Act will improve access to mental health treatment
For decades, insurers have provided less coverage for mental health than for diseases like cancer or diabetes -- often imposing stricter limits on treatment, higher co-payments and higher deductibles."It was totally unfair and inappropriate. Frankly, it was a clear demonstration of the stigma people place on mental illness," said James T.R. Jones, a University of Louisville law professor with bipolar disorder. "It was gross discrimination."
But a new federal law, due to go into effect in just over a year, promises to level the playing field for many of the 58 million Americans a year who suffer from mental disorders.
The Mental Health Parity and Addiction Equity Act -- passed as part of this year's bailout legislation -- will require employers and insurers to cover mental health and substance abuse at the same level they cover physical health.
"It will be a great thing," Jones said.
Since 2000, Kentucky has had its own mental health parity law, but it doesn't apply to a key group covered by the new law -- workers at self-insured companies that use their own money to pay health insurance claims. These companies, which are almost always large, employ about a third of Kentuckians who get insurance through their jobs.
Indiana also has a parity law, but both states exempt employers with fewer than 50 workers, as does the new law.
Despite the exclusion for small companies, the new law expands coverage for 113 million Americans, according to the Virginia-based advocacy organization Mental Health America.
Its overall financial impact is unclear, although many mental health experts say it may save money by getting people into care early so they don't wind up in emergency rooms with a crisis. The Congressional Budget Office estimates the law will push up insurance premiums by two-tenths of 1 percent -- or about $23 a year for an average family premium of more than $11,000. And Humana spokesman Jim Turner said costs associated with the new law "will have minimal impact on Humana health-plan members or Humana's operations."
Although no one says the law will cure all problems with mental health care, several patients and professionals said it's a step toward changing the way society views mental illness and making care more accessible to sufferers.
"I think it's one of the most positive things to happen in recent times for mental health," said Michelle Spurlock, vice president of nursing at Our Lady of Peace, a Louisville psychiatric hospital. "I can only hope it breaks down the stigma that still exists."
Cost of treatment
Experts said many Kentuckians and Hoosiers now skip mental health care because of cost.
Nationally, Mental Health America estimates that 67 percent of adults and 80 percent of children needing mental health care don't get it, "in large part because of discriminatory insurance practices."
Many patients also are forced to cut their care short.
Bonnie Rosenblatt said she was getting help at a psychiatric hospital this summer when she reached her health insurance limit -- about 20 days of care. Her doctor wanted her to stay, she said, but she couldn't afford to.
"I felt pretty desperate. I felt sick," said the 60-year-old former teacher from Louisville, who was in an outpatient program to treat her disorders. "I wasn't ready to leave yet."
Insurers not only place limits on days; some also set high co-payments for mental health. Spurlock said she has seen co-payments as high as $500 that must be paid up-front.
Spurlock said Our Lady of Peace keeps hospitalized inpatients as long as medically necessary even if insurance runs out, negotiating payment plans or relying on charity care. But she said people sometimes choose to skip needed outpatient care.
"We've seen some decrease in our outpatients. People are choosing to go for fewer days," she said. And many mentally ill patients wait to seek care until they are seriously ill, resulting in more of them ending up in emergency rooms.
Even before mental health benefits run out, people are finding it increasingly difficult to use them. A growing number of psychiatrists and psychologists, citing low reimbursement rates and problems with claims, are choosing not to take insurance or to only take certain types, said Dr. Jon Marhenke, an Indianapolis psychiatrist and immediate past president of the Indiana State Medical Association.
Rosenblatt said her psychiatrist doesn't take her insurance, and she must pay $95 a month out of pocket for the care. That's part of the $500 a month she pays for mental health care overall.
"I'd like them to treat mental health issues like they do physical problems," Rosenblatt said. "It's not equal."
The new law -- which takes effect January 2010 -- will change coverage in many ways, affecting treatment limits, out-of-pocket costs, co-payments, co-insurance (the percentage people pay toward care) and deductibles. It applies to substance abuse treatment as well as mental health.
It's still unclear exactly how many people in each state will be newly covered because it's difficult to calculate the number who would be affected beyond those working for self-insured companies. Several mental health advocates said the law is not a panacea. Besides not applying to small businesses, there are no requirements about which conditions must be covered. There's also a "cost exemption" if a health plan can prove that parity raises its total plan costs by more than 2 percent the first year and 1 percent afterward.
Some insurers, such as Humana and Anthem Blue Cross and Blue Shield, have expressed support for the law, as have advocates.
"It is a huge step forward in terms of improving access to treatment," said Ramona Johnson, CEO of Bridgehaven Mental Health Services, where Rosenblatt said she's now getting good care. "It hopefully will change our culture's attitude about mental illness."
Reporter Laura Ungar can be reached at (502) 582-7190.