Insurance falls short for mental health
04 03 08 - 18:24
Bills aim to expand mental-illness coverage in Ariz.
Amanda J. Crawford
The Arizona Republic
Mar. 4, 2008 12:00 AM
Couper Harding was not yet in kindergarten when he started taking his meds.
There had been uncontrollable rage, biting, kicking. One day he turned a hose on dozens of kids in his Montessori-school class.
He saw therapists and psychiatrists. The meds didn't help much. One day Couper, unusually strong for his age, picked up a vacuum cleaner and threw it at his parents.
At age 6, he was admitted for his third hospital stay. That's when Couper's health-insurance company decided it was not going to pay any more. Two weeks into his hospitalization, it dropped Couper from his parents' plan. The family had to pick up thousands of dollars of medical costs but was lucky to qualify for a state program to help with the rest.
Couper, now 12, has bipolar disorder, Tourette syndrome and obsessive-compulsive disorder - serious mental illnesses, diseases of the brain. If he had leukemia or cancer or most any other disease, the insurance company would have to treat him differently.
But in Arizona, unlike many other states, health-insurance companies don't have to treat mental illnesses the same as physical illnesses, a double standard that mental-health advocates say leaves families like Couper's struggling to get the care they need and often turning to taxpayer-funded programs to pick up the bills.
"Couper has a higher risk, if not the same risk, of dying as any of those kids who have leukemia or cancer," Couper's mom, Tammy Fisher, said. "If Couper doesn't have access to his meds or he got dropped from his insurance and we couldn't afford them ... Couper could kill himself. Tell me that is not a deadly disease."
Problems reaching parity
For more than a decade, bills in the state Legislature have sought to force insurance companies in Arizona to provide the same benefits for illnesses of the brain as they do diseases of the heart, lungs or liver. But year after year, those efforts have fallen flat, running up against powerful business and insurance lobbies, and a continuing stigma against those with mental illness, supporters say.
Arizona is now among 11 states that do not have mental-health parity laws that require equality in coverage, according to the Arizona chapter of Mental Health America.
A proposal in the state legislature this year wouldn't require insurance companies to provide mental-health benefits in their plans, but it would require that if they do, that behavioral-health services are covered at the same level as other medical services.
Opponents say they believe that the requirement would increase the cost of health insurance, which is already out of reach for many families and small businesses.
Rep. Kirk Adams, R-Mesa, said he opposes insurance mandates in general and believes proponents of mandates often ignore the potential ripple effects on the system.
"If new mandates increase the costs for everyone . . . and a subsequent number of people no longer carry insurance, we are not improving the system," Adams said.
Insurers argue that they provide the services that the market dictates and that their products meet consumer demand.
"We design our benefit plans to reflect market demands," said Regena Frieden, spokeswoman for BlueCross BlueShield of Arizona. "We believe our mental-health benefits are strong, and this is a mandate, not a market-driven decision."
Mental-health advocates point to studies in other states showing that health-insurance costs go down when people can access the appropriate care by lowering their reliance on primary-care physicians, for example, and turning to therapists instead. Costs also go down for taxpayers, they say, who now end up picking up the costs for some families' behavioral-health care.
Sherri Walton, vice president and public policy chair for MHA of Arizona, said she's seen estimates that roughly 10 percent of the low-income individuals receiving state-funded mental-health services through the state's Regional Behavioral Health Authorities have private insurance that either doesn't cover mental-health services or not to the extent they need. That doesn't include those who qualify for other state-funded services, such as long-term care or the state's program for people with developmental disabilities.
"Why should we, the taxpayers, be subsidizing the insurance companies? We should be requiring them to provide the care and treatment that people are paying them to provide," Walton said.
When Couper was dropped from private insurance, which he had through his stepfather's job, the family turned to the state.
Though the family had to pick up one week of his hospitalization at a cost of more than $7,000, most of the rest was covered through the Arizona Long Term Care System, since Couper was found to have a physical disability, Fisher said.
Since then, ALTCS, part of the state Medicaid system, has been footing the bill for much of his behavioral-health needs, despite his family's six-figure income and employer-provided private insurance. Many families aren't that fortunate.
Misperceptions continue Mental-health parity bills this year in the House and the Senate appear stalled, though proponents still hold out hope. The House version, House Bill 2145, received an informational hearing in one committee, but never went to a vote.
This week is the last week for committee action in the chamber.
Supporters say they are hoping to revive it later in the session. Sponsors Rep. Ed Ableser and Sen. Rebecca Rios, Democrats who have both worked in the mental-health field, say they are concerned about the influence of the insurance lobby on the issue, and continuing misperceptions about mental illnesses.
On Ableser's legislative office door, a bumper sticker reminds visitors that "Mental illness isn't a sin or a crime, it is an illness."
"This is an issue where the time has come and gone where we should have addressed mental-health coverage in Arizona," Rios said. "In a few years, we are going to look back and say, 'Why did it take so long to do this?' like we do with DUI (laws) or mandatory seat belts. One of these days we are going to get it."