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| MENTAL HEALTH PARITY | |
 June 1999 
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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. |
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David
Irish of Tucson, AZ, asks: The question is should healthcare insurance providers be allowed to deny coverage of any medical conditions on the basis of cost alone. Laurie
Flynn responds: Parity is not just about insurance and is not just a cost issue. First and foremost, parity is a civil rights issue. The Domenci-Wellstone legislation is intended to eliminate discrimination against persons who suffer from biological brain disorders through no fault of their own. It is part of a broader struggle for justice and an end to stigmatization. Chip
Kahn responds: Health plans routinely cover very expensive conditions, such as cancer and severe trauma. Health plan sponsors and administrators are not primarily concerned by the possibility that a particular condition may be quite expensive, nor by the possibility that multiple treatments may be necessary. They are concerned about their ability to properly manage and adjudicate the claims; in other words, whether the risk is "insurable" in the traditional sense. For mental health in general, a primary concern is variability in treatments for the same mental condition, without acceptable explanations for that variability. Healthcare insurers provide coverage for the types of services that the purchasers of their policies choose to pay for. Because of concern for costs, some employers must limit the benefits they can afford to pay for their employees. Employers also are reluctant to pay for treatment when it is difficult to determine when treatment is needed, what kind of treatment is needed, and whether or not it will do any good. Because of this, plan sponsors and administrators are skeptical of their ability to determine when treatment is indicated, which treatment is appropriate, and whether or not treatment is likely to be effective. These considerations are not unique to private health insurance sponsors. Neither Medicare nor Medicaid currently provide parity in mental health and substance abuse benefits relative to benefits for physical illness. The Congressional Budget Office has estimated that providing mental health parity within Medicare and Medicaid would cost the federal government roughly $135 billion over a six year period.
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