Eliminating Health Insurance Discrimination
Against Persons With Brain Disorders, is Needed and Cost Effective
People with brain disorders having behavioral symptoms face blatant
health insurance discrimination.
Nearly 98% of private sector health insurance plans impose some form
of unfair, discriminatory limits on brain illness treatment, such as higher
co-payments, and fewer allowable outpatient visits and inpatient days than
are provided for other illnesses.
If a brain disease has physical symptoms, like Parkinson's, Alzheimer's
or Multiple Sclerosis, it is covered the same as any other physical illness.
If the symptoms are behavioral, such as schizophrenia or manic depression,
the coverage is much less. Ironically, Parkinson's involves a deficit in
the brain chemical dopamine and schizophrenia involves an excess of the
same chemical, yet Parkinson's is fully covered, and schizophrenia is not.
AB 88 eliminates discriminatory coverage for specified, medically
diagnosable behavioral brain disorders.
AB 88 requires health plans and insurance companies to provide non-discriminatory
health care coverage for specific brain disorders with behavioral symptoms.
With the possible exception of serious emotional disturbances in children,
all of the covered disorders are wholly or partly genetic and all involve
abnormalities in the function of the brain.
The disorders covered by AB 88 are schizophrenia, schizoaffective disorder,
bipolar disorder (manic- depression), major depressive disorders, panic
disorder, obsessive-compulsive disorder, borderline personality disorder,
pervasive developmental disorder or autism, anorexia nervosa, bulimia nervosa,
and serious emotional disturbances in children, as defined in California
law.
Non-discrimination laws prove that equitable coverage of brain illness
results in minimal cost increases.
The experience of states with non-discriminatory coverage documents this.
In California, where the vast majority of citizens are in managed care
plans, the cost is likely to be de minimus--about $1.00 per member per year
according to a recent report from Rand-- for covering medically necessary
treatment for definable brain diseases and disorders.
Reviews, protocols, cost controls and medical necessity criteria
can be applied by health plans to psychiatric disorders in the same way
they can be applied to treatment of all other diseases, and AB 88 only requires
non-discriminatory coverage for diagnosis and medically necessary treatment.
Numerous medical studies demonstrate that when patients are adequately
treated for their mental disorders, they see other doctors less often for
other "physical" disorders, offsetting the cost of the treatment
for the mental illness.
Nearly 2/3 of small business owners and 9 out of 10 California voters
support non-discriminatory health care coverage for mental disorders.
In an April, 1998 poll of small businesses by the California Chamber
of Commerce, 65% of business owners said they support a state mandate that
mental health coverage be in their health plans, even if it increases premiums
up to 5%.
In a November, 1997 poll of California registered voters by the Field
Institute, 90% of poll respondents supported health insurance plans covering
mental illnesses in the same way diseases such as diabetes, asthma and other
chronic physical diseases are covered.
Brain disorders and diseases affect nearly 25% of Americans.
Every year, over 50 million adults -- at least 22 percent of the U.S.
adult population -- suffer from diagnosable brain disorders or diseases
with behavioral symptoms.
18 million Americans are affected by depression each year -- twice as
many as are affected by coronary artery disease.
The high costs to society and businesses of untreated and undertreated
brain diseases are well- documented.
Although approximately 2.8% of American adults have severe brain disorders
such as schizophrenia, manic-depression, severe depression, obsessive compulsive
disorder, and panic disorder, they are about 25% of the people on federal
SSI and SSDI and about 33% of the homeless. Because of inadequate coverage,
persons with severe brain diseases exhaust their resources and end up on
Medi-Cal in disproportionate numbers.
The MIT Sloan School of Management reported in 1995 that clinical depression
costs American businesses $28.8 billion a year in lost productivity and
worker absenteeism.
Equality in health care coverage could help the state save money.
In 1993, the National Mental Health Advisory Council concluded that equality
in coverage for severe brain illnesses would result in a net savings of
$2.2 billion a year.
9% of new admittees to California prisons suffer from serious biological
mental disorders, according to a recent report by the Legislative Analyst.
Nationally, an estimated 7% of prison inmates--seven times the general
population--have schizophrenia. Effective treatment could greatly reduce
this, saving society significant costs in crime, incarceration, and human
suffering.
Advances in medical science have yielded successful and cost-effective
treatments for brain disorders in the last two decades.
Major depression can be treated successfully with antidepressant medications
and psychotherapy in 65 to 80% of all cases - a success rate which exceeds
many current common medical treatments for non-psychiatric illnesses, such
as angioplasty, which is only 41% successful.
Clozapine treatment for schizophrenia saves an average of $23,000 in
treatment costs per patient annually, largely by reducing the need for hospitalization.
| 