Insurance Sought For Idaho’s Mentally Ill Advocates Face Uphill Battle To Convince Lawmakers To Require Insurers To Cover Mental Illness Like Other Major Diseases
Zina McGee opened the mail one day and found a $52,000 bill from the state of Idaho. The bill was for one year of care at State Hospital South for her son, who is schizophrenic.
“That was more than everything I had,” McGee said. “If I had had to pay it, I would have lost everything.”
Because her son is an adult, McGee didn’t have to pay it. She’s lucky. Thousands of other Idaho families are trying to figure out how they will pay for the care of mentally ill relatives.
In most cases, health insurance isn’t readily available to pay for mental health care. And when it is, it is quickly depleted, leaving patients and their families struggling to pay for the expensive, long-term care so often needed.
In McGee’s case, her son’s insurance offered only a maximum of $25,000 in mental health coverage - less than half the cost of a year at the state hospital.
Insurance companies that do pay for mental health care usually cover only about 50 percent of treatment costs, compared to 80 percent for most other illnesses, McGee said.
That’s why McGee and others in Idaho have been pressing the Legislature to pass a bill mandating insurance parity for mental illness. If passed, such a bill would require companies to offer mental health care coverage at the same benefit rate they offer for other serious illnesses.
But five times in the past five years, efforts to sell the Legislature on the idea have failed, said Ardia Johnson, a Boise woman who represents the National Alliance of the Mentally Ill in Idaho and several other western states.
“It is an issue of moral justice,” said Johnson, who suffers from depression and is considered mentally ill. “Mental illness is a brain disorder, a physical illness every bit as much as Parkinson’s disease and epilepsy, so why is coverage for its treatment especially carved out for limitation?”
Johnson attributes part of the problem to a lack of education.
Most people don’t know or understand that mental illnesses are, in fact, physical illnesses. It took Johnson and others from the alliance three years of visits to the Legislature to make that point. Now her job is to get legislators to understand that paying for mental illnesses through insurance premiums ultimately will save money for both the state and for private enterprise.
“Just as with any other illness, early diagnosis means early treatment and the earlier the treatment, the better the recovery and the more people we can help before they slip into devastating illness, which becomes very expensive,” she said.
A mandate from the Legislature would ensure companies were including mental illness coverage in their health plans and force insurance companies to offer coverage rates equal to those for other kinds of illnesses.
“Nobody likes the word mandate, but mandates can be a good and necessary thing when people aren’t doing what’s right,” Johnson said.
“And you can’t talk about this without talking about the public health system.
“When there is no coverage, at some point these folks are getting dumped into the public system, costing the state more and more. We’re going to pay for this one way or another.”
That’s the case with McGee’s son. His illness was so debilitating that he could not continue working and lost his health insurance. Since his diagnosis of schizophrenia almost 20 years ago, the state has paid for all of his care.
Mental health advocates say Idaho’s insurance industry is standing in the way of any kind of mandate. Industry leaders argue a mandate would send insurance premiums through the roof.
Actuaries for insurance provider Blue Shield anticipate premiums would jump an average of 10 percent, spokeswoman Lynn Darrington said. That’s too big a burden for companies to shoulder when the need for care is so limited, she said.
“Over the past three years, .003 percent of our subscribers have maxed out their mental health care benefits,” she said.
“Our concern is that this is a small percentage. The majority of our customers are not asking for this kind of care and a state law would pass costs on to those who are least able to afford it.”
That’s not to say insurance providers don’t think mental health benefits aren’t important, Darrington said. They recognize the need, but would prefer to see those benefits offered through a health maintenance organization.
“That would better control costs,” Darrington said. “Under a managed care environment, we project an increase of only about 2.4 percent.”
Johnson disagrees. In fact, she said, some 15 states have already passed insurance parity laws without seeing dramatic cost increases.
A 1995 survey conducted for the alliance of 57 New Hampshire insurance providers found that premiums remained flat or saw small to moderate increases. None of those companies attributed the increases directly to the 1995 parity legislation, the study said.
“We’ve got a real battle ahead of us to educate the industry,” Johnson said. “We are a state of small businesses with a lot of independent growers. But if we can pass legislation to get minimum wage for farm workers, we can do insurance parity.”
For some companies, it may not matter what the Idaho Legislature decides.
The Domenici-Wellstone Mental Illness Parity Provision, passed by Congress early last year and signed into law by President Clinton in September, will require all businesses with 50 or more employees to offer basic lifetime care and financial protection for the mentally ill.
The law also applies to companies that are self insured. It is a first step toward equalizing health insurance coverage for the mentally ill, Johnson said.
“It won’t do everything, in fact there are loopholes even in Domenici-Wellstone, but it is a start,” she said.
“Eventually, we will stop the discrimination. We have family members and advocates who are in it for the long run. We will not go away. We’ll be here until we get equality.”
xxxx Parity study After New Hampshire passed mental health parity legislation in 1995, the National Alliance of the Mentally Ill conducted a survey of 57 insurance providers. The survey found that premiums remained flat or saw small to moderate increases. None of the companies attributed the increases to the legislation, the study said.