Insurers Say Not All Ailments Are Equal

Mental Health Experts Pushing For Parity Laws

June 21, 1999|By Jeremy Manier and Sue Ellen Christian, Tribune Staff Writers.

Twenty-five years ago, the state of mental health care was captured in Woody Allen movies with anxious urbanites recalling their dreams while lying on a couch in five-day-a-week sessions of psychoanalysis.

Since then, the mental health profession has made enormous strides in understanding mental disorders and using sophisticated medication to treat them--but the societal stereotype has stuck.

Although insurers now pay the lion's share of costs for proven psychiatric medication, most still balk at covering the outpatient doctor's visits and occasional inpatient care that are necessary to diagnose severe mental illness and adjust drug dosage.

The gathering political movement to mandate equal coverage for mental illness and physical diseases was a prime focus of the White House Conference on Mental Health, hosted this month by Tipper Gore, wife of Vice President Al Gore. But advocates are becoming increasingly aware that their goal can be reached only if they can show it won't raise total health-care costs--and that the "Woody Allen syndrome" is a thing of the past.

"Twenty-five years ago, they thought (long-term therapy) would help a lot of people--today that's not the case," said Suzanne Andriukaitis, executive director of the Alliance for the Mentally Ill of Greater Chicago. "That's not what we're talking about providing parity for at all; we're talking about seeing a psychiatrist to get medication, and 15 minutes once a month getting a medication check."

The gap in payments can be stark. Many health plans pay virtually nothing for hospitalization of patients with serious mental illness. Even federal employees, who are slated to get equal coverage for mental health care under a plan announced by the Clinton administration in May, must pay up to $250 per day toward the cost of an inpatient stay for mental illness, compared with a one-time $200 deductible for other diseases.

Opponents of parity laws say requiring equal coverage would represent a costly, unfunded mandate foisted on the private sector.

"All they'll do is cause businesses to drop health-care insurance altogether," said Kim Maisch, Illinois director of the National Federation of Independent Businesses.

Yet Bank One, formerly First Chicago, found that even though it implemented a more generous overall benefit package to specifically address depression in the workplace, its mental health costs decreased dramatically as a percentage of overall health-care costs. More outpatient treatment and early intervention replaced the need for costly hospital care.

Yet some employers are too small to take on any sort of increased premiums, despite the long-term benefits.

For Donna Willey of Chicago's North Side, illness has limited the kinds of jobs she can accept. Willey, 39, has struggled during the past 15 years with schizo-affective disorder, which has some symptoms of schizophrenia and some of depression. Willey now has a part-time job using her master's degree in computing and education from Columbia University in New York, and she hasn't been in the hospital since 1995.

Though Willey is ready and able to work full time, she can't--she is dependent on federal disability benefits, which provide the safety net of hospitalization. She must earn less than $500 a month in order to keep the benefits and has to stay poor to qualify for the $1,000 a month she receives in free medications from drug companies.

Willey's employer, Andriukaitis of the Alliance for the Mentally Ill of Greater Chicago, says insurance just for the two of them, given Willey's history, would be an unreasonable $650 a month for minimum coverage.

Similar problems arose for Carl Lambrecht of Highland Park, whose daughter Mary was diagnosed with schizophrenia in her late teens. Fortunately, earnings from Lambrecht's scientific instrument export business helped the family absorb the $30,000 in hospitalization and treatment costs for Mary, who has since received a master's degree and works for a communications company in New Jersey.

Such stories have caught the attention of lawmakers mindful that the cost of mental health insurance lapses often falls on taxpayers.

Momentum for legislative changes started with the federal Mental Health Parity Act of 1996, which barred health plans from keeping different spending caps for mental illness and other diseases. Although most insurers have found ways around that law--such as requiring higher co-payments for mental health or allowing fewer doctor's visits for mental conditions--the last three years have seen an explosion of additional state legislation.

Of the 25 states with some form of parity law on the books, 19 have been passed since the beginning of 1997. One such bill has passed the Illinois House of Representatives each of the last three years--including a bipartisan 89-26 vote last March--only to be killed in the Senate Rules Committee.