“I shouldn’t be forced to pay for your health problems and your family’s health problems”
While many opponents perceive that the current health bills are popular among Conservative Republicans mainly because it paves the way for a huge tax benefits for wealthy people, and punishes poor people, there are two real Federalism debates that warrant serious attention here: 1) Should people be forced to buy insurance when they’re healthy and don’t feel the need for it? And 2) Whether health insurance and health care should be regulated closer to home, by States and not by the Federal government.
Aside from major cuts in Medicaid, which pays for nearly 40 percent of all behavioral health services in our country, the most critical issues for mental health stakeholders in the current debate is the preservation of the gains of the 20-plus year crusade to mental health parity and the inclusion of a basic mental health benefit, including addiction treatment, in any public or commercial insurance policy. BEWARE: There’s a “red herring” in the swamp of the House and Senate bills, assuaged by the President, which puts a few dollars into a separate pool for opioid addiction treatment. Such a fracture of the behavioral health benefit is a populist strategy but one that will effectively spell the end of the broader mental health and addiction benefit requirement.
To get a picture of the impact removal of this requirement would look like, all one has to do is remember the days before parity.
MHAW’s ancestral agency, Clubhouse of Suffolk, was founded by six people who had family members affected by psychiatric disabilities. In those days, many family members shared a saga of going to any extent possible to find treatment that held hope of reversing the course of their loved ones spiral. In those times, 38 percent of commercial insurances didn’t cover mental health conditions, 45 percent didn’t cover substance abuse, and many people needing care had both issues. For most of those with policies that did provide coverage for these conditions, there were annual and lifetime caps on treatment services. As a result, many bankrupted their family savings trying to obtain care for their loved one. Family fractures and divorce were common consequences as families wrestled with decisions like state hospital commitment and “tough love” strategies. Many families and people, at their most vulnerable points in their despair, were taken in by charlatans who offered hope through high-priced and unproven, even bizarre treatments.
Many families saw their loved ones end up in jail…prisons like Rikers Island became the newest and largest psychiatric institutions in the nation – a problem that has still not be adequately addressed.
There is much to learn from these times: As State institutions emptied and the paradigm for behavioral treatment in the community pushed forward, it took two leading U.S. politicians who were political polar-opposites to forge a movement that would change behavioral healthcare for the next generation. New Mexico Senator Pete Domenici, a conservative and one of the Republican Party’s elder statesman, and Paul Wellstone, a liberal Democrat from Minnesota, shared the experience that each had family members affected by psychiatric disabilities.
Their efforts led initially to the Mental Health Parity Act of 1996 which provided that large group health plans cannot impose annual or lifetime dollar limits on mental health benefits that are less favorable than any such limits imposed on medical/surgical benefits. Some States, like New York, began to build on this Act and pass their own parity bills. Tragically, Senator Wellstone perished in a plane crash in 2002 and did not live to see what became the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. This Act prevents group health plans and health insurance issuers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits.
Following the passage of the 2008 law, Senator Domenici – retiring from his position due to a degenerative brain disease, reflected to TIME magazine on the bi-partisanship that led to the adoption of this commitment to mental health care in all health insurance:
“Now when I’m finished with a speech and I’m mingling around — even if the meeting were oil and gas operators in Dallas, Texas — almost always somebody will come up and say, “Hey, keep with it, Pete, I’ve got a nephew…” Or, “My uncle Billy had this…” In other words, it is more prevalent than you think. Out of almost any crowd somebody will tell you a story about their family. Those kinds of things are always coming up. Even President Bush spoke to me personally and very eloquently about it. He said, “You don’t have to convince me, I’m over that hurdle.” Every time we got close [to passing the bill], he’d ask about it.”
“Strangely enough, when I would speak to this among a group of Senators, it took more time than I thought to get some of them to come up and join me and say, ‘I want to work on this because I have a relative or a friend.’ But eventually, four or five Senators came up to me and said, ‘We got to work on this, Pete, because it’s real.’ It took many a month until that first bill got to the floor. Then we just rolled it through the Senate.”
Because of that bi-partisan policy conviction, we have seen significant progress in shortening and reducing hospitalizations and emergency room visits, the evolution of evidence-based practices for more complex conditions including co-morbid addiction and mental health conditions, trauma-informed care (which has been vital for serving our Veterans), and early intervention. And, thanks to increased mental health education and anti-stigma efforts, greater access to behavioral health services. We still have a long way to go – especially when it comes to serving people of color and minority cultures in our country.
But we should have long passed the residue of self-centered thought in health care and mental health care – thanks to courageous leaders like Senators Domenici and Wellstone. We are all inter-connected in health through our shared vulnerabilities, whether that be for mental illness, addiction, heart disease, aging, or cancers.