I’m glad this is happening:
The Mental Health Parity and Addiction Equity Act of 2008 interim rules were issued by the Obama administration and showcased today on January 29, 2010.
The law is officially known as the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. The law essentially requires employer-sponsored health plans to provide coverage for addiction and mental illness on a level consistent with other health problems.
I have a friend who volunteers for several mental health organizations who is very happy with these changes. Hopefully some of you with some expertise can explain what the changes are from the status quo and why this is such a big deal.
MikeJ
Just talk. Worse than Bush. Thrown under the bus. Black Jimmy Carter.
Yutsano
In a nutshell: health plans have to include mental health coverage, period. Before that it was a patchwork of whether your employer’s plan would cover your psychological coverage or not. It was a VERY good rule change in that regard. I forget the details (like what the minimum standard was, I think six visits in a year or something like that plus inpatient coverage) but overall it was a huge positive in the world of mental illness awareness and coverage.
DougJ
Look for Rahm to spike this before it becomes law.
General Winfield Stuck
Another case of Obama failing on everything.
4tehlulz
This just proves that Obama is a corporate sellout.
Violet
One example:
Co-pay for in-network doctors is: $35.
Co-pay for in-network mental health professionals is $60, with a limit of ten visits a year. After that it’s all out of pocket.
Out of network benefits are significantly worse.
Requiring plans to cover mental illnesses at the same rate will help people who really need the coverage get and stay well. It can be exceptionally challenging to find the right doctor and treatment for mental illness. And if your mental illness is untreated it affects every other area of your life.
AnneS
@Violet: Another note to add to Violet’s comments — depending upon your insurance plan, prescriptions for mental health care are not covered to the same extent as those for physical health care. More out of pocket expense and another discouragement to seeking and continuing with help for a mental illness.
locanicole (lurker)
It’s great but I wish they had made a bigger deal out of it way back when. What it means is that my kid can get the therapy she needs. I actually limited her visits and paid co-pays until someone clued me in to it. Now no co-pays, no limits; just like physical therapy. We went from 20 visits per year at $20 each and then 100% after that to 60 visits a year and no co-pay. Thank the FSM….and now I can keep her on my insurance until she’s 26. Hopefully this will give the numbnuts in D.C. enough time to work out all the other healthcare nighmares like pre-existing, chronic illnesses.
HinTN
Yutsano got it exactly right. The rule requires insurance carriers to cover mental health the way they cover other health, and that’s a BIG deal. Previously there was little to no coverage. So, if you have insurance, even state plans and medicaid, this is big. As to the other comments, yes there is a major fail to date from Obama and this may simply drive premiums up, but at least the subject is now health and not a fragmented set of subdivisions.
zed
An example. Before this went into effect, psychotherapy visits were subject to my deductible, followed by a 50% coverage from my carrier, with a yearly maximum of 52 visits. After the change, my deductible still must be paid, but I am now covered 80% and with no maximum visits.
This act will save me a ton of money
LindaH
Another example. My (very good) insurance policy only covers 26 visits per patient per year. The year my ex was spiraling into a bipolar Obsessive Compulsive nightmare, I was literally counting visits to various therapists, psychiatrists, etc just to make sure that if he had to be checked into an inpatient facility we hadn’t outrun our coverage before December 31. I also had to keep count of my visits to make sure that I had some left while trying to deal with a husband who was falling apart and work in marriage counseling sessions to try and keep the marriage going until he could be properly helped. Taking away that stress would have helped immensely.
R-Jud
I have four relatives who will benefit greatly from this. They can now see their therapists when they need to without having to worry about using up their covered visits for the year.
Robertdsc-iphone
@MikeJ:
You mean Herbert Hoover with a tan?
Doctor Gonzo
As a Minnesotan, the loss of Paul Wellstone still sucks.
Tecumseh
Just from my own experience, I know that health insurance companies usually run far away from anything related to the mental side of things. When I lost my health insurance and called health insurance brokers about getting insurance on my own, I told the insurance brokers I was dealing with that I was taking a variety of pills for some (mild) emotional/anxiety related issues and they basically told me good luck as there would be no way I’d get coverage. Anything that forces insurance companies to have to provide those services and decently is a really good thing.
rootless_e
@General Winfield Stuck: He should have refused to issue regulations until a new bill, starting from scratch, replaced this bipartisan joke.
Annie
@LindaH:
What you have had to go through — counting visits in the midst of crisis — just makes me want to scream…I applaud your strength and commitment. This is something no one should have to go through while dealing with an extremely difficult situation. This shows that even with “good” health insurance, it is not enough. Mental illness is a medical condition and should be covered, without families worried about being cut off.
One of the best comments I heard about Obama facing the “lions den” yesterday was that Republicans are seriously trying to maintain that they care about health care reform and health abuses, when for years when they were in power, they did nothing. Now, all of a sudden they care about reform, but they are just concerned about costs and government control. What bullshit. They never cared about health coverage, as evidence by the state of our current system.
I hope reform comes in time to ease some of your stress, but know that there are people who do care.
General Winfield Stuck
@rootless_e:
The Perfect is cheap in Progtown, ponies cheaper still.
OK, I will stop gratuitous hippie bashing, for now.
Mike in NC
Mental illness? So the entire GOP Congress stands to get more free medical care to treat their ODS? Not change we can believe in, my friends.
Comrade Luke
Not having been following politics all that closely when Wellstone died, I have a question for the people who were: would Wellstone be considered closer to Kucinich today?
It seems like he was pretty left (which is a good thing in my book), but anyone left of Obama these days is considered a DFH, so I was just wondering where he’d fall on the spectrum if he were alive today.
General Winfield Stuck
@Comrade Luke:
Not really. Wellstone was a principled liberal, Kucinich, not so much and has seen alien spaceships. Though since I have to, won’t hold it against him.
chopper
my insurance only covers like 10-12 visits a year. and its good insurance. low enough co-pay for in-network therapists, i don’t wanna know what it is for out-of-network.
the non-mental-non-dental-non-vision side of my insurance is fantastic. not that i expect to use this expanded coverage but i’m very, very glad it’s now there (especially having kids now, you never know).
bey
@rootless_e: And there, my friends, is a perfect example of an ideologue. Perfectly content to consign people to short lives of misery, in order that the purity be maintained.
My mentally ill son committed suicide a few years ago. There were a lot of reasons, but one of them was his despair at not being able to afford the mental health care – substantial and very very expensive – that he needed.
He required anti-psychotics, anti-depressives, monthly psychiatric monitoring of his medications, and regular ongoing therapy. The only insurance he could purchase was the state disaster plan for people who were otherwise uninsurable. It provided drug benefits, but no mental health benefits whatsoever. Even with sliding scales, he spent more than 50% of his take home income on care in addition to his premiums.
He lived with me, because he couldn’t afford to live on his own and couldn’t envision being able to ever live anything approaching the normal life of a man in his late 20s.
This will save many lives, and make many more worth living. It will spare untold numbers of people misery. So before you open your piehole, you might consider the cost of purity, you sanctimonious jerk.
Darkrose
Before MA passed a state law requiring parity, I got 8 one-on-one therapy sessions plus another 12 group sessions per year. Let me tell you that seeing your therapist once every six weeks? Not that useful.
For people who don’t live in states with parity laws, this is huge.
General Winfield Stuck
@bey: So sorry beh, I know the special pain of someone close taking there own life. We have a medical system that kills people out of greed. No other way to put it. Not an advertisement for the supposed greatest country on earth, specially since it’s the richest one.
Anne Elk (Miss)
I work for a psychiatric practice. This is good – WAY good. One thing that is still not clear to me about it, though, is whether it prevents insurance companies from doing what we refer to as “carving out” – ie, farming out the mental health benefits/management to an outside company, which can then have different benefit levels. For example, we have several patients who are all members of a local union. They carry a Blue Cross card, but for their group, mental health benefits are “carved out” to Cigna Behavioral Health. So, the patient has a completely different benefit structure and payor for mental health. Plus, although our doctors are in-network with Blue Cross, they are out of network with Cigna – which usually means a much higher deductible and a totally different amount due from the patient than what the card says. I also wonder if these new rules will eliminate the need/requirement for mental health visits to be pre-authorized by the insurance provider. After all, you don’t need pre-auth to see your doctor for your high blood pressure, so why should you need it for your depression or anxiety?
Still, it’s still very good news for those in need of mental health services.
Hiram Taine
@bey: Sorry to hear of your loss, my sympathies as someone who also suffers from mental problems and can get no help at all any more.
That being said I think you should have your sarcasmometer recalibrated, mine pinged pretty loudly on the post you were replying to.
SiubhanDuinne
@Anne Elk (Miss): That is your theory and what it is, too, and it is yours.
SiubhanDuinne
@bey: I am so terribly sorry. I can’t imagine the pain.
nepat
@bey:
I could be mistaken but I think rootless was being satirical in his comment – and mocking the very purity you point out – by equating this bill with HCR overall and how “progressives” constantly make the perfect the enemy of the good.
Very very sorry about your son.
bey
@Hiram Taine: Possibly, and if so I apologize for my outburst.
This is a red-hot button with me. I’m a strong proponent of universal care, but if I can’t get that now, I’ll take a public option, and if I can’t get that now, I’ll take subsidized care for low-income people, and if I can’t get that now, I’ll take not allowing insurance companies to deny coverage for pre-existing conditions.
In other words, I’ll take any improvement over the status quo, with to goal of continually working towards universal care. Every step forward directly affects people who need help.
General Winfield Stuck
@bey:
Couldn’t have said it any better.
SiubhanDuinne
This thread puts me in mind of Ado Annie’s lament in Oklahoma!:
“With you, it’s all er nuthin,
All fer you, and nuthin fer me.”
Silver
Yes, but what does Megan McFucktard think about it?
http://meganmcardle.theatlantic.com/archives/2010/01/mental_health_parity_for_insur.php
Apparently, the administration has issued rules requiring parity for mental health treatment with other illnesses. They’ll take effect July 1st. If you want to know why health insurance costs keep marching upward seemingly uncontrolled, this is why: mandating new benefits is always popular, and the government doesn’t have to pay for them.
I am very sympathetic to the plight of the mentally ill. Unfortunately, most of the people who will tap the benefits are not severely ill people who need intensive care; they’re people who are unhappy. Unhappiness is not a condition for which psychotherapy, or antidepressants, have been shown to be very effective. (Severe clinical depression, yes. But contrary to the belief of people who felt awfully down the time their boyfriend left them, these two conditions are not the same thing.) Since the moderately unhappy and dissatisfied are much more prevalent than those with serious disorders, that’s most of what we’ll be paying for: someone to listen to complaints. That’s what Senators are supposed to be for.
If I ever see her walking through a crosswalk, I’m gunning it, and blaming whatever happens on Toyota’s faulty gas pedals…
Hiram Taine
@bey:
I wish I could believe that is the way it’s going to work out, that low income people (no income in my own case) will get subsidized care.. Sadly I think that low income people will get subsidized insurance that many of them will be unable to make use of because the high deductibles and high co-pays will put the actual care out of reach financially.
I see the current HCR bill as mostly helping those who already could afford insurance premiums and the other costs but who have been shut out of insurance due to preexisting conditions. That it helps these people is great but I’m also concerned for those who cannot afford insurance.
The enforcement method for the insurance mandate is clear, the IRS will levy fines that the individual *will* end up paying one way or another.. The enforcement against the insurance companies breaking the rules is far less clear to me anyway. The experience of California in trying to curb abuses by BCBS in that state does not make make me sanguine that the insurance companies can be held to the law in the long run.
General Winfield Stuck
@Silver: deleted cause Silver might have had blockquote fail.
Yutsano
@General Winfield Stuck: I would go with that assumption. I blinked for a second before coming to the same conclusion.
Silver
Yep, that callous paragraph before the part where I talk about running her down in a crosswalk should have been in italics.
Those were her words…shouldn’t have gotten up to do some stuff before the post came up, sorry :) Epic blockquote failure on my part.
cmorenc
There IS one nasty-sounding, yet essential question to be asked about mental health coverage:
– how much extra will adding this coverage cost per person, per family? I’m not speaking here merely of nominal premiums, but also of any additional costs in taxpayer subsidies.
This is a very hard question indeed that needs to be honestly answered, even apart from whether we should do it despite the extra costs involved (y’never know when the afflicted person might turn out to be you or a dependent member of your family).
This is the same very hard question that needs asking about LOTS of crushingly expensive medical illnesses, not just mental illness. How can we go about covering this in a humanely adequate fashion to relieve insufferable illness or individual/family financial burden, without imposing an unsustainable financial burden on other individuals/families/businesses/governments to function? Chronic mental illness is often NOT a cheap thing to treat.
It’s not enough to simply say “well, the Canadians are doing it successfuly, the French are doing it successfully”, unless…you can round up the support within the US to adopt either similar single-payer type programs, or else come up with an alternative system that accomplishes this without a different model, other than the exhorbitant, hole-ridden, often callous private insurance system we have now.
Yes, insurance companies all too frequently behave very callously and with financial crassness. However, you cannot simply order insurance companies to cover more without either allowing additional premium money, subsidizing with taxpayer money, or forcing greater efficiency (meaning cutting out either administrative middlemen or coverage or profits or…unnecessary or ineffective procedures). Now…how are we going to do that?
BTW: yes, I worked in the mental health field up-close for over two years, with some of the most severely chronic cases in the system, and saw first-hand the process of what happens to families as the financial burdens accumulate and extend over time. Schizophrenia, bipolar disorder, and so on. I also have a close relative who is bipolar. Invariably, there comes a point where, absent extended-length insurance, one of two things happens: the family exhausts its financial resources, and can no longer help the ill person gain treatment, except at public hospitals on the public dime. OR: the family makes the tough decision to cut the ill person financially loose as an endless chronic sinkhole, before it exhausts their resources for other family members. This is not an abstract problem at all to me.
maus
Wow, this is wonderful.
Something Fabulous
Phew, thanks for clearing that up, Silver: I was still working on becoming coherent enough to reply by the time you did. “Broke up with your boyfriend” indeed. MMcA can kiss whatever part of my ass she can reach.
My Dad, too, has been depressed my whole life (not to mention most of his), and there is ALWAYS impact on the family: there was a magnificent time many years ago when my mother was in one hospital being treated for breast cancer when the other hospital nearby called my brother and me to inform us that the new fiscal year was not going to kick in for two weeks, so someone was going to have to come pick up my dad from the locked ward the next day and since my mother was unavailable, who would it be?
Fortunately, he and she both made it through that period, somehow. Ad though my mom died last year, my dad now– through medicare and the VA and the BC supplemental– has everything covered. It takes several people to keep all of that straight for him now, but at least he is getting what he needs. And with this new iteration of otherwise ruinously expensive anti-depressants, he is not seasonally depressed for the first time ever, this year.
And (whatever other issues he has), no, he is not one of those “government out of my medicare!” freaks. Instead he is actually concerned for younger, non-vets: “What do they do, without family to help?” He, at 83, is all for single-payer. Go, Dad.
Something Fabulous
@bey: Oh, and in my ranting bey I forgot to write what I was setting out to: My most sincere condolences. I cannot imagine what that would be like, being the parent in that sad and horribly frustrating situation. So very sorry.
J. Michael Neal
This is great. Now, it would be great if they did the same thing with disability insurance. Lose a leg? You can get disability payments for the rest of your life. Find yourself at two in the morning with a bottle of vodka in one hand and a bottle of xanax in the other, hoping that, if you take it all, you won’t have to go to work in the morning? Three years, maximum. After that, it doesn’t matter whether you’re ready to go back to work yet.
The way disability insurance works, I should still be collecting; your eligibility is determined by whether or not you can go back to work *at the same job you had when you were covered.* I may get back to work doing something else (in which case my wages would be deducted from my disability payments), but I will never be able to go back to making markets in options. No way.
As it happens, I’m probably no longer disabled in terms of being able to get a job that pays somewhere in the same range of what I was making at Citi (though probably without the bonus), but I can’t get a job. As far as I’m concerned, I ought to be considered disabled so long as no one will hire me because of the disability I had. When it comes to protecting people with mental health issues during the job search process, the ADA is a joke.
middlewest
I remember in college during the Nader revolution, I was informed by members of the True Progressive Left that Paul Wellstone was a sell-out corporatist tool in sheep’s clothing, just like Al Gore. Their proof was that he sometimes made compromises with conservatives on legislation, which was simply unforgivable. I wonder how long it will take them to turn on Franken. (Or have they already?)
wenchacha
@Anne Elk (Miss)
My family now has the Cigna/ValuOptions mental health carve-out. It was infuriatingly bad the first time we had to endure it, and this year it has been somewhat less so. I think I will be able to keep my therapist.
My concern is that our medical coverage is entirely out-of-pocket! We can’t use regular doc visits toward our annual deductible; only “procedures” count toward that. I’m scared that I’ll be guaranteed parity with the medical plan that sort of sucks.
Megan McCardle must be in rareified company if she doesn’t know people with chronic depression that is unrelated to faithless boyfriends. We aren’t exactly legion, but there are plenty of us who appear normal enough, thanks to anti-depressants and good therapists and doctors. Take that away from us, or make it impossible to afford, and we’ll be much more noticeable the few times we have the energy to be in public. What a sorry excuse for a human being.
Persia
@chopper: Yeah, when I ran out of visits I was looking at $120/week out of my own pocket. couldn’t do it. Fortunately the drugs seem to be doing enough for me at this point.
The Other Steve
Kucinich ran for President so he could meet women.
chopper
@bey:
put me down as also believing that rootless was being sarcastic, riffing on the general’s comment.
also, put me down as being full of sorry about what happened to you. having a kid myself, and a clinical psychologist for a wife (the stories she tells) makes me so glad for anything we can get that puts better mental health coverage in the hands of parents of mentally ill children.
Wile E. Quixote
Why is it named after Wellstone and Domenici, those guys are sane? Shouldn’t they have named it after Jim DeMint and Michelle Bachmann?
Wile E. Quixote
@McMegan McArdle
You know, if the Atlantic would fire this ignorant c#nt I might renew my subscription.
LongHairedWeirdo
I suffer from chronic depression and ADHD-primarily inattentive. What this means is, sometimes I’m very, very tired. Have you ever tried driving late at night when you’re doing everything you can to stay awake, and it’s working, but just barely, and you realize you’re being a dumbshit for continuing to drive, but there’s no safe place to stop yet?
That’s what I mean when I say I’m sometimes very, very tired.
Now, if I could have sworn I was addicted to downers or painkillers, I could have gotten inpatient treatment that lasted significant amounts of time, and they would have done lots of stuff to help me break my “addiction”. But because I wasn’t on drugs, the insurance companies were free to say “tough shit; your MD can try a few antidepressants to see if they help.”
Thankfully, I learned about ADHD and learned that feeling like one had narcolepsy or sleep apnea could be a stealth-symptom of ADHD. So, I talked to a shrink, who agreed. But I could only see that shrink every two months or so, and my insurance company could have decided not to let me continue at any time. They were a decent insurance company – but they didn’t *have* to be. So, ugly situation.
Mental health parity changes this.
Colette
I’m one of the fortunate ones whose company has between 2 and 50 employees, and who has sucktastic Blue Cross, aka Bastard Coverage-deniers, as our insurance company, so the law doesn’t apply to us. It’s the Other Doughnut Hole of mental health coverage.
Still, I’m really, really glad that this makes things better for many people. One step at a time is better than no progress at all.
Carol
Megan McCardle..grr..I was going to write that even the most balanced of us can have an event that takes us emotionally careening, out of control, and even catatonic. How dare she dismiss this as trivial? I mean, should a grieving widow not have access to mental health counseling that could help her go on with her life? This isn’t some situation comedy where “minor” mental illness just provides punchlines. Even minor tics can interfere with keeping and getting jobs and organizing life.
I loved life more when I was on my meds. Things got done quickly and were far more organized. I could keep up with my other medications as well. Even my house was cleaner, as I paid more attention to small details.
Then I realized that maybe this bill can help me too. I have ADHD, and my meds were too expensive to keep when I get laid off. Maybe now I can get them more affordably and keep organized and on a steady regimen now?
geg6
Fuck Meghan McArdle with a rusty pitchfork. The only time I needed mental health coverage was when my SO basically tossed me out of the home I’d lived in with him for 18 years. I had put all of my emotional and financial resources into that relationship and home, a home that wasn’t in my name and money I couldn’t get back due to that fact and that we weren’t married. I had almost no resources to find another place to live, three lawyers who told me I had no recourse, and the emotional baggage of complete betrayal and despair. I became suicidal, lost 30 pounds (and I’m very thin to start), and spent most days weeping uncontrollably or paralyzed with fear. When my supervisor insisted I see someone, it turned out that I am mildly depressive as my “normal” state and this situation sent me into a major depression. Thankfully, my insurance covered my treatment, which literally saved my life. I am still paying on shit I bought for that house 5 years ago (several loans I took out for home improvements), but I’m alive, have not relapsed, and have a new wonderful man in my life. That bitch McArdle can get fucked as far as I’m concerned.
Carol
Amen, geg. I got very depressed when my father died, and there was no available counseling. I entered a church at the time, and while I don’t regret what happened, it’s hardly the time to make such a major decision in any event.
Things happen to the best of us, especially as we get older, and while we don’t need lifetime stuff, things can get rocky at times.
sparky
an incremental change anyone could believe in, though it will lead to increased premiums. not that anyone will mind that, of course.
it would be nice if y’all could stop setting up strawmen. the argument was never that health care had to be perfect, just that it was wrong both politically and institutionally to turn the government over to the private sector. if that’s the kind of solution people like so much, we could simply have Halliburton hire every unemployed person in the US and then worry about it later.
pps: as long as i am being argumentative, the supposition that a failure to pass whatever-you-want-to-call-it will be a deciding factor in November is, well, unfounded. who exactly in the general public will remember (who would otherwise vote D), and what are the Rs going to do: run ads saying who failed to pass health care reform?
ppps: as a person who has a family with some mental illnesses in it, i certainly welcome changes in perception that permit this kind of progress. and, knowing how intractable and soul-crushing such illnesses can be for both the affected person and his or her family, i am deeply sorry for your losses and troubles.
Betty
The CEO of the insurance company I worked for insisted that these people claiming the need for mental health benefits just wanted a friend to talk to- not really sick, just feeling bad. I think the bigger issue for the insurance companies is that mental illness is often a chronic problem that needs long-term coverage- something they’d just rather avoid paying for.
gil mann
Domenici’s a total wingnut, but he had a sister with severe depression or something. I’m for whatever works but it sure would be nice if this country could identify problems which members of our ruling class don’t have personal experience with.
By the way, Wile E, you’re a smart, funny guy, but damned if you don’t manage to bring a tinge of sexism to almost everything you write. Saying things like “cunt” less would only make your comments shine that much brighter.
Carol
Betty, I think some CEO’s skipped their psychology classes. Mental illness is very real and very debilitating-and a real social issue. Subtract the mentally ill from the homeless population, the substance abuse population, and the jail population, and you would see the difference.
A long time ago I read that only $7 per patient was spent on research on mental illness. While the number has increased, I’m still astounded at how far we have to go-and how little is really being done to push it along.
David Moisan
@Carol:
I have ADHD and recurrent depressive episodes.
I have gone through a lot of grief getting care at first (20 years ago) due to many of the factors people cite. I’ve been on the wrong end of the economic scale for a long time. Things like getting psychotherapy but no meds, choosing to pay to see said person vs. meals, having people tell you ADHD doesn’t really exist, etc. (which is something Rush L. loves)
After 20 years of this, it is outright barbaric that mental health services don’t have parity with “regular” health care in facilities and access to care.
We are paying for this disparity. Oh, are we ever! And will we ever!
Some of us already have (Bey, I’m very sorry for your loss.)
LiberalTarian
Well, I wish he’d send some help to people who are mentally ill and *don’t* have health insurance. In California, the mental health programs for the poor are being *gutted*. Like, all the staff laid off except for the county seat, where there’s still just a skeleton crew. Half or three-quarters of beds in mental health facilities being discontinued.
I’m very happy that people with insurance are now going to be able to get more mental health help. But, honestly, if you are well enough to hold down a job and get insurance, you are already head above water.
The real kicker is that they have laws that keep the middle group, you know, the 21-64 group without physical disabilities, from being able to get state health insurance without a diagnosis.
And, your parents have no rights where you are concerned, so they can’t force you to get help unless you are threatening to kill someone or yourself.
So, if you are mentally ill, your parents can’t get you help without your consent, you cannot get medical insurance and your parents cannot get it for you, and if you have a psychotic break you end up in jail or in a place that will give you anti-psychotics for 3 days and then turn you loose on the streets again.
Yay for people who get more mental health care, yeah, that’s great. Now, can we help families with mentally ill adult children? PLEASE??