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Simple Fairness
February 15, 2007 • Volume 7, Issue 7This week, an overwhelming majority of the Senate Committee on Health, Education, Labor and Pensions voted for legislation requiring all private insurance companies to cover mental illness treatment at the same rate as they do for treatment of physical conditions. The vote signals likely passage in the Senate, and similar legislation has strong support in the House of Representatives.
These bills are a good step toward lifting the unfair restrictions on mental health coverage in the private insurance plans that cover 113 million Americans. According to cosponsor Senator Pete Domenici, Republican of New Mexico, “What we are doing here is simple fairness.” As lawmakers move toward mental health equity, however, they should not forget that similar action is sorely needed to provide equal access to mental health treatment for people with Medicare.
Under current Medicare rules, Medicare pays 80 percent of the cost of a doctor treating a physical ailment and patients pay 20 percent. But mental health patients must pay half the cost for therapy treatments out of pocket because Medicare only covers 50 percent.
This payment limitation prevents older adults and people with disabilities who cannot afford the cost of therapy from receiving proper treatment. Letting mental illness go undiagnosed and untreated severely hinders the quality of life for people living with afflictions like schizophrenia and depression, reduces their ability to function and leads to higher mortality rates—because they cannot pay.
Nonmedication treatment for mental health conditions have been shown to provide significant relief. For many older adults, a particularly vulnerable population, therapeutic interventions not only help treat mental health problems effectively, but also help strengthen their ability to cope with the stresses of living with mental illnesses, improve compliance with drug regimens and offer social support.
However, the inequity built into Medicare’s payment rules for mental health treatment makes treatment out of reach for people with limited financial resources and reinforces the outdated notion that mental illnesses are less important to treat than physical diseases.
The sponsors of the mental health parity bills are optimistic that Congress will finally pass the long-awaited measures. But our representatives in the House and Senate who support the proposed legislation must remember that these bills still fail to provide people with Medicare the equality of care that they need. Until older adults and people with disabilities living with mental health conditions are also given coverage parity, Medicare’s rules are still, simply, unfair.
Medical Record
“An estimated 59 percent of all disabled [Medicare] beneficiaries have some type of mental disorder, compared to 21 percent of aged beneficiaries” (“Medicare and Mental Health: The Fundamentals,” National Health Policy Forum, November 27, 2006).
“The Mental Health Parity Act of 2007 (S. 558) was today approved (18-3) by the Senate Health, Education, Labor and Pensions Committee. The bill requires health insurance plans that offer mental health coverage to provide that coverage on par with financial and treatment covered offered for other physical illnesses like heart disease, diabetes or asthma” (“Senate Committee Passes Mental Health Parity Bill,” Office of Senator Pete V. Domenici press release, February 14, 2007).
The Medicare Mental Health Copayment Equity Act, previously introduced in Congress, would reduce the coinsurance cost for Medicare mental health visits from the current 50 percent to the 20 percent level required for all other medical services covered under Medicare Part B (“H.R. 1125 [109th]: Medicare Mental Health Copayment Equity Act of 2005,” March 3, 2005).
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The Louder Our Voice, the Stronger Our Message Asclepios — named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
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