Wednesday, March 28, 2007
Mental Health Parity Hearing Is DepressingDavid Hogberg writes:
Today I attended the Health Subcommittee hearing in the House of Representatives on "Mental Health and Substance Abuse Parity." Mental health and substance abuse parity means that if a health insurance program covers mental health and substance abuse benefits, it must cover them in the same way it covers benefits for other conditions. Thus, if an insurance company has a $20 co-pay to see a family physician, it cannot charge a higher co-pay to see a psychiatrist.
The bill in the House is sponsored by Patrick Kennedy (D-RI), who was also a witness at the hearing, as was his colleague, Jim Ramstad (D-MN). A similar bill has been introduced in the Senate by Senators Ted Kennedy (D-MA), Pete Domenici (R-NM), and Mike Enzi (R-WY).
Here are some observations about the hearing, in no particular order:* The hearing was a collegial affair, which is disheartening for those who favor limited government. No member of Congress challenged the witnesses on their testimony. Every one congratulated all the speakers on their courage and dedication to this issue. And it is little wonder. Patrick Kennedy's bill has over 250 cosponsors. The one in the Senate has 42. President Bush has indicated he would sign a mental health parity bill. No point in arguing when it's that close to being a done deal.
* During his remarks, Patrick Kennedy emphasized that substance abuse is a disease, and people are not at fault for having it. I couldn't help but think that was a tad self-serving.
* Jim Ramstad claimed that it is a "myth" that the mental health parity bill is a mandate. It's not a mandate, because "it doesn't force any insurance company to cover mental health benefits." It only requires them to cover such mental health benefits the same way as other benefits if they offer mental health coverage. I came to the realization today that the ability to twist logic is a prerequisite for holding elected office.
* Kennedy was in full social crusader-mode. He noted that there is a 35 percent high school dropout rate in parts of his state of Rhode Island, and a lot of that is due to kids who have parents who are depressed or abuse alcohol and drugs. He noted that 82 percent of those in prison are substance abusers. In addition to solving the problem of high-school dropouts and the prison population, he also argued that passage of mental health parity bill would have a "salutary effect" on the stigma of mental illness. Exactly how that will happen, well, he didn't explain. But who needs trifling details when you are busy saving society?
*Ramstad also claimed that it is a "myth" that this bill would impose any costs on employers and insurers. He pointed to a New England Journal of Medicine (NEJM) study that examined the experience of Federal Employee Health Benefits Program (FEHBP) when it adopted mental health parity. (CBO actually said that the Senate version of the bill, which imposes fewer requirements than the House one, would impose some costs. But why bother with contradictory evidence when you are busy saving society?) Anyway, the NEJM did find that six of the seven insurance programs in FEHBP did not see an increase in costs after adopting mental health parity. But here's the rub: those programs used managed-care organizations to act as gatekeepers to receiving mental health benefits. In other words, they kept costs from increasing by restricting access to mental health benefits. As the study noted, "Although spending increases resulting from the implementation of parity did not occur, neither did access to mental health and substance-abuse services increase." And the one insurance program that did see an increase in access? It didn't use a managed-care organization. So, insurance companies will cover mental health benefits equally, but, to control costs, it won't give you access to them. I wonder how long Congress will let that happen?
* Representative Xavier Becerra (D-CA) chimed in that in Los Angeles there are 80-85,000 homeless people, many of whom were suffering from mental illness. Kennedy then claimed that the Latina population had the highest rate of suicide of any ethnic group. Since homeless people don't have health insurance, and Latinas general have low rates of insurance coverage, it's not clear how a mental health parity bill would help them. They would have to get insurance. And, for the likes of Kennedy, Ramstad, Becerra and Subcommittee Chairman Pete Stark (D-CA), that would mean that the taxpayers would have to provide them with it. That leads to me to wonder if providing more government-run health insurance wasn't the real purpose of this hearing.
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Posted by Amy Ridenour at 12:17 AM