Insurance companies strike back ... so beware

Should it be any surprise that the primary foe to mental health parity is big business?

Just ask Christine Stearns, vice president of the New Jersey Business and Industry Association, who says the insurance industry should be spared from contributing toward mental health treatment.

With health insurance costs rising at four-times the rate of inflation, New Jersey should not require employers to pay for "virtually unlimited coverage" for treatment of substance abuse and a wide range of behavioral problems, Stearns says.

Stearns said New Jersey employers saw their health insurance costs rise by a cumulative 55 percent in four years (2001 to 2004). Businesses participating in NJBIA’s 2005 Health Benefits Survey reported paying an 11 percent average increase in the cost of providing health insurance to their employees in 2004. Their average cost was $7,300 per employee.

Adding new mandatory coverages at a time when employers cannot even keep up with current health insurance cost increases is "bad public policy," Stearns says.

“Many employers have reached the breaking point," Stearns says. "Imposing this mandate will cost real people all of their health insurance benefits. Not only will they have no access to treatment for behavioral disorders, but they will lose coverage for hospitalization, prescription drugs, doctor visits, blood tests, and everything else.”

Furthermore, insurance plans are already required to cover serious mental health illnesses and most insurance plans already provide coverage for substance abuse, although not the unlimited coverage that would be mandated under A-807.

“It’s not just a question of whether or not employers should provide this coverage,” Stearns said. “It’s a question of priorities. Should we require unlimited treatments for

Stearns also says such a mandate would not apply to all insurance plans; only those sold in the state’s regulated market, which insures only about 2.4 million residents. Almost all small businesses (those with two to 50 employees) that provide health benefits are in the regulated market, so this mandate would be imposed on the small employers who would be least able to afford it, she said.

But Debra L. Wentz, chief executive officer of the New Jersey Association of Mental Health Agencies, Inc., says mental health insurance parity would provide stability for employers who routinely deal with staff-level emotional and behavioral issues.

“Treatments for mental illness have been proven effective and can help individuals achieve a fulfilling life of recovery. However, there are many barriers, including inadequate funding and stigma, that prevent children and adults from receiving the therapy and other support services they need,” she said.

Pink Floyd - Mother Lyrics

Mother, do you think they'll drop the bomb?
Mother, do you think they'll like this song?
Mother, do you think they'll try to break my balls?
Ooooowaa Mother, should I build a wall?
Mother, should I run for President?
Mother, should I trust the government?
Mother, will they put me in the firing line?
Ooooowaa Is it just a waste of time?
Hush, my baby. Baby, don't you cry.
Momma's gonna make all of your nightmares come true.
Momma's gonna put all of her fears into you.
Momma's gonna keep you right here under her wing.
She won't let you fly, but she might let you sing.
Momma's gonna keep Baby cozy and warm.
Oooo Babe.
Oooo Babe.
Ooo Babe, of course Momma's gonna help build a wall.
Mother, do you think she's good enough,
For me?
Mother, do you think she's dangerous,
To me?
Mother will she tear your little boy apart?
Ooooowaa Mother, will she break my heart?
Hush, my baby. Baby, don't you cry.
Momma's gonna check out all your girlfriends for you.
Momma won't let anyone dirty get through.
Momma's gonna wait up until you get in.
Momma will always find out where you've been.
Momma's gonna keep Baby healthy and clean.
Oooo Babe.
Oooo Babe.
Ooo Babe, you'll always be Baby to me.
Mother, did it need to be so high?

Talkin' about a revolution...in mental health parity...well, sort of

In New Jersey, a revolution in mental health parity is taking place. But it's almost a revolution by default.

The General Assembly in Trenton is supposed to post a mental health parity bill in the lame duck session this year that could finally bring about long-needed equalization of insurance benefits.

But the road to get here has been long and rocky. And unnecessary, really.

And mental health advocates don't understand why Trenton politicians fail to sense the growing public desire to do something to help people who suffer from postpartum depression, schizophrenia and other disorders.

People see the impact of these disorders on city streets. Many people who can't afford to get treatment self-medicate by using illegal drugs and alcohol. Their addictions cost them their lives, their families and their homes. Many end up homeless, or in jail.

"Equalization of insurance health benefits to properly cover mental disorders including substance use disorders is right and just," said Joseph Napoli, immediate past president of the New Jersey Psychiatric Association. "It is also cost-effective. The present inadequate coverage for these disorders is penny-wise and dollar-foolish."

Napoli is cautiously optimistic that the legislature will finally act. But mental health parity is not a new idea in New Jersey. And every time it's been given a chance to work, something gets in the way that defeats it - or weakens it.

In 1999, for example, New Jersey passed a parity law, but in a final compromise, the required health benefit coverage was limited to "biologically-based" mental disorders and excluded substance use disorders.

This has created a loop hole that insurance companies have used to deny coverage, says Napoli.

He noted that Aetna and Horizon inadequately cover care for New Jersey residents who suffer from anorexia nervosa because these insurance companies have decreed - contrary to scientific evidence - that anorexia nervosa is not "biologically-based."

Although the present law lists eight "biologically-based" mental disorders, anorexia nervosa is not among them.

"We can easily count the numerous ways that we all pay dearly because insurance companies refuse to cover these disorders at the same amounts and limits that apply to other disorders," Napoli said. "Insurance companies' costs are greater for general medical conditions complicated by mental disorders."

Hope re-emerged in 2002, when N.J. Sens. John Matheussen and Joseph Vitale sponsored a parity bill that would eliminate the loop hole. Assemblywomen Loretta Weinberg and Mary Previte sponsored a companion bill. Unfortunately, Napoli noted, the state budget crisis torpedoed these bills.

In 2006 Sens. Vitale and Barbara Buono and Assemblyman Robert Gordon, among others, re-introduced the parity bills. In December, the New Jersey Senate passed S807 with a vote of 29 to 9 - despite Governor Corzine's opposition.

In May, the Assembly Appropriations Committee voted the bill out of committee. Five months later, the bill is pending in the General Assembly

Napoli is hopeful that some action can finally be taken. So-called shrewd lawmakers, however, pushed any consideration of it until after the fall elections. Apparently, legislators must believe that support of this legislation could be used against them in an election campaign.

And support is not a guarantee, given Corzine's prior opposition to parity legislation.

Right: Dick Codey

But New Jersey is home to Senate President Dick Codey, the former acting governor who became a national symbol for championing mental health causes on a political level and bringing more money and attention to mental health programs.

Oh, and by the way, he also happens to have the highest approval ratings of any public official in this state.

To Napoli, the whole thing is dumbfounding.

"How can we allow this discrimination against individuals suffering with mental disorders, including substance use disorders?" Napoli said. "We need parity now."