By Cynthia Wainscott and Thom Borneman
This op-ed was published in the May 21, 2006, issue of the Atlanta Journal-Constitution.
Forty million Americans do not have health coverage. Some analysts are quick to suggest that "basic health coverage" is the answer. That prescription, however, risks spreading a "virus" that now infects most commercial health coverage in this country and lurks in the fine print of most employer-provided health plans: singling out mental health care for rigid coverage limits.
Consider the case of a nurse with a history of chronic depression and suicide attempts. Good psychiatric care has kept her depression in check and enabled her to keep working. Under her health insurance plan, however, she faces a lifetime coverage-limit of 75 treatment sessions - regardless of medical need. Insurance sets no comparable benefit limits on needed treatment for any other illness. Is such discrimination rational?
Limiting access to needed mental health care can actually increase overall health care costs. Such findings persuaded the prestigious National Business Group on Health to urge employers to equalize medical and behavioral health benefits and end these discriminatory practices.
According to the 2003 report by the President's New Freedom Commission on Mental Health, about half of the people in this country who need mental health treatment do not receive it. Insurance barriers contribute to that treatment gap. Strangely, federal law tolerates this blatant discrimination. In fact, the tax code rewards employers by subsidizing the health insurance they provide their workers, regardless of whether or not they treat employees fairly.
The Senate earlier this month narrowly defeated legislation which claimed to offer small businesses a path to affordable coverage. Just as lobbyists live to fight another day, the demise of the so-called "Health Insurance Marketplace Modernization and Affordability Act" won't end employers' call for help in providing "basic health coverage." But are Americans clamoring for very limited, low-cost insurance that won't pay for needed care if a family member develops cancer, diabetes, depression or heart disease? Getting insurance that provides coverage only if one stays relatively healthy is like playing Russian roulette.
The recent Senate health care debate is yet another reminder of unfinished congressional business. Legislation named for the late U.S. Sen. Paul Wellstone (D-Minn.) would simply require health insurers that offer mental health care to provide those benefits in a non-discriminatory way. Opponents have repeatedly blocked this legislation, modeled after the parity requirements in the Federal Employees Health Benefits Program. Parity opponents have long asserted that such legislation would increase health care costs. But an exhaustive study evaluating parity under the federal benefits program, recently published in the New England Journal of Medicine, shows that providing mental health and substance abuse coverage on par with other health coverage can improve insurance protection without increasing health care costs.
"Basic health coverage" offers a Band-Aid, but it won't stop the bleeding, and it risks further harming the patient. The recently defeated HIMMA bill aimed to deliver on the promise of low-cost, limited health coverage by encouraging insurers to target younger, healthier workers while freeing them from state consumer laws. That formula would leave those with the greatest health care needs - and therefore the greatest need for insurance - at greatest risk.
If Congress seeks to cure the problems ailing our health care system, it must at a minimum adhere to the Hippocratic oath and avoid doing harm. Rather than exposing Americans to further risk through inadequate insurance, Congress should pass legislation ending insurance discrimination against people with mental health problems.
It just makes sense.
Cynthia Wainscott is acting president and CEO of the National Mental Health Association.
Dr. Thom Bornemann is director of the Carter Center's Mental Health Program.
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