Fitting mental health into the health care equation

    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 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.

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    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.

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