Mental Health Benefits in Health Care Reform

Providing more mental health care will be costly. The bill for health care reform is expected to be in the hundreds of billions of dollars. Premiums could rise 1 percent to 3 percent for everyone if basic mental health benefits were mandated, and more for fuller coverage, according to the Council for Affordable Health Insurance, which represents small insurance companies.

"You'll probably run into people like the guy at Joe's Auto Body who makes $9 an hour and can't afford that," said J.P. Wieske, the council's director of state affairs. "That's the rub. You increase the comprehensiveness, and you probably make it unaffordable."

But there are costs now, advocates say. Mental health disorders and addiction cost U.S. businesses $171 billion a year in lost productivity, according to estimates from the Campaign for Mental Health Reform, an umbrella group for mental health advocates. That doesn't count costs to the criminal justice system, nonprofit groups and other public providers - or costs to society, advocates say.

When problems are left to linger, they only get worse, according to Mental Health America, a mental health and education association. People with mental health problems typically die 25 years earlier than the general population because they often have other untreated conditions such as diabetes, heart disease or cancer. Half the people with a mental health diagnosis have problems by age 14 but do not get treatment for a decade, leaving them less able to study and work, the group says.

The goal for mental health advocates is to go beyond basic coverage for the uninsured and attain parity with medical coverage. Those with mental health insurance now typically pay higher deductibles, pay more for drugs and are allowed fewer services, such as days spent in the hospital, said Kirsten Beronio, Mental Health America's vice president of public policy and advocacy. That will change in the coming months for some, however, because a law passed last year requires insurers that offer mental health coverage now to provide benefits on par with their medical coverage.

"We've battled discrimination for so long," she said. "We want to build on our progress and not go backward."

The major House version of the health care overhaul bill would require behavioral and addiction coverage on par with medical coverage for just about everyone. On the Senate side, the two major bills exempt smaller employers from providing coverage and one exempts some larger employers, too.

The Murky Politics of Mind-Body

Now a critical moment has been reached in a 15-year debate in statehouses and in Congress over whether treatment for problems like depression, addiction and schizophrenia should get the same coverage by insurance companies as, say, diabetes, heart disease and cancer.This month, the House passed a bill that would require insurance companies to provide mental health insurance parity. It was the first time it has approved a proposal so substantial.The bill would ban insurance companies from setting lower limits on treatment for mental health problems than on treatment for physical problems, including doctor visits and hospital stays. It would also disallow higher co-payments. The insurance industry is up in arms, as are others who envision sharply higher premiums and a free-for-all over claims for coverage of things like jet lag and caffeine addiction. Parity raises all sorts of tricky questions. Is an ailment a legitimate disease if you can’t test for it? A culture tells the doctor the patient has strep throat. But if a patient says, ‘‘Doctor, I feel hopeless,’’ is that enough to justify a diagnosis of depression and health benefits to pay for treatment? How many therapy sessions are enough? If mental illness never ends, which is typically the case, how do you set a standard for coverage equal to that for physical ailments, many of which do end?

House Approves Bill on Mental Health Parity

After more than a decade of struggle, the House on Wednesday passed a bill requiring most group health plans to provide more generous coverage for treatment of mental illnesses, comparable to what they provide for physical illnesses. The vote was 268 to 148, with 47 Republicans joining 221 Democrats in support of the measure. The Senate has passed a similar bill requiring equivalence, or parity, in coverage of mental and physical ailments. Federal law now allows insurers to discriminate, and most do so, by setting higher co-payments or stricter limits on mental health benefits.