Kennedy Calling For Equal Coverage Of Mental Health — Yes, Still

Former Congressman Patrick Kennedy testifies at a Massachusetts hearing on mental health parity. (Courtesy of Scott Bryson)

Former Congressman Patrick Kennedy testifies at a Massachusetts hearing on mental health parity. (Courtesy of Scott Bryson)

Mental health “parity” is officially a done deal. Congress passed a law back in 2008 requiring health insurers to treat mental health on a par with physical health, covering care for mental illness and addiction no less than they cover physical care. Many states have also passed their own mental health parity laws.

So why has former Congressman Patrick Kennedy of Rhode Island — lead sponsor of the 2008 bill together with his late father, Sen. Ted Kennedy — spent much of the last couple of years criss-crossing the country to advocate for mental health parity? Why did he feel the need to come to a Massachusetts Division of Insurance hearing this week to push parity yet again?

You could find the answer at the hearing itself.

It came from Benedetto Mitrano, who testified that his drug-addicted son, Michael, had been through several treatment programs, but died in August. “Insurance always refused to pay for one reason or another,” Mitrano said. “He was never ‘sick enough.’ My son is dead. Is he sick enough for them now?”

He was never ‘sick enough.’ My son is dead. Is he sick enough for them now?”

And from Dr. Matthew Mostofi, a Tufts Medical Center emergency physician who compared two patients from his previous night’s shift, one with appendicitis, who was treated quickly, and one who was suicidal, and had to wait many hours for care, held up by insurance requirements:

“Both have emergency medical conditions,” he said. “If you look at these two patients, which is more life-threatening? The fact of the matter is, this depressed suicidal patient has a higher mortality [risk] than the patient with appendicitis, and yet this is the one that we delay and make wait, and I believe illustrates disparity.”

And from Trudy Avery, who fought to get her insurance carrier to pay for her son’s addiction treatment: “What is written on paper and what actually occurs are two different things,” she said.

Therein lies the rub. Though mental health parity is the law of the land, the federal government has not yet issued its final regulations translating the law into practice, so it cannot be actively enforced. In the wake of the Newtown shooting, the Obama administration pledged to issue those final rules, but they are still not out.

Some can wait no longer. Class action lawsuits alleging violations of the parity law have been filed in California and, just this month, in New York. The New York State Psychiatric Association accuses insurer UnitedHealth Group of limiting actively suicidal patients to just one psychotherapy session a week, among other denials, Psychiatry News reports.

Former Congressman Patrick Kennedy (YouTube/NAMI)

Former Congressman Patrick Kennedy (YouTube/NAMI)

Meanwhile, around the country, many states have been moving forward to decide for themselves how to enforce parity — hence the Massachusetts hearing, and Kennedy’s presence. (Listen to an excerpt of Kennedy speaking in the sound file at the bottom of this post.)

Massachusetts is gathering public comment on proposed parity rules through April 5, and Kennedy says that given the state’s leadership in health reform, what it decides will serve as an important bellwether for other states.

“You are where the rubber hits the road,” Kennedy told the commissioners presiding at the hearing.

If Massachusetts is any indication, several points of contention on parity rules arise: Continue reading

Report: Inpatient Detox Costs Patients Ever More Out Of Pocket

Source: Health Care Cost Institute

Source: Health Care Cost Institute

Here’s some valuable national context for a hot local struggle over inpatient detox beds.

The local news, from the Boston Globe yesterday:

Brigham and Women’s Faulkner Hospital is modifying its plan for closing an inpatient drug and alcohol detoxification unit, after the proposal drew heavy criticism from patients, hospital staff, and mental health advocates who said the state has too few such specialized facilities and the change could harm patients.

“Sure,” I thought when I saw that. “Those attempted cuts fit with all you hear about mental health care as the neglected stepchild of other medical care, and substance abuse as the even more neglected stepchild of mental health care.”

But that’s just my lazy, impressionistic thinking. The quants with hearts over at the Health Care Cost Institute have just used their monumentally huge data sets of tens of millions of insurance claims to pin down what’s been happening lately with inpatient substance abuse payments. And I’d say they, too, found a certain stepchild factor, at least in terms of what patients must pay out of pocket.

Their new report says, according to the press release:

In 2011, out-of-pocket payments for mental health admissions more closely aligned with payments for medical/surgical admissions. However, the amount spent out-of-pocket on substance use admissions remained higher than payments for medical/surgical admissions. Out-of-pocket payments for substance use hospital admissions grew at twice the rate of out-of-pocket payments for mental health or medical/surgical admissions between 2010 and 2011.

The report also found that rates of inpatient detox had taken a major jump after the federal “parity” law, requiring health insurers to cover mental health similarly to physical health, kicked in: Continue reading