An Agenda For Insurance Equality

July 30, 2008
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In their day jobs, Kent County Commissioners Paul Mayhue and Nadine Klein know all too well about the devastating toll that untreated mental illness and uncontrolled substance abuse can have on families and individuals.

By trade, Mayhue is a social worker and Klein is a family-law attorney. They also are two of the 12 individuals that make up the Kent County Discussion Group for Mental Health Parity, which is working to have treatments for mental disorders and substance abuse receive the same insurance coverage that physical ailments do, in a state that doesn’t call for that type of coverage.

Klein, like Mayhue, has seen her share of jobs lost, marriages dissolved and futures ruined, with children usually suffering the nastiest and most lasting consequences when conditions like depression, schizophrenia and addiction have taken root in a household.

“What I’ve seen is when a mental health or substance abuse issue gets to a breaking point, someone will come to see me, or give the other spouse an ultimatum, or both. If they don’t follow through on that ultimatum, they file for divorce,” she said.

But Klein pointed out that a family can still be destroyed by the problems, even when a divorce isn’t in the cards.

“Substance abuse is one of the major causes of the abuse and neglect of children.

“I haven’t done juvenile court work in a long time. But when I did do it, it was frequently what led to the termination of parental rights for kids that were usually in a single-parent home, and the parent was using some type of substance and could not get clean and take care of a child or children and they’d end up losing the children,” she said.

“That kind of substance abuse issue is extremely expensive for everyone involved. The emotional toll on the family, the cost to taxpayers to put a child in foster care and then go through the whole termination process with a parent: Those types of things are all very expensive.”

Klein said sometimes an individual doesn’t know how or where to get help for a condition, or doesn’t want to be stigmatized by a society that likens an emotional disorder to a character fault, and will try to handle it alone by self-medicating. But that prescription can often lead a person into substance abuse or can take someone deeper into an existing addiction.

“It’s a very frustrating issue in family law because it just rips families apart, and kids are the ones that end up getting the brunt of it,” she said.

Legislation that calls for parity has been introduced at the federal and state levels. The U.S. House has passed a bill that requires equity in group policies for mental health disorders and substance abuse. The U.S. Senate has ratified a similar bill. But previous attempts at this type of legislation haven’t made it through Congress.

Four bills that make up a parity package were introduced in the state House last summer and were still in the chamber’s insurance committee when HQ went to press. Taken together, the bills would provide inpatient and outpatient coverage in private policies and those issued by HMOs and Blue Cross Blue Shield, the state’s nonprofit insurance company. Comparable bills have made it through the state Senate and are in that chamber’s committee.

A House fiscal analysis, though, reported the bills potentially would “significantly increase the cost of health insurance provided to employees of the State of Michigan and its local units of government.”

But the Michigan Mental Health Association disputes the cost claim.

“There is no credible evidence for that,” said Mark Reinstein, association president and CEO, of the House cost analysis.

“We’ve got 42 states with parity. We’ve got 9 million federal employees with parity. We’ve got special studies of that program. We’ve got Congressional Budget Office studies. Not one of those 42 states has ever repealed any of their laws,” he added.

Reinstein said some of those state parity laws contain clauses that would allow a state’s insurance commissioner to sunset the statue if the cost for parity went up by more than 2.5 percent, and none have done that. The Congressional Budget Office put the net increase for coverage at 0.4 percent for the federal workers who have had this type of coverage since 2001.

“I understand that the business community is afraid here. That has happened in every single state. As far as we can tell, once it actually happens, it just sort of peters out and goes away because it just doesn’t prove to be that big a deal,” said Reinstein of opposition to parity by employers. “But in a state that doesn’t have parity, that doesn’t stop the business community from being afraid, and I understand that.

“The miniscule direct cost, if any, that accomplishes parity can be more than offset by long-term savings to employers through less absenteeism, increased productivity and reduced use of emergency rooms and other medical care.”

Reinstein didn’t think either the state House or Senate would vote on the parity issue before the fiscal year ends on Sept. 30.

Proponents of a mental health parity law in Michigan say the coverage would not only help the individuals who need treatment, but also the providers that give it. Klein chairs the board of directors for network 180, the agency that is the county’s official substance abuse provider. She believes coverage for substance abuse would lower the caseload for network 180 because insurers would offer private coverage in their networks, and that change would allow network 180 to branch out into other mental health areas.

“Especially in the substance abuse area, usually there are people who aren’t qualified to get Medicaid and they don’t have any insurance, so we help them out. If they had insurance, there would be fewer people who would be seeking the services of network 180, and then network 180 would be able to target other populations in areas where we’re not penetrating yet,” she said.

The strategic plan for network 180 is to make its services available to people with more types of afflictions in Kent County, but that is difficult due to the number of substance-abuse cases the agency handles on an ongoing basis. Fewer addiction clients would allow the agency to use more of its limited resources to treat people with depression and bi-polar disorder.

“It would also be beneficial because, then, mental health wouldn’t be so stigmatized. I think that if everyone’s insurance had mental-health coverage and it was treated like a regular physical illness, it wouldn’t be so taboo,” said Klein.

“Now, if they do seek treatment, they’re not going to let anybody know about it. If someone gets cancer or something, everyone knows and they have the support of their friends, family and the community. But if it’s mental illness, it’s something that someone generally hides, doesn’t tell anybody about, and then doesn’t get that support. I think you need the support for both physical- and-mental-health issues.” HQX

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