Kristine G.

Dumas Research Paper Working Draft (2) 11/16/13 Its All in Your Head: Insurance Companies are not to Blame for the Lack of Long Term Mental Health Care It was not safe for thirteen year old Melissa to go home, for she was suicidal and as her mother has stated, had a history of cutting herself. Facing hundreds of thousands of dollars in medical bills, Melissas mother Cathy was desperate to help her daughter. Firmly believing that her current insurance company, Anthem Blue Cross, would cover all expenses, she sought the needed help for Melissa. One cannot help but feel empathy for the mother as she seeks to save her daughter. After a little more than a week in a hospital, Anthem Blue Cross refused to cover any of the medical expenses relating to Melissas care (Abelson). Surely the Mental Health Parity and Addiction Equity Act signed into law by President George W. Bush in 2008 would have forced Anthem Blue Cross to supply the coverage Melissa needed (Beronio). Unfortunately, it became very apparent that determining what the 2008 law actually required was unclear. Confusion over the requirements of the new law, coupled with a clause that excluded insurance plans in effect prior to the laws enactment, made the law itself fall well short of its original goal- parity between medical and mental health (Abelson). Cathy made an impassioned plea to the Connecticut state government to intercede on her daughters behalf with Anthem Blue Cross. Insurance companies are currently required by two recent laws to offer and deliver insurance coverage for long term mental illness similarly and at the same levels they currently offer for medical health insurance (Beronio). The problems facing our country today, and specifically the one in four Americans who face mental illness or substance abuse disorders annually, are the lack of easy access, an inadequate infrastructure, and a bottlenecked delivery system for mental health care (Bringing). Logically, something must be done to correct these problems and provide the basic care that that the

human person deserves. Insurance companies are not to take sole blame and responsibility for the problems creating this lack of long term mental health care. The individual person, the community, the medical profession, the insurance companies, the government, and society at-large, all share equally in the blame and have equal stakes in the responsibility for creating and solving our current mental health care crisis. There is No Health without Mental Health It becomes clear to all who delve into the issue of long term mental health care, that our past experience as a society has been less than acceptable in our understanding and treatment of these conditions. As reported in the Clinical Manual of Prevention in Mental Health by Michael T. Compton there is a dramatic shift in the focus on prevention and treatment of behavioral disorders. The medical field is accepting mental health as a legitimate and necessary part of our overall human health. A ray of light is seen on the horizon as mental health is now beginning to receive the much needed attention it has lacked for so many hundreds and thousands of years. At the heart of this transformation is the fact that society of the present day has finally begun to realize the simplest of all truths; there is no health without mental health (Power). Parity and Affordable Care Laws The Paul Wellstone and Pete Domenici Federal Mental Health Parity and Addiction Equity Act of 2008 expands prior state and federal laws to extend coverage protections to insurance plans that were previously exempt from complying with state and federal regulations. The parity law guarantees similar coverage for all mental illnesses such as bipolar disorder, schizophrenia, and chronic depression in relation to the coverage provided for other medical maladies such as high blood pressure, cancer, and diabetes (Druss). Sympathy for those suffering these illnesses makes the argument for parity that much more acceptable. Reason tells us that all illnesses must be mitigated, and every action taken to

eliminate them. The insurance companies are bound by this law to provide long term mental health care. The Affordable Care Act, also known by the slang term of Obamacare, looks to further extend the coverage and protections the federal parity law set into motion. From the outset, the term Obamacare looks to instill disdain in those who may personally oppose the presidency of Barack Obama. To counter this, supporters of the president focus their rhetorical response on the benefits of the act, by drawing attention to the moral and ethical reasons for enacting such a law. All insurance plans enacted after January 1, 2014, will be required by the Affordable Care Act to provide mental health care and coverage as an essential benefit of the plan. In addition, the Affordable Care Act will apply the federal parity rules of 2008 to all new individual and small group market plans established after January 1, 2014. Coverage of essential health benefits will be available to all Americans accessing insurance plans with the guarantee of comparable coverage for mental and medical health maladies (Beronio). The Obama administration projects that around of 32.1 million Americans will have new access to health insurance that includes adequate coverage under policies that are in compliance with the federal parity laws. In addition, the administration forecasts that over 30 million currently insured Americans will see an increase in their essential covered benefits. Americans can rest assured that mental health care will be covered as an essential benefit of any plan they choose after January 1, 2014. The ethical and logical arguments made by the Obama administration guaranteeing 62 million Americans access to better quality health care became an emotional assault on the consciences of law makers. This rhetorical strategy implemented by the Obama administration, over powered the negative rhetoric of their opponents, and succeeded in Obamacare becoming law. Now, the dilemma we all face is quite complex; to provide medical and mental health care to 62 million more Americans with the current infrastructure we have in place.

The question as to whether or not insurance companies should be required to cover long term mental illnesses has now been definitively decided by this federal law. The expectation has now been set that all plans will offer benefits on an equal level between the accepted medical maladies of the present day, and the new and evolving mental health disorders that are just now beginning to be studied and understood. The rhetorical appeals launched by the Obama administration have succeeded in uniting a large enough majority of Americans around the idea of guaranteed health care to make it law. Only time will be able to show us if the fruits of the plan- easier access, and deliverability- are true. Insurance executives argue that they are being asked to write a blank check because the lack of study and research into mental health illnesses does not guarantee the benefits of all procedures and care services that will be required of them when providing coverage (Abelson). At the same time, insurers and other opponents appeal to the extra costs of insuring an additional 62 million people. They also argue that the current infrastructure will not be able to handle the addition of so many more insured persons. The Crisis of Delivering Douglas Nemecek, M.D., Chief Medical Officer- Behavioral Health, at Cigna Health and Life Insurance Company admits in the foreword that he wrote to their guide for Treatment of Behavioral Health and Substance Use Disorders that we continue to be faced with a shortage of mental health services and clinicians in many areas of the country (Cigna). Nemecek is stating the obvious. Any rational person would understand that with the implementation of the Affordable Care Act, availability of the guaranteed health care will be even more inaccessible. As an example of the already approaching storm of inaccessibility, Kaiser Permanente was fined $4 million dollars in 2013 for failing to provide mental health treatment in a timely manner. The state of California concluded that Kaisers written guide to its health services was so complicated and misleading that it could dissuade an enrollee from pursuing medically necessary care (Craft). The Washington Post supports both insurers claims with an

article referencing seven facts about the mental health system in America. Fact number three in the article states that the care provided for mental health is worse than the care provided for other medical services. The article referenced also states that access to mental health professionals is limited (Kliff). Although affordable health care is now the law of the land, access to this mental health care appears blocked by the barrier of an inadequate number of providers. As the Affordable Care Act continues to be implemented, the inadequate number of current providers will only worsen. In an effort to combat the shortage of mental health professionals, under the federally funded National Health Service Corps, health professionals who qualify, will have their academic financial loans paid in full in exchange for two years of service in an approved Health Professions Shortage Area as designated by the federal government (Talbot). The Stigma of Mental Health Unlike medical maladies, mental health illnesses possess limited accepted medical evidence to support the variety of treatments used to combat them (Abelson). Insurers, according to Brent Barnhart, Director of the California Department of Managed Health Care, seem to view mental health illness as secondary to other health (Abelson). Insurers balk at such a statement and argue that they are being asked to cover and pay for services that have not been studied to determine their overall beneficial effect (Abelson). Along with the lack of medical evidence, and the insurers perceived diminished view of mental illness, those suffering from mental illness often fail to recognize their own ailments . Many suffering from mental illness fail to seek treatment (American). Compassion forces us to think about the individual and our duty to help our fellow man. The argument of the insurers blank check is trumped by the compassion created for the individual alone against the corporate empire. Barriers to mental health access, such as cost, availability, limited scientific studies, varied definitions of a diagnosis, and wide-ranging treatment options, are a result of an overall societal view towards the mentally ill. The phrase its all in your head was a mantra that many, including myself,

grew up with and became accustomed to. This expression was synonymous with the belief that people with mental illness were just simply crazy. The term crazy, perceived then and now by the members of society, signifies a mental, and not a medical problem. A recent Gallup Organization survey makes it is easy to see that people are subject to their socioeconomic experience. The survey reveals that the lower the income, and the lower the educational levels, the higher the instances of negative mental health. The cycle becomes apparent in that our personal social and economic status influences our own personal mental health (American). Generally the lower we sink in status the greater our chances of experiencing mental stress. The more mental stress or illness we have, the lower our socioeconomic status. The stigma of being labeled as crazy has been ingrained into the American culture. Fortunately, within the mental health field, we are experiencing a shift away from personalized preventative measures and treatment, to a more population based approach to mental health care (American). Population-based care is described in terms of panels of health plan members or patients associated with a particular physician, practice or delivery system. In this model, the health industry works to provide care to members of a specific and designated population (American). As a result of aging populations, seen as a specific and designated group, recent advances in pharmaceutical treatments for mental illness, and the debates over the Affordable Care Act mental illness has been pushed to the front of the public discussion on health care; a place it has never seen or been before (Power). Regardless of what side of the rhetoric you are on, either the blank check insurance industry that feels they are wasting valuable financial resources, or the moral imperatives who believe full mental health care is an ethical obligation of humanity, participating in the discussion over long term mental health care is advancing our understanding of this most important issue. The federal Mental Health Parity and Addiction Equity Act along with the federal Affordable Care Act have set the standard of law that insurance companies are required to provide coverage for long term mental health disorders. In resolving the very important question as to whether or not

insurance companies should be required to provide long term mental health coverage, a new and more important question has now been raised. Society must now face the dilemma of how to adequately provide these mental health services in light of the shortage of providers that is foreseen when 62 million more Americans become insured. At the same time, we must discuss the age old stigmas associated with mental health to breakdown the wall of fear and shame that keeps many individuals from seeking treatment. In my own personal experience, I was denied life insurance due to a diagnosed mental health condition. These discriminatory practices are the greatest threat to the recovery of our nations mental health system (Triad).
F1- The disparity between access to mental health care, and the ease of purchasing a firearm- As drawn by Nick Anderson of the Houston Chronicle 1/12/11

The Judgment Cathy eventually won her appeals to the state of Connecticut, and Anthem Blue Cross was required to pay for Melissas long term mental health care (Abelson). The federal health care laws have set the foundation for proper mental health care. It is now up to the individual person, the local community, the medical profession, the insurance companies, the government, and society at-large, to share equally in the blame for the historic lack of adequate mental health care. Together we must accept equal stakes in the current responsibility for solving our accessibility, infrastructure, and provider shortages, and in delivering mental health care from its longstanding crisis. Its not all in your head; the solution is in all of our heads.