Mental health parity may finally become a reality

The Wellstone Act could bring better health care to millions of Americans

Mental health parity may finally become a reality
Andrew J. Nilsen

Katie Bird thumbs through a stack of opened envelopes, at least a hundred deep, on the coffee table in her lawyer's office.

"These weren't even all my denials," she explains. "Just the ones we saved."

Behind her are three accordion folders overflowing with more paper, the remains of two years of war with her insurance company.

Katie Bird, framed by files from the long fight with her insurance company
Mark N. Kartarik
Katie Bird, framed by files from the long fight with her insurance company
Paul Wellstone at a parity rally in summer 2002, while Pete Domenici speaks
Paul Wellstone at a parity rally in summer 2002, while Pete Domenici speaks

The files chronicle the nine appeals where she begged her provider to cover treatment for her eating disorder. Among the insurance reviewer's reasons for denying care: "There are also religious groups who fast and that is not psychopathology."

"Insurance companies create the rules and change them to suit their needs," says Bird's attorney, Elizabeth Wrobel. "Most patients simply give up and believe what the insurance company has told them, which is that they are not really sick or do not qualify for the benefits for which they have paid."

Bird's problems began at age seven, when she first thought she was fat. By age 13, her mother caught her with diet pills and sent her to the first of many treatment facilities. For the next 18 years, Bird cycled in and out of therapy.

In 2007, Bird had a daughter. Two years later, she was hospitalized for three weeks. She was 108 pounds and needed cardiac care. She knew she had to make a change.

"I was still working out in the hospital," Bird remembers. "I was going to bed at night afraid I wasn't going to wake up, and I didn't want my daughter to grow up thinking that was okay."

When Bird left the hospital, she entered treatment at the Emily Program. There, her team recommended residential care in order to break a lifetime of bad habits: 24-hour supervision onsite at the program. The Emily Program was a "preferred provider" in Bird's insurance company's network, and all four of her doctors agreed that the prescription was necessary based on how Bird's condition fit into the American Psychiatric Association's treatment guidelines.

But Bird's insurance company, United Behavioral Health — the behavioral care arm of Minnetonka-based giant United Health — wouldn't cover it.

Over the course of those nine appeals, UBH pulled out all the stops: Bird wasn't trying hard enough to get better, read one denial letter, and "needs to be taking responsibility for her own behavior." In another, Bird wasn't "actively psychotic, suicidal or homicidal," and so didn't need such a high level of care. Bird didn't meet UBH's own guidelines for care, went a third, though the company wouldn't clarify what those guidelines were.

"I find it so striking how differently my clients are treated in comparison to patients who require significant medical treatment," says Wrobel. "Imagine telling someone with breast cancer to try harder."

There's a federal law, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, that is supposed to do exactly what Wrobel describes: make insurance companies cover treatment for mental illness and addictions "on par" with how they cover physical ailments, an idea known as mental health parity.

It should have helped Bird before she ever landed in court. But since Congress passed the act in 2008, insurance companies haven't had to listen to it.

"I'm frustrated," says Sen. Al Franken, the latest Minnesotan to lead the parity charge. "The real problem is that the interim regulations are unenforceable. We've made hundreds of phone calls, written letters, but on the question of whether or not the intent of the law has been carried out, the answer is comme ci comme ca." Kind of.

On January 16, President Barack Obama signed 23 executive orders on gun violence. Four of them talked about mental health, and one of them pledged to finalize what the rules would be for the Wellstone Act.

When Congress first passed the act, the legislation was a landmark 12 years in the making.

"My dad always called it a civil rights bill," says Paul Wellstone's son, Dave. "It was a big deal."

The bill would have given 113 million Americans increased access to mental health care, according to SAMHSA, the U.S. government's substance abuse and mental health branch. In Minnesota, it would have affected about 40 percent of those with health insurance. That's nearly two million people.

And those big jumps in coverage would have come at minimal cost, many studies indicated. Reports from both the Surgeon General and the U.S. Department of Health and Human Services showed that parity laws would result in a less than 1 percent increase in overall health care costs. In 1999, when President Clinton ordered parity for federal employees' health care plans, the switch actually saved the government money.

The Wellstone law was passed with all this in mind, putting in place temporary measures that were supposed to last until 2010, giving regulators time to put together a final set of rules. But then those rules never materialized.

"People don't realize that until a law has a rule, it's not worth the paper it's printed on," says Jim Ramstad, who championed the bill in the U.S. House during his nine terms representing Minnesota's third congressional district.

Instead, the temporary guidelines have meant that insurance companies can interpret the law as they see fit.

Next Page »