Mental health parity may finally become a reality

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

Others, however, are more skeptical.

"The White House has promised 'later this year,'" says Ellen Gerrity. "But everyone knows that later this year can become another year. It's not a comfortable position to not have an exact date."

If regulations aren't approved by October, when the Affordable Care Act begins to take effect, then that will mean at least another year "of people not getting the care they deserve," says Dave Wellstone. "And the care they're entitled to under the law."

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

Wellstone isn't backing down until he sees President Obama's signature on final regulations.

"There are two schools on this," he told a group of University of Minnesota students at a recent action strategy meeting. "The first is to just let it happen. But I'm in the second, the school of keep pushing hard. It's been four years. We can't really sit around much longer."

Gerrity notes that Paul Wellstone, the man who inspired parity, wouldn't have been surprised at how much work remains to be done.

"Paul always talked about it as similar to civil rights, as a long march," she remembers. "It is a long march. And we're still walking it." 

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10 comments
land0218
land0218

I worked for Cigna for five years and saw all of this unfold on a daily basis.  Sometimes it was blatant, and other times it was a bit more confusing.  I completely agree that if a person has benefits and has not used them, then regardless of the level of care, especially if it is being recommended by an M.D., that person should be allowed to receive care for their issues.  If they have no insurance, that's another complicated matter.  

The one hang up, and I think this article pointed it out, is that when a person does not get the care needed, and they end up getting tossed around the system, getting "lower levels" of care, such as outpatient or intensive outpatient to save on cost, when the reality of it is that if they were simply allowed to receive a residential program from the beginning, maybe the years of hassle, other failed treatments, and expense could have been avoided.  Unfortunately, once you've maxed your benefits for the calendar year, forget it, your done!  And there is an abundance of elephant dung sized health care plans to see to it that you exhaust your benefits as fast as possible.  In other words, if your benefits renew calendar year starting in January, and your actively seeking help for you mental health or substance abuse  issues, you could conceivably max out by February, and spend the rest of the year without help or treatment, unless you keep paying out of pocket.  

This issue could easily be a 900 volume tome, and I could ramble on at great length, but I guess from the insurance perspective, they only do what is necessary to keep a human being alive and functioning (feed themselves, dress themselves, bathe)  at the bare minimum of expense, which I think is where the term "medical necessity" stems from.  And why the insurance companies have the power to determine this over the M.D. treating the patient, I will never know.  Mental health and substance abuse are not as easy a fix as mending a broken arm, or stitching up a wounded knee, they're much more long term, and progress can move very slowly.  If I may be allowed to be a bit of a hippie about it, my hope is that if we the human species have any hope of progressing further, and sustaining life on this planet, the cost, no matter what ridiculous financial figures they produce, would ultimately become a true non-issue.

...bit of rant I know, sorry, just wanted to get that out and add it to the discussion.  Thanks. 

markmywordz
markmywordz

There is an important technicality here that needs to be better explained.  Minnesota already has a mental health parity law so Minnesotans who buy health coverage from anything other than large employers were already covered by the parity law.

This new law was only for large employers who are exempt from all state mandates like mental health parity.  And, most important for these large employers, they don't actually buy insurance.  They are self insured so it isn't actually the insurance company issuing the denial, it's a third party administrator (many times an insurer who is running a TPA) that is implementing the coverages laid out by the employer.

So the complaints about the insurers not paying, should be more appropriately leveled at the employers who were not willing to pay.

Finally, there is a very important reason for claims denials.  It's to keep costs low.  While the call for better coverage is certainly worthy and nobody can deny it is very much needed, the problem is that it is extraordinarily expensive and most of these people want the treatment, but they want somebody else to pay for it.   The 'somebody elses' of the world would likely be more willing to pay for the care, if there was a way to make the care less expensive. 

senatortombstone
senatortombstone

You cannot get something for nothing. Insurance companies probably do not cover these mental maladies because they are difficult to define, diagnose, and successfully treat. Forcing insurance companies to do so at the point of a government gun is evil and will probably result in less coverage for the mentally ill and higher insurance costs for us all.

DonkeyHotay
DonkeyHotay topcommenter

Mental Illness = America's BIGGEST Health Care problem

hansengigi
hansengigi

the lines between illness and health are very blurry, and political.  my own doctor has told me to lose 60 pounds.  I cannot find success-- despite spending thousands of my own money on various plans and groups.  I would like to try total immersion (similar to the article's subject, a residential treatement plan).  However just like the other ways I've tried, insurance won't cover a dime of it. 

My point is this:  I am basically sort of healthy, but my asthma, depression, and blood pressure are getting worse, and I would be more productive and happier if I could lose weight.  But, Big Insurance doesn't see this as a problem, and won't pay to try to get me "healthier". 

It's not the middle-health people like me who get care, it's the extremely low-health people who get care, just like government benefits--  the middle class pay pay pay their taxes, but the low-income receive the majority of benefits.

AutismMN
AutismMN

Great article.  I hope people will start paying more attention to the laws that protect our most vulnerable people.  

hansengigi
hansengigi

@DonkeyHotay 

you replied to me "stop putting so much food in your mouth. Hope that helps."

Unfortunately, it doesn't help.  I have been faithfully on various low-calorie, low-carb, low-fat, etc diets, and none of them had any long-term success. 

What I need to be healthy will take more than "stop putting so much food in your mouth". 

Everything I've done with my own efforts has failed---that's why I need professional help. 

If a stomach-staple surgery would help lose the weight, reduce my asthma, blood pressure and depression/anxiety, then shouldn't I qualify for that?  But I don't weigh ENOUGH yet, so I don't qualify. 

It is really crazy how they restrict medical care only to the very sickest, or the very youngest, or the very poorest.  Those of us with jobs, sort of sick but not deathly sick, who are paying into Medicare & Medicaid, need medical care too, so we can keep paying for all the 47 percent who pay nothing.

 
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