MENTAL HEALTH PARITY

June 1999
		Should health insurance agencies have to cover treatment for mental health? The president of the Health Insurance Association of America, Chip Kahn, and the executive director of the National Alliance for the Mentally Ill, Laurie Flynn, take your questions.

Forum Introduction What is included in the Domenici-Wellstone measure? How will private policies react to federal changes? Does parity really drive up costs? Is expense the deciding factor? How much coverage do people have now?

Anna Holbert of Seattle, WA, asks: What kind of coverage does the Domenici-Wellstone measure require? Is it likely to be approved? Chip Kahn responds: The current Domenici-Wellstone proposal, S. 796, requires that any limit on the number of in-hospital days or on the number of outpatient visits covered for mental health treatment must not be more restrictive than the limits on the number of inpatient days or outpatient visits for medical and surgical treatments. This is an expansion of the Mental Health Parity Act of 1996, which requires that any annual or lifetime limits on total benefit payments for mental health treatment must be no less generous than the equivalent limits for medical and surgical treatments. In addition, for "severe biologically-based mental illness" there can be no coverage limits that are more restrictive than the equivalent limits for medical and surgical treatments. It is important to note that neither this proposal, nor the existing Mental Health Parity Act, requires employers to include coverage for mental health treatments in their benefit plans. However, if such coverage is included it must meet the benefit requirements noted above. If the cost of mental health coverage becomes prohibitive, employers are free to drop it entirely from their benefit plans. The bill has been referred to the Senate committee on Health, Education, Labor and Pensions. No floor action has yet been taken on the bill. Laurie Flynn responds: First, it requires health insurance parity for the most severe, biologically-based mental illnesses, such as schizophrenia, bipolar disorder, major depression, obsessive-compulsive and panic disorders, post-traumatic stress disorder, autism, and other severe and disabling mental disorders such as anorexia nervosa and attention-deficit hyperactivity disorder (ADHD). Health plans would no longer be allowed to impose unequal restrictions on annual or lifetime benefits, inpatient hospital days, outpatient visits or out-of-pocket expenses. Second, the bill would prohibit limits on the number of inpatients hospital days and outpatient visits for all mental health treatment in general. The bill only would apply to health plans that already provide mental health benefits. Small businesses that provide health insurance to 25 or fewer employees also would be exempted. In essence, the bill requires equal treatment for mental illnesses which are just as much "physical" disorders as diabetes or coronary disease. NAMI is hopeful that Congress will approve the legislation before adjourning for the 2000 elections. There is a growing, bipartisan movement that supports parity. Since 1991, 25 states have enacted parity laws, which have been signed by both Democratic and Republican governors, including Texas Governor George W. Bush. Six states have passed such laws to date in 1999. The clear trend of bipartisan consensus is the priority given to the most severe mental illnesses, which matches the approach of the Domenici-Wellstone bill.

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