meanwhile, Domenici spokesman Chris Gallegos said it's a matter of Majority Leader Bill Frist, R-Tenn., finding a time suitable to bring it up "because the legislative schedule is being very constricted as we move ahead." -- 30 -- |
