Legislation targets Medicare mental health inequality

But a tight budget and a lack of GOP support diminish prospects for mental health parity in 2003.

By Markian Hawryluk, amednews staff. June 16, 2003.

Washington -- Mental health advocates are increasingly optimistic that Congress will reauthorize and strengthen federal laws requiring large private insurers to put mental health services on equal footing with physical health services. Yet Congress may still let the largest U.S. insurer off the hook.

Medicare mental health parity remains far down the list of priorities for lawmakers considering how to reform the health program this year without bankrupting the Medicare trust fund in the process.

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Medicare pays only half the cost of beneficiaries' mental health services and has a 190-day lifetime limit on care in a freestanding psychiatric hospital.

"To deny that service is putting us back in the medical age of leeching and bloodletting. We're beyond that," said Rep. Fortney "Pete" Stark (D, Calif.). "To me it's immoral, it's obscene, it's shortsighted ... to deny mental health services to anyone who needs them."

Fears that full Medicare coverage for mental health services would result in a flood of new spending have caused lawmakers to resist moves toward parity thus far. But Stark vehemently discounts those worries.

"The idea that it costs more I think is pretty much trash," he said. "Denying the services may add to the cost in the long run."

Medicare pays only half the cost of beneficiaries' mental health services.

Laurie Young, executive director of the Older Women's League, said there is no evidence to suggest that parity would cause Medicare spending to skyrocket.

"In fact, we know that parity is not that expensive," Young said. "We have more than six years of experience of parity in the insurance industry from the original Mental Health Parity Act, and we've shown that it doesn't dramatically increase costs."

Young said ignoring mental illness is what truly drives up costs. "Research has shown that when an older person's health problems are complicated by mental illness, they'll have more visits to primary care physicians, they will use more medications, and they are more likely to have emergency room and hospital visits," she said.

Studies have shown that untreated mental illness can impact the severity of other health problems, said Joel E. Streim, MD, president of the American Assn. for Geriatric Psychiatry. Mental health problems have been linked in repeated studies to worse outcomes and increased mortality rates.

"The lack of parity for mental health treatment is unconscionable and of great consequence to older adults who feel more stigmatized by psychiatric illness than any other group," Dr. Streim said. "Despite widespread need, many seniors may decline, delay or drop out of treatment because of the high co-payment."

Hicma Gardner, who runs a drop-in center in Philadelphia for people with mental illnesses, said many of the seniors she sees must decide between paying for rent, food, medication or health services because of Medicare's cost structure.

"Something is wrong with the system that cares more for other parts of my body than for my brain," Gardner said.

Although many seniors may start out with medigap policies that cover at least some of the Medicare co-payment for mental health services, often seniors can't afford to keep up payments for that additional coverage. "As people become mentally ill, they tend to become downwardly mobile," said Ron Manderscheid, PhD, chief of the survey and analysis branch at the Substance Abuse and Mental Health Services Administration.

Legislative outlook

Stark has introduced legislation that would reduce the Medicare co-payment for mental health services to the same 20% level paid for physical health services. It also would eliminate the 190-day cap on psychiatric hospital stays. The bill would increase Medicare spending by an estimated $3 billion a year, according to mental health advocacy groups.

The bill has 51 Democrat co-sponsors in the House but no Republicans. Sen. Jon Corzine (D, N.J.), who introduced a companion bill in the Senate, said the Republican-controlled House remains an obstacle to a Medicare mental health parity bill this year.

"I'm not as optimistic as I'd like to be," Corzine said. "It would pass in a nanosecond in the Senate, but we have continued problems of prioritization and even its worthiness in the House."

A separate bill introduced by Sens. Olympia Snowe (R, Maine) and John Kerry (D, Mass.) would phase the co-payment down to 20% over six years at a much lower $1.5 billion cost over five years. But House Republicans have remained cool to the idea, particularly as they struggle to pass a Medicare outpatient prescription drug benefit and other reforms with limited funds available.

The American Medical Association has backed the move toward mental health parity.

"Mental health parity acknowledges that mental health disorders are true illnesses which demand medical treatment," said AMA President Yank D. Coble Jr., MD.

The Mental Health Parity Act, passed by Congress in 1996, prohibits large group plans in the private market from setting lower annual or lifetime spending limits on mental health services. That measure will expire at year's end unless Congress acts.

More than 260 organizations nationwide have backed the Paul Wellstone Mental Health Equitable Treatment Act, sponsored by Sens. Pete Domenici (R, N.M.) and Edward Kennedy (D, Mass.), as its replacement.

That bill would require full parity in all aspects of private health coverage, including spending caps, visit or day limits, coinsurance, deductibles and out-of-pocket maximums.

ADDITIONAL INFORMATION:

Weblink

Thomas, the federal legislative information service for bill summary, status and full text of the Medicare Mental Health Modernization Act of 2003 (HR 1340) (thomas.loc.gov)