An Analysis of Mental Health Parity

In lieu of an abstract, below is the first paragraph of the paper. The issue of parity for mental health insurance coverage is a complicated one, involving not only health care, but politics, economics, and moral and ethical questions as well. From a nursing perspective, separating a patient's mental wellness from his or her physical wellness directly contradicts the critical nursing value of holistic health care. From the perspective of mental health advocacy organizations, and from those suffering from mental health disorders, this purposeful disregard of mental illnesses is viewed as discrimination. For certain groups within the federal government and for the insurance companies, mental heath parity is seen as prohibitively costly to the insurance industry and to employers. In order to sort through these different perspectives, it is helpful to look at the recent history of the mental health parity movement. This article is available in The Review: A Journal of Undergraduate Student Research: http://fisherpub.sjfc.edu/ur/vol8/iss1/7 A n Analysis of Mental Health Parity Sarah Hamlin Feb. 24, 2006 Introduction The issue of parity for mental health insurance coverage is a complicated one, involving not only health care, but politics, economics, and moral and ethical questions as well. From a nursing perspective, separating a patient's mental wellness from his or her physical wellness directly contradicts the critical nursing value of holistic health care. From the perspective of mental health advocacy organizations, and from those suffering from mental health disorders, this purposeful disregard of mental illnesses is viewed as discrimination. For certain groups within the federal government and for the insurance companies, mental heath parity is seen as prohibitively costly to the insurance industry and to employers. In order to sort through these different perspectives, it is helpful to look at the recent history of the mental health parity movement. Brief Political History of Parity For over ten years, legislative advocates at the federal and state levels of government have been actively pursuing parity with limited success. In 1996, U.S. Senators Paul Wellstone and Pete Domenici authored the Mental Health Parity Act (MHPA), which passed and became effective in January of 1997. This act intended to bring mental illness insurance coverage in line with that of physical illness by prohibiting the use of lifetime and annual coverage limits. It did not, however, require that the parameters for deductibles, copayments, or day/visit limits be equal to those of medical coverage (Murray & Henriques, 2004). The MHPA also had an expiration date of September 30, 2001, at which time the benefits of the bill would cease, pending passage of a new extension bill by Congress. Updated bills were proposed by the Senate and the House of Representatives incorporating equal co-pays and deductibles for mental health benefits and equal number of in-patient days and provider visits for mental illnesses as for other illnesses. They also prohibited limits set on scope or duration of treatment (Killeen, 2002). These proposed bills were in part based on the 2001 Federal Employees Health Benefit Program (FEHBA), which required comprehensive parity coverage for mental illness following a 1999 executive order from former President Clinton. The new bills never made it out of committee, despite bipartisan support (Killeen, 2002). The 1996 bill was officially extended in 2002, preventing loss of ground in the fight for parity and, in 2003, the Paul Wellstone Mental Health Equitable Treatment Act (MHETA) was written, requiring full coverage parity (Murray & Henriques, 2004). On March 17, 2005, the Wellstone bill, numbered H.R.I402.IH, was introduced in the House of Representatives by Congressman Patrick Kennedy of Rhode Island. In late May, another bill, the Medicare Copayment Equity Act (S.l 152.IS), was introduced. This was proposed by Senators Olympia Snowe and John Kerry to eliminate discriminatory rates for outpatient psychiatric services. Both bills were referred to committee and, to date, no further action has been taken (Thomas, 2005). On November 17, 2005, Senator Barbara Boxer submitted and proposed an amendment to "provide an additional $500,000,000 for each of fiscal years 2006 through 2010, to be used for readjustment counseling, related mental health services, and treatment and rehabilitative services for veterans with mental illness, post-traumatic stress disorder, or substance use disorder" (Thomas, 2005). The amendment was rejected by the Senate and ruled out of order by the chair (Thomas, 2005). Another federal government action which could lead to further inequality for mental health care is the recent proposal to cut Medicaid funding. According to the National Mental Health Association (2005), reductions in benefits currently provided by Medicaid would include mental health coverage, as well as adding new restrictions on amount, duration, and scope of services covered. Additionally, some individual states, such as New York, are similarly affecting health care for low-income people, by implementing caps on Medicaid spending. Other states, however, have passed some form of mental health parity legislation. As of 2003, 34 states had passed parity laws.