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Payment Parity for Medicare
August 30, 2007• Volume 7, Issue 34Should the government discriminate against people with mental illness?
Medicare coverage rules have not changed since the program was created in 1965: patients must cover 20 percent of the cost of a doctor’s visit—but pay 50 percent of the cost of outpatient mental health care.
This is no small burden on those with Medicare. Fifty-nine percent of individuals with a disability who have Medicare suffer from a psychiatric condition, while nearly 25 percent of older Americans endure “significant symptoms” of mental illness. Such common factors as social isolation, life transitions and chronic physical pain contribute to the prevalence of depression and other psycho-social illnesses among our nation’s older adults.
The result of Medicare’s outdated coinsurance payment scheme? It not only creates a financial barrier to accessing mental health treatment, but reinforces the long-standing stigma against mental health care. Consequently, only half of those with Medicare who suffer from a mental illness receive treatment. According to a 1999 Surgeon General’s report, mental illness remains the second leading cause of healthy years lost to death or disability, with mental impairment limiting the daily functioning of an estimated 29 percent of people with Medicare.
The American Psychiatric Association has projected that increasing affordability and access to mental health services in community settings would reduce unnecessary spending incurred when patients are forced to seek costly emergency room treatment or long-term hospitalization.
The bill reauthorizing the State Children’s Health Insurance Program (SCHIP) that recently passed in the House equalizes the coinsurance rates for mental health services and all other outpatient visits and includes a host of other important Medicare reforms.
Unfortunately, the children’s health bill in the Senate includes no Medicare reforms. It makes no effort to end the 40-year wait for mental health parity and provide equal treatment of those with mental illness under Medicare. That’s not for lack of support in the Senate for mental health parity.
In June of 2007, Senator Olympia Snowe, Republican of Maine, introduced the Medicare Mental Health Copayment Equity Act, requiring uniformity between Medicare copayments for mental health and other outpatient visits. Along with Senator Snowe, Democratic senators Joseph Biden, Jack Reed, Richard Durbin and John Kerry, as well as Republican senators Susan Collins and Gordon Smith, signed on in support of the bill.
If these senators truly believe it is time to end Medicare’s discriminatory treatment of mental illness, there is a way to get it done. Right now, lawmakers in the House and Senate are trying to reconcile the different children’s health bills that passed in each chamber. The Senate, however, does not want to include any of the House’s Medicare improvements, including the provision that provides for mental health parity. That can change if the senators who support mental health parity push their colleagues to accept the important reforms in the House bill.
Medical Record
“There is no justification for making seniors and disabled Medicare enrollees pay so much more for mental health care, and yet sometimes it felt as if we were trying to move a mountain…. There will be tough negotiations with the Senate about the whole package, and the APA will fight to make a 20 percent coinsurance for Medicare mental health services the law of the land. Today's patient-focused action is encouraging and we hope to move forward in this positive direction” (Dr. Carolyn Robinowitz, president of the American Psychiatric Association, “APA Hails House Action to End Medicare Discrimination,” Medical News Today, August 5, 2007).
“The Medicare program was established to guarantee health care coverage for all older adults and people with disabilities. However, the 50 percent coinsurance for mental health services has proven to be a harmful barrier preventing many Medicare beneficiaries from accessing services they need. Since its enactment in 1965, we have learned that mental health disorders are highly prevalent in the elderly and disabled populations covered by the Medicare program.... There is simply no reason for maintaining a discriminatory barrier to mental health care for America’s seniors and individuals with disabilities, particularly since these populations present a high incidence of mental health concerns” (Letter to Representatives John Dingell and Joe Barton, Medicare Mental Health Equity Coalition, American College of Physicians online, May 2, 2007).
“Medicare patients seeking mental health services should not have to pay 30 percent more than a patient with a physical condition—it’s not only unjust, it’s immoral.… We as a nation, we value our citizens too much to put an unfair penalty on those who seek help for the less visible wounds some face. Our bill will eliminate the extra burden for mental health care services, and ensure that the unfair mental health penalty no longer stands” (Senator John Kerry, “Snowe, Kerry Introduce Medicare Mental Health Copayment Equity Act of 2007,” Senator Olympia Snowe Press Release, July 2, 2007).
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