PARITY PASSES -- Kudos
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| Topics: Congress, insurance, parity, recovery
When members of the 110th Congress leave Washington for their home districts, they do so having delivered a major blow against insurance discrimination for people with a mental illness or addictive disorder. A decade's worth of work culminated on Friday by sending the Paul Wellstone and Pete Domenici Mental Health and Addiction Equity Act of 2008 to the president.
Hats off to those who labored during the last ten years, and to those who rallied last week with dizzying efforts to eliminate disparities in employee sponsored private insurance. Congressional leaders benefited from the heft of mental health and substance abuse advocacy organizations, business associations, unions and trade associations who showered their elected representatives with messages.
The bill which was passed differed slightly from those each chamber carried earlier - the House in March, the Senate last year -- with bi-partisan support. Summer negotiations about the wording of consequential provisions slowed finalizing the version which, last week, was tucked into the rescue package to avert meltdown of the nation's financial infrastructure.
One of the sticking points threatening the reconciliation of HR 1424, backed by advocacy organizations and professional associations, with S. 558, backed by insurance and business, was how to pay for it. There were other disagreements, to be sure, such as what role insurance would have in determining the medical conditions to be covered and out-of-network provisions. But given the gravity of last week, the $3.9 billion agreement seems like a mosquito bite alongside the $700 billion voted to keep the economy juiced.
Good health is good business
Although the amounts -- $3.9 billion versus $700 billion -- differ, the principles of promoting a healthy nation are related. It is well established that when people with a mental illness or addictive disorder receive treatment, they not only recover but go on to contribute to the economy. A 2005 report produced by the National Business Group wrote, "Research has conclusively shown that depression and other mental illness and substance abuse disorders are a major cause of lost productivity and absenteeism." They rank among the top five causes of short- and long-term disability for employers. And parity means the end of "perverse discrimination" for the 19 percent of the work force with a serious mental illness or substance abuse disorder the report estimates is employed full time.
Clearly employer sponsored parity moves the agenda toward obtaining resources. But greasing these wheels is just the beginning. Now it is important that service providers promote full use of evidence-based treatments, including but not limited to medication management. The National Business Group writes: "Current research suggests that the most effective method of treatment is multimodal and combines pharmacological management with psychosocial interventions such as psychotherapy."
Parity can become an opportunity for private psychiatrists who have bailed out of the cumbersome insurance restrictions on psychotherapy to treat those who can ill afford hefty fees. In this regard it is essential that insurance decision-making not get bogged down in a bureaucratic process that delays treatments with an eye to short-term cost savings at the long-term expense of comprehensive patient health. As CQ's HealthBeat Editor, John Reichard, wrote, "It's uncertain exactly how employers and insurers will practice medical management techniques to control the costs of their mental health benefits."
Still words like "rejoice," "historic," "kudos," "new era," peppered the email blitz described the long awaited moment and praised the indefatigable lawmakers -- Rep. Patick Kennedy and Jim Ramstad, Sen. Pete Dominici and the ailing Ted Kennedy --who pushed this when it seemed entirely uphill. By last week, when it appeared that time was running out, the younger Kennedy, as he has all year, maneuvered to keep this alive. To assure its success, lobbyists set up hot lines to patch callers directly to congressional offices; unions, community groups and advocates emailed membership to contact their representatives. It added to the chaos surrounding the larger rescue package.
Of those who guided the effort, MIWatch applauds:
- Sen. Dominici, whose leadership dates to his daughter's schizophrenia. Since the 1980s, and his friendship to the young NAMI, and the nascent NARSAD, he has soldiered on behalf of the one family in four who wrestle with a mental illness, the one in 100 with schizophrenia;
- Reps. Jim Ramstad and Patrick Kennedy. Despite the intransigent Republican dominated Congress, Ramstad refused to give up. With a Democratic majority, coupled with the indefatigable partnership of Patrick Kennedy, there was a realistic opportunity. Eighteen months ago they traveled the country to listen to people in recovery from addictive disorders, as well as those burdened by insurance discrimination. Each told his story of recovery from alcoholism and Kennedy shared his about the additional challenge of managing bi-polar disorder;
- Sen. Ted Kennedy, life-long friend to health reform who signed onto this cause 10 years ago, with passion, commitment and loyalty.
We celebrate them all. And now, it is up to the service sector, the professional community of those working with psychiatric and addictive disorders to carry this to the next level, to show that the benefits of access to care are good not only to promote recovery for the individual, but they are good for the nation.
