[ EDITORIAL ]

By STEPHEN H. FEINSTEIN

Special to The Capital-Journal

Imagine that your child has a serious health problem that will require a lifetime of treatment. You open your health insurance benefits manual.

You find for this particular disorder you are entitled to 30 days of hospitalization per year. Moreover, any treatments will be covered at 100 percent of the first $100, 80 percent of the next $100, and 50 percent of the next $1,640 in any year up to a total of $7,500 in your child's lifetime.

You read on and find that for all other disorders the insurance company will pay 80 percent of the cost of treatment after a deductible of $300 is satisfied. Moreover, your maximum out of pocket expense will be $2,000 per year and the overall lifetime limit will be $2 million. Does that seem fair or reasonable to you?

These are exactly the insurance inequities that people who have mental illness have been forced to accept. The result of this unfair and unequal treatment is that individuals and families affected by serious mental illnesses who have jobs and health insurance have had to bankrupt themselves to pay for treatment, are forced to depend on public agencies for care and treatment, and/or struggle to survive without adequate or effective treatment.

There was a time when mental illnesses were poorly understood and the effectiveness of medications and other treatments was far from optimum. People with these disorders were the butt of jokes and their suffering was somehow conceived to be of their own making. In spite of the advances in our understanding of the origins of mental illness and the major advances in effective treatment over the past 20 year, the inertia of decades of stigma continues to be reflected in the way Kansas health insurance is structured today.

There should no longer be any question about the need for or timeliness of legislation in Kansas that will ensure equal treatment for those who have insurance and need treatment for mental disorders.

Nonetheless, the health insurance industry continues to vigorously lobby against parity for Kansans. They make two arguments. The first is that government should not be in the business of mandating business practices. The second is that the cost of parity could make health insurance so expensive it will reduce either the number of people insured or the quality of their existing coverage.

Kansas statutes already regulate the insurance industry, and these statutes specifically address coverage for mental illnesses. Proponents of mental health parity are not asking for a new mandate. We are asking that the mandate be revised to reflect the state of knowledge about the treatment of mental illnesses.

The health insurance industry says that requiring the same coverage for all illnesses might cause large increases in the cost of health insurance and, as a result, many employers would drop this benefit or their employees would not be able to afford it. They would like our legislators to believe that more data needs to be obtained before they should correct the inequities in the system. But they choose to ignore the Report On Mental Health Parity to the Congress by the National Advisory Mental Health Council and the report to the Office of Personnel Management, "A Look At Parity in Employer- sponsored Health Benefit Programs," both published last year. These reports examined the cost issues based on parity experiences in 31 states as well as a large number of major corporations that provide generous mental health and substance abuse benefits to their employees.

Parity level benefits were given to the 8.7 million beneficiaries of the Federal Employees Health Benefit Program this year. A sophisticated statistical simulation model estimated that there would be a total increase in health insurance premium costs of 1.4 percent when parity is implemented. A key finding in the OPM report was that, "The costs of providing appropriate treatment for mental and addictive disorders must be measured in a larger context that also considers disability costs, employee absenteeism and lost productivity. Taking these into consideration, employers found that traditional benefit limitations were not cost effective. Further, increasingly, employers have focused on health system performance based on employee health and functioning."

Parity has been tested in Kansas. The state offered 25 percent of its employees mental health parity through existing managed care plans for three years and now has extended that coverage to all 90,000 state employees. The decision to include all state employees was based, in part, on the finding that parity caused less than a 1.5 percent increase.

But in the final analysis, mental health parity should not be about costs. It ought to be about doing what is right and fair.

We hope that the 2001 Legislature will act now to end the discrimination in health insurance and offer relief to working individuals and families crushed by the financial burden of mental illness.

Stephen H. Feinstein is chairman of the Kansas Mental Health Coalition and president of NAMI Kansas.

Copyright 2001
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