[NYAPRS Enews] BS: Health Reform Could Provide Huge Lift For MH Coverage

[Matt Canuteson]

A Cry For Mental Health Change; Reform Legislation Could Be Huge Step
Forward, Advocates Say


By Meredith Cohn Baltimore Sun October 4, 2009


Deneice Valentine was a wife, mother and college-educated professional
with a family income in six figures. But for a year and a half in the
late 1990s, she slept in a small park across the street from Morgan
State University.

Valentine was diagnosed with major depression and a stress disorder but
lost her mental health insurance after her divorce. She eventually lost
her Baltimore home, custody of her children and the ability to care for
herself.

Stories like hers are the reason that mental health advocates have
joined the immense lobbying effort in Washington on health care reform.
If they are successful, advocates say, reform legislation could be a
huge step forward for the mentally ill. Of uninsured Americans who might
gain coverage, an estimated one in four has a mental health condition.

But while key lawmakers have included some provisions for the mentally
ill in the bills winding through Congress, high costs and competing
needs mean the amount of care and the number of people who would get it
remain uncertain.

Valentine was saved by a police officer who plucked her from a park
bench and dropped her at a state psychiatric hospital where she stayed
for a year and a half on the public's tab. Once an auditor at the
Department of Defense, she now works at a mental health organization
coordinating support groups and helping others navigate through the
public system.

"I'm lucky," said Valentine, now 55 and living in Baltimore. "I could go
work somewhere else and make two to three times my salary, but this is
too important to me."On Capitol Hill, the debate has centered on issues
such as government-run health care and sideshows about "death panels."
But the main goal of the overhaul is to provide general health coverage
to 30 million Americans with no insurance. Even more lack mental health
coverage or are underinsured, leaving an estimated 25 million with an
untreated behavioral disorder. Many also are substance abusers.

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.

Beronio said those left out likely will be poorer and sicker, "and it's
troubling that this population would have less coverage."

In Maryland, there are about 750,000 people without health insurance.
But the situation is better than in most states for mental health
because Maryland covers some people who don't qualify for Medicaid and
even some people whom the state doesn't provide with medical care, said
Dr. Brian Hepburn, executive director of the state Mental Hygiene
Administration.

Still, the people who get state aid are typically those in crisis, which
probably costs the state more than if it offered early care, Hepburn
said. They are people coming out of psychiatric hospitals, the homeless,
those in jail or prison and those on disability because of mental
illness.

The state picks up the tab for about 15 percent of approximately 100,000
people in treatment at any time, with Medicaid paying the rest. With its
annual budget of $950 million, Maryland runs six state hospitals, which
largely treat people sent from the jails, and two institutions for
children. The funds also go to treat people in private facilities near
their homes.

It is not known how many more people need services. And adding a lot
more people to the system could be a challenge, Hepburn acknowledged.
But more insurance would help pay for it. There could be savings to
those with insurance now because private hospitals typically charge them
more to compensate for treating those without.

"If everyone had insurance, that would be very helpful," he said. "We
spend much of our time trying to budget and preserve services for
persons who are uninsured."

One of those institutions that receives public money is the Sheppard
Pratt Health System, the largest provider of mental health and addiction
services in Maryland. But the system treats more people than it is
compensated for, said Steven Sharfstein, its president and chief
executive.

Some of those whom Sheppard Pratt treats are not fully covered by public
or private sources, costing the facility and patients more. The parity
bill passed by Congress should at least help those who already have
insurance, Sharfstein said.

"When you don't have coverage or enough coverage, you can't afford
medication and the likelihood of relapse is much greater," Sharfstein
said. "It's penny-wise and pound-foolish."

That's Deneice Valentine's story. She relapsed after losing her
insurance and ended up costing the state for an extensive stay in the
hospital. Now she is functioning well, but she still needs medications
that her insurance doesn't fully cover. She sometimes cuts corners. She
also has a daughter who has insufficient insurance from her college to
cover drugs for her bipolar disorder and must come up with extra money
for that.

Valentine works at the National Alliance for the Mentally
Ill-Metropolitan Baltimore Inc., a nonprofit support provider and
advocacy group. Kathryn Farinholt, the executive director, said she
hired Valentine for her skills and not her experience with mental
illness, though she said that helps.

Farinholt said she hopes health care reform will mean that fewer people
will have to have Valentine's experience. It's better for her, her
family and the country if she's a functioning member of society, she
said.

Farinholt said her group did an unscientific study of people who come
for support groups on Saturdays and found that 90 percent had been
homeless in the past two years.

"That's stunning," she said. "Some people have good insurance. Some
people are getting good care in the public system in Maryland. There are
some people in the middle not getting anything, and some aren't getting
enough. There is a cost to society. To everyone."

By The Numbers

*More than 25 million Americans suffer from untreated mental illness or
substance abuse disorders.

*Health care reform seeks coverage for 30 million Americans who have no
medical or mental health coverage. More lack mental health care or are
underinsured.

*An estimated one in four people without insurance has a mental
disorder.

*Untreated mental illness and addiction cost the country a combined $171
billion in lost productivity each year.

*Those 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 get no treatment for a decade.

http://www.baltimoresun.com/health/bal-md.hs.mental04oct04,0,2950490,pri
nt.story

 

 

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