[NYAPRS Enews] WHYY: Fitting Mental Health Into The Health Care Equation

[Harvey Rosenthal]

Fitting Mental Health Into The Health Care Equation

By Maiken Scott  WHYY  September 9, 2009

 

Mental Health advocates scored a victory with the passing of the mental
health parity act last year, but say the legislation still doesn't help
many Americans affected by mental illness. As the health care reform
discussions continue, they are seeing opportunities for expanded mental
health coverage.

 

Mental Health advocates have long criticized the discrepancy in
insurance coverage of mental health compared to physical health. The new
legislation going into effect in January addresses this issue to an
extent. Group health plans with more than 50 employees have to apply the
same rules to mental health benefits as they do to other health
benefits.

 

Plotnick: They can not have higher co-pays or put limits on number of
visits that are more than they have on any other health condition.

 

That's Debbie Plotnick of the Mental Health Association of Southeastern
Pennsylvania.

 

Plotnick has personal experience with the mental health system. When her
daughter was diagnosed with bi-polar disorder she had to borrow money to
pay for much of her care:

 

Plotnick: What allowed us to get the kind of treatments that we needed
was that we were lucky enough to have some good credit and families
should not have to operate on credit to get the kinds of treatment that
their family member needs.

 

Plotnick says with the new parity legislation mandating insurance
coverage for mental illness, it will be easier for families to afford
and access treatment.

 

Policy expert Trevor Hadley is not so optimistic. He says just because
services are included in your insurance benefits doesn't mean you will
actually receive them:

 

Hadley: Because you have benefit books, and they say you can get so much
of this, and so much of that, but it doesn't mean you can get all of
that - it means that you can get all of that if your doctor thinks you
need and if your managed care company agrees.

 

Hadley directs the Center for Mental Health Policy at the University of
Pennsylvania. He says in a managed care environment, people will engage
in the same tug of war over mental health services as they already do
over other benefits:

 

Hadley: In every hospital with every therapist office, somebody is
recommending eight session, and the insurance company says NO, we think
six is enough.

 

But even with potential faults, the parity law was the ticket to bring
mental health into the health care reform discussion says Andrew
Sperling of the National Alliance for the Mentally Ill:

 

Sperling: We're no longer shunted off to the side as something
considered irrelevant to the health reform debate, or sort of a
side/unimportant issue if you will, parity essentially got us to the
table now, where we are a full player in the debate about reforming the
health insurance system.

 

With parity becoming more of a reality, advocates now want to tackle
another major issue - and that's mental health care for the uninsured.

 

There is a strong connection between poverty and mental illness - many
of the country's most severely mentally ill are accessing care through
Medicaid.

 

Stephen Metraux researches Urban Health at the University of the
Sciences in Philadelphia - he says not enough people qualify for this
service:

 

Metraux: That leaves a lot of people without any kind of regular
coverage but needing mental health services and also in particular
needing medication.

 

Metraux says health care reform should include a provision to make more
people eligible for Medicaid:

 

Metraux: And for people who are indigent and who are severely mentally
ill that would dramatically expand access, and would make a huge
difference in their lives.

 

That concept worries U Penn's Trevor Hadley. He says states are already
struggling to pay their share of the Medicaid budget. He says an
expanded Medicaid system wouldn't be funded well enough to provide
quality care:

 

Hadley: So people would end up with access for more people, but
decreased benefits for everyone and that's my greatest fear.

 

Hadley says ultimately, the issues of how much and what kind of mental
health care will be provided depends on how much Americans are willing
to spend. 

 

http://whyy.org/cms/news/health-science/behavioral-health-health-science
/2009/09/09/fitting-mental-health-into-the-health-care-equation/17272 

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