Testimony & Statements
AAGP’s Statement on Parity for Mental Health Services
Statement to the U.S. Senate Health, Education, Labor & Pensions Committee’s hearing on achieving parity for mental health services
July 11, 2001
The American Association for Geriatric Psychiatry (AAGP) commends the Senate Committee on Health, Education, Labor, and Pensions for holding this hearing on parity for mental health benefits under private-sector health benefit plans and welcomes the opportunity to share its views on this important issue. AAGP is a professional membership organization dedicated to promoting the mental health and well being of older Americans and improving the care of those with late-life mental disorders. AAGP’s membership consists of 2,000 geriatric psychiatrists as well as other health professionals who focus on the mental health problems faced by senior citizens.
AAGP strongly supports non-discriminatory treatment for Americans with mental illness, and non-discriminatory coverage of mental health services under all types of health benefits programs. We believe that arbitrary limits on coverage of mental health care should be eliminated wherever they exist. Today, nearly 98 percent of all private health benefit plans impose arbitrary limits on coverage of mental health services -- requiring patients to pay higher coinsurance, allowing fewer visits to the doctor or shorter stays in the hospital, and applying higher deductibles before benefit payments begin. These limits, which have been in place since the early days of health insurance, are based on the assumption that mental health problems are somehow less real, or less amenable to treatment, than other health problems.
Nothing could be further from the truth. Mental health problems are very real and can profoundly affect the ability to function and lead a meaningful and productive life. For example, approximately 18 million Americans, many of them senior citizens, are affected by depression annually; and their depression causes more disability than many common medical illnesses. Recent research indicates that of six major medical conditions, only severe heart disease was more disruptive of daily functioning than depression. In addition to causing substantial disability, depression and other mental illnesses are associated with significant increases in medical comorbidity and mortality. Excess mortality is attributable to both suicide and non-suicide deaths.
Mental health conditions are also now far more treatable than they were when arbitrary limits on treatment were originally imposed. Better understanding of neurochemistry and brain functions, together with advances in pharmaceutical research, make the success rate in treating many mental health problems, including depression, significantly higher than that for treating many medical problems. For example, the National Institute of Mental Health (NIMH) estimates the success rate in treating depression at 70 to 80 percent, compared with a 45 to 50 percent success rate in the treatment of heart disease.
Why have arbitrary limits on mental health benefits persisted despite widespread recognition of the need for, and efficacy of, treatment? There is still, to be sure, an element of invidious discrimination involved, with some assuming that mental health problems are caused by an individual's weakness of character, rather than by genetic and other biological factors beyond his or her control.
A more significant reason for the persistence of such limits, however, is concern about the potential impact that their removal could have on health care costs and premiums. These concerns fail to take into account that untreated, or inadequately treated, mental health problems can have an adverse impact on the costs of treating other health conditions.
Research shows, for example, that older persons seeking care for common medical problems have more visits to their primary care physician, use more medications, and are more likely to have emergency room or hospital care when their problem is accompanied by depression or another emotional disorder. In addition, outcomes of medical treatment are worse when complicated by mental health problems: rehabilitation from a hip fracture or heart attack is less successful and more expensive when complicated by depression. This evidence suggests that parity for mental health benefits might reduce, rather than increase, health care expenditures.
Experience in States and health benefit plans that have adopted parity for mental health benefits also supports this conclusion. In Minnesota, for example, the Blue Cross-Blue Shield plan reported a five to six percent premium reduction for small employer groups after enactment of mental health parity legislation in 1995, while the Allina Health System in that state experienced only a small 26 cent per month increase. Likewise, the North Carolina state employees' health benefits program saw payments for mental health services actually decrease as a proportion of total benefit payments after parity was adopted in 1992.
Better access to mental health care also averts broader, societal costs resulting from reduced productivity, disability, and increased law enforcement costs.
The Mental Health Equitable Treatment Act of 2001 (S. 543), which is currently cosponsored by at least 12 members of this Committee1, is an important step toward achieving the goal of parity for mental health care in all health benefit programs. While it would not mandate that private payers include mental health benefits, it would prohibit those group health plans and health insurance issuers that do offer such benefits from imposing higher out-of-pocket costs, or more stringent treatment limits, for mental health services than for medical-surgical benefits.2 This more comprehensive approach to parity would replace the current law restrictions on the use of lifetime and annual limits on mental health benefits, which were enacted in 1996 and are due to expire later this year.
From a public health perspective, achieving parity of mental health benefits under Medicare would reduce unnecessary morbidity, disability and mortality. From a financial and social perspective, AAGP believes that enactment of S. 543 would help the Medicare population in at least two ways. First, private-sector limits on mental health benefits directly affect those Medicare beneficiaries who retain employment-based coverage either as a primary payer ("working aged" beneficiaries and their spouses), or as a secondary payer (retirees and their spouses). Closing the gaps in employment-based mental health benefits would give these populations greater protection against the substantial out-of-pocket costs they would otherwise incur. Second, the current limits on employment-based coverage of mental health services discourage workers and their families from seeking appropriate care and send a message that mental health problems are less worthy of society's attention. By removing the barriers to mental health care experienced by many Americans during their working lives, S. 543 could help to reshape the attitudes of future Medicare beneficiaries toward seeking care for mental health problems, such as depression, experienced after retirement.
For these reasons, AAGP encourages the members of this Committee who have not yet agreed to cosponsor S. 453 to do so, and we urge the Committee to report the bill favorably for consideration by the full Senate in the near future.
1 Senators Bingaman, Clinton, Dodd, Edwards, Harkin, Jeffords, Kennedy, Mikulski, Reed, Roberts, Warner, and Wellstone.
2 Employers with 25 or fewer employees would be exempt from this requirement.
The American Association for Geriatric Psychiatry (AAGP)
7910 Woodmont Avenue, Suite 1050, Bethesda, MD 20814
Phone: (301) 654-7850, Fax: (301) 654-4137, Email: main@aagponline.org
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