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Bill does not pass without amendments; MMA warns against health mandates

Passage of HB 667 good news for psychiatric association

JACKSON — The enactment of the Mental Health Parity Act of 1996 was the first step in “ending discrimination” against individuals with mental illnesses, according to the American Psychiatric Association (APA), but most state laws, as well as the federal law, are limited in scope or application.

According to the APA, the federal law only applies to mental health annual or lifetime cost limits, but not to substance abuse, co-payments, deductibles or inpatient and outpatient treatment bills, and state parity laws are all very different from one another.

But House Bill 667, a parity measure that specifies health plans offered by small employers that currently do not offer mental health illness benefits must offer optional mental health benefits, was passed into law recently in Mississippi. The law also provides for Mississippians equivalent payment rates for mental health inpatient services and partial hospitalization as set for other medical and surgical treatments. The rate of payment for outpatient visits will be a minimum of 50% of covered expenses, which may be limited to a maximum payment of $50 per visit, according to a press release dated April 19 and released by the APA.

Mississippi is the 32nd state to enact some form of parity legislation.

“This is a historic first step in our efforts to dispel the myths and stigma surrounding the treatment of mental illness (including substance abuse disorders) and move forward to extend parity in health insurance coverage,” said Daniel B. Borenstein, M.D., president of the American Psychiatric Association. “We applaud both the Mississippi Legislature and Gov. Musgrove for breaking down the barriers for the people of Mississippi from receiving treatment and recovery from mental illness. Together, the Mississippi Legislature and Governor recognized that we have acquired an immense amount of knowledge that permits psychiatry to respond effectively to the needs of persons with mental illness.”

The APA as well as the Mississippi Psychiatric Association (MPA), along with a coalition of family members and patients who worked to achieve parity, believe the enactment of HB 667 is important.

According to the press release, the enactment of the bill “will be an important beginning in tearing down any obstacles to progress in health insurance coverage and treatment of mental illness and substance abuse disorders.”

Dr. Angelos Halaris, federal legislative representative for the MPA and a member of the commission on government relations for the APA, and the chairman of the Department of Psychiatry at the University of Mississippi Medical Center, is excited about the enactment of HB 667. Halaris chaired the task force on parity legislation on behalf of the MPA; the task force consisted largely of members of the MPA as well as key members of related associations and organizations in Mississippi.

“It is really very obvious and common sense that if people are healthy they report to work regularly,” Halaris said. “Absenteeism is expected to go down significantly and productivity on the work side is expected to increase significantly.”

Halaris said it is hard to predict what the cost increase in insurance premiums will be, if any, but said that based on available data in other states that had enacted similar legislation, the average increase in premiums was around 1% to 2% or 3% to a maximum of 4%.

In Mississippi, only certain health insurance policies are to provide covered benefits for the treatment of mental illness.

The mental health parity bill will go into effect Jan. 1, 2002, and although Halaris said the money it will save businesses is well worth the mandate, Jerry McBride, president of the Mississippi Manufacturer’s Association (MMA), does not agree.

“Basically, we oppose mandates on health insurance coverage,” McBride said. “The cost of health insurance is one of the top problems our employers are having now. It keeps rising, and they’re getting to the point they can’t afford it and their employees can’t.”

McBride fears that mandates on health insurance coverage will raise premiums to the point that many employers will stop providing it, and employees will stop paying for it, too.

“People argue if you provide coverage it’s going to be cheaper,” he said. “That may be true, but we believe the employer ought to determine what coverage they’re going to offer and how much they’re going to.”

McBride added he was not questioning the validity of insurance companies offering benefits such as mental health care, but said he did not believe it was right to force benefits on anyone.

“If you let them go through you’re going to cause people to start dropping insurance,” he said. “I’ve had these very serious conversations with some of our members. Keep sticking these mandates on there and you’ll eventually have people start dropping their insurance.”

The bill was amended, though, noted McBride, to exempt employers with fewer than 100 employees from having to carry the insurance. Another amendment to the bill that mandates that health insurance sold in Mississippi cover mental health care costs allows employers to opt out of the coverage if the coverage causes their health insurance costs to rise more than 1%. Still another amendment to the bill provides that state law requires the same benefit for state employees and schoolteachers.

Regardless of the amendments, McBride still opposed the bill.

“There may be some ways for some people to get out of this, but it is a mandate,” he said.

Said Halaris: “We know that the increase in premium costs traditionally gets passed back onto the consumer in one fashion or another, so industries that have been opposing parity legislation in Mississippi as well as in other states really choose to take a very tainted and partial and unobjective view on this issue. And that is in spite of the fact that there is literature on these issues that I believe sets the record straight as far as the cost-benefits analysis of expending non-discriminatory insurance coverage for the mentally ill. That is simply looking at money matters.”

The MMA successfully lobbied against nine other mandates in 2001, including treatment of infertility, coverage for abuse victims, treatment of diabetes, coverage for services of marriage and family therapists, podiatrists, comprehensive rehabilitation services, bone mass measurement, post-mastectomy care and social anxiety disorder.

“I’m not questioning the validity of some of these things, but you’re forcing these benefits on people,” McBride said.

Contact MBJ staff writer Elizabeth Kirkland at ekirkland@msbusiness.com or (601) 364-1042.

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