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June 27, 2008
Mental Health Parity to Filibuster?
For those in the know, there are two bills that advocate for mental health parity; e.g.: the senate and house versions. The senate bill S 558 was passed last September, and the house passed it’s version “The Paul Wellstone Act” HR 1424 this March. Not surprisingly, there are key differences between the two bills. The most notable is the fact that the senate version does not allow parity for all diagnoses outlined in the DSM (the diagnostic manual psychiatrists and other mental health providers use). Reflecting on my own experience as an outpatient psychiatrist, the main gap in the senate version is the exclusion of equal benefits for treatment of addictive disorders, and probably eating disorders as well.
Big business and America’s Insurance Plans support the senate version. CEO and President of AIP states that the house bill will “turn back the clock on advances in the quality care and impose excessive costs on patients and employers. The (house bill) will undermine the progress that has been achieved in behavioral health benefits through coordinated-care strategies.” Coordinated-care strategies—otherwise known as pre-authorizations, utilization review and other tactics insurance companies use to deny benefits!
The CEO of AIP continues, “the (senate bill) is a balanced approach that would preserve access to health plans’ medical management (translation: deny benefits) and quality-improvement (translation: cost containment) programs.”
The (Bush) “administration has concerns with HR 1424, which would effectively mandate coverage of a broad range of diseases and conditions and would have a negative effect on the accessibility and affordability of employer-provided health benefits and would undermine the uniform administration of employee benefit plans… the administration strongly opposes House passage of HR 1424 or any legislation that expands benefits and remedies beyond what is included in the Senate-passed S 588."
Uniform administration of employee benefit plans, who are they kidding? There is nothing uniform in administering these plans, both patients and their physicians struggle on a daily basis to understand exactly what mental health benefits are available. Try calling an insurance company to advocate for your patient and see how much time it takes before you reach someone who can handle your query (or isn’t too difficult to understand because English is their second language)
James Scully, MD, medical director and CEO for the APA (American Psychiatric Association), called the passage "historic." "We're very pleased and applaud finally that, after many years — indeed decades — of trying to end discrimination against people with mental illness in the insurance world, this bill passed the House. It's long overdue, but we know it's been a long struggle to educate people that mental illnesses are real and diagnosable and treatable the same way as other medical illnesses."
Does Dr. Scully realize that the House AND Senate must pass this legislation e.g.: agree on which version to adopt? The differences in the two versions have caused division among even those who would support the concept of mental health parity and who have already said they would support the Senate bill. In a report Mar 6, WebMD noted that several conservative senators have threatened to block the House and Senate from meeting to reconcile the bills.
References/ links:
http://www.uschamber.com/issues/letters/2008/080304_wellstone.htm
For more information: www.politico.com/news/stories/0708/11805.html
Robin Stone, M.D.
www.insight-psychiatry.com
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
