Federal survey says current laws are failing to
broaden access to mental health care.
KATHRYN FOXHALL
Monitor staff
Some employers are circumventing the 1996 law meant to
reduce the disparity between mental health and other types of
health coverage, according to a survey by the U.S. General
Accounting Office (GAO). The result, says the report, is that
Americans are seeing little or no increase in access to mental
health services.
In response, APA is urging Congress to pass legislation to
completely ban discrimination in mental health insurance
coverage.
The 1996 Mental Health Parity Act prohibits
employer-sponsored group health plans from imposing annual and
lifetime dollar limits on mental health coverage that are more
restrictive than those for medical and surgical coverage.
Congress is expected to begin work in earnest to reauthorize
the law after the first of the year, because it is set to
sunset Sept. 30, 2001.
The GAO survey of 863 employers has found that 86 percent
are complying with the law, but most are also restricting
mental health benefits in some other way, most often by
covering fewer office visits or fewer hospital days.
APA recently told Congress that the GAO report is one
reason the arguments for more comprehensive protection are
more evident than ever before. The association is backing a
bill sponsored by Rep. Marge Roukema (RN.J.). Her H.R.
1515 aims to outlaw discrimination in any mental health
benefit design feature and for any diagnosis.
APA is also supporting a bill (S. 796) introduced by
Senators Pete Domenici (RN.M.) and Paul Wellstone
(DMinn.), but is advocating that Congress expand it to
cover all diagnoses. The bill seeks to lengthen the list of
methods by which insurance plans may not discriminate: It
would outlaw lower limits on outpatient or hospital days for
mental health services. It would also reduce the number of
"small employer" plans exempted from the rules, by lowering
the "small employer" definition from 50 employees to 25.
The Domenici-Wellstone bill also seeks full parity for
those diagnoses it terms "severe mental illnesses." It would
ban any health plan discrimination for a list of "biologically
based" illnesses, including schizophrenia, bipolar depression
and major depression.
But APA, which has long supported full parity for all
mental health diagnoses, fears that under the
Domenici-Wellstone bill's incremental approach, employers
would almost certainly offset the perceived cost of new parity
requirements by restricting mental health coverage through
other avenues, just as the GAO report shows happened under the
1996 law. This time, the association cautions, the only
avenues left would be by increasing costs for people whose
illnesses are not labeled as "SMI," through co-payments,
deductibles or out-of-pocket payments. Given the smaller pool
of beneficiaries who would bear those costs, the increases for
those patients could be drastic, perhaps even prohibitive for
access to service, APA says.
"APA believes that it is wrong, and bad public policy, to
divide persons into groups for parity coverage, based on the
perceived underlying reason for their mental disorder," the
association said in written testimony to the committee looking
at the GAO report.
In addition, APA's testimony pointed out, several of the 11
states that have "full parity" law--that is, comprehensive
rules against discrimination--have found that those rules
increase costs only 2 percent or less.
The GAO report, "Mental Health Parity Act," is available on
the Internet at: http://www.gao.gov/.
