Mental Health: An Even Playing Field?

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Sen. Pete Domenici and Bush at a conference on mental health benefits

Tipper Gore's pick for President didn't win, but there's hope yet for her pet cause. As Congress considers legislation granting parity for insurance coverage of mental health disorders and medical problems, President Bush is urging lawmakers to send him a bill by Memorial Day.

He may have to wait a while longer. While Congress as a whole approves of guaranteeing the same insurance coverage to mental health patients as to patients with physical ailments, and approved a limited version of a parity law in 1996, there is considerable disagreement over the extent to which that parity will be extended. Should everything from insomnia or moodiness be covered, as the Senate insists? Or will coverage be limited, as it has in the past, to major mental health problems, like severe depression or schizophrenia? House Republicans are wary of creating truly comprehensive parity, fearing resulting insurance costs will be too great for employers to bear.

The Senate is expected to back a broader plan, while the House will push for more limited coverage. The differences will be hammered out in committee before being sent to the President for his signature. Meanwhile, the President announced the formation of a commission to study mental illness in America.

For those who count mental illness among their personal battles, parity legislation isn't just about making health care more accessible, it's about making patients feel less ashamed of having mental health problems. Sen. Pete Domenici, Republican of New Mexico, spoke with CNN after the President's speech Monday. "We want to get rid of the stigma so there's no more discrimination," he says. Domenici, whose daughter suffers from mental illness, is a sponsor of the Senate bill.

Getting rid of that stigma means addressing mental illnesses with the same seriousness as physical ones. "I think there are disorders that should absolutely be covered, like depression or panic disorders," says Dr. Wayne Katon, vice chair of Psychiatry & Behavioral Sciences at the University of Washington School of Medicine. "They should be treated exactly like medical disorders — because they are medical disorders. Not covering them means we don't believe these are real disorders, and on a scientific basis we're way past that way of thinking."

Ralph Ibson, vice president of government affairs at the National Mental Health Association, agrees. "Parity is a broad way to address the second-rate way in which mental health is treated in terms of both insurance coverage and federal funding." The NMHA, which is the country's largest and oldest nonprofit group addressing issues facing people with mental illness, issued a statement Tuesday, praising the President's proposal, but urging Congress to provide full coverage to all mental health disorders. "We strongly support the Senate measure," says Ibson, "which provides a prohibition on discrimination by diagnosis. To limit parity to some subset of diagnoses is just to create a new version of stigma."

As with any sweeping legislation, of course, there are financial considerations. Monday, White House Press Secretary Ari Fleischer said the administration hopes to achieve "maximum parity" in insurance coverage "without driving up costs so high that people lose insurance in the end." According to the American Association of Health Plans, a trade group representing more than 1,000 HMOs, a true parity proposal would add "billions of dollars to health-care costs." Higher bills, the employers' lobby warns, would translate into higher health care premiums for both employers and employees.

But proponents of parity legislation argue the cost-benefit analysis actually favors employers in the long run. Asked about employers' fears that blanket coverage could send insurance costs sky-high, Dr. Katon pointed out that while the there could be financial benefits to employers who extend coverage to mental disorders. "I think employers would actually benefit from coverage, even if it is more expensive, because employees who are well are less likely to call in sick or take extended time off," Dr. Katon says.

Mental health disorders take a significant financial toll, according to a 2001 study by the NMHA. Untreated and mistreated mental illness costs American business, governments and families $113 billion a year. Mental illness is also the second leading cause of disability and premature death.