January 7, 2010
Not There Yet: Comparing the House & Senate Health Care Reform Bills
On December 24, just as Santa was hitching his reindeer, the Senate passed a historical bill in support of health care reform. The gravity of the bill has been compared to the Social Security Act of 1935. Analysts point out, however, that the current health care reform bill lacks bipartisan support—representatives voted 220 to 215, divided straight along party lines. Furthermore, the differences between the House and Senate bills must yet be negotiated.
This article takes a brief look at some of the differences—potential sticking points—between the bills passed by the House and the Senate.
Individual mandate: Both proposals require that Americans hold a minimum amount of health insurance, or face a financial penalty. The penalties differ slightly between the House and Senate proposals, but both exempt American Indians, people with religious objections, and people suffering financial hardship.
Employer contribution: Both proposals require most employers to contribute to the cost of health insurance for at least some of their employees. The House version requires employers with a payroll of $500,000 or more to provide employee coverage, or pay a federal tax penalty. The Senate version does not stipulate that employers must supply insurance coverage, but companies with 50 or more full-time employees will face penalties if they do not. In the Senate version, employers who do not supply coverage will be required to provide vouchers to low- and middle-income earners who will be expected to buy their own coverage from an insurance exchange.
Insurance exchange: The House proposal supports the creation of a national insurance exchange, whereas the Senate version allows the states to organize their own exchanges. Both proposals are open to individuals who do not qualify for insurance through their employer or a government program. The Senate version allows access to insurance exchanges for employers with less than 100 employees, while the House proposes a graduated approach—twenty-five or fewer employees in the first year of the program, 50 or fewer in the second year, and 100 or fewer in the third year.
Public option: The House supports a public insurance option which would be operated on a non-profit basis by the government. This public insurer would negotiate directly with hospitals, doctors, and pharmaceutical companies. The Senate proposal does not include a public option—rather the government would enter into contracts with insurance companies to offer two national health plans, one of which would be operated as non-profit.
Expand Medicaid: The House proposes to extend Medicaid coverage to everyone with incomes less than 150 percent of the poverty level ($33,075 for a family of four), while the Senate proposes to cover everyone with incomes less than 133 percent of the poverty level ($29,327 for a family of four). In both proposals the federal government would cover around 90 percent of the costs, with the states making up the balance. This works out favorably for the states because they currently contribute 43 percent to Medicaid costs on average.
Insurance regulations: Both proposals prohibit insurers from denying coverage or charging higher premiums because of a person’s medical history or health condition. The House proposal goes further, however, by outlawing price fixing and bid rigging, and removing the current exemption of insurance companies from antitrust laws. The House is also more generous in limiting premiums for older people to no more than double that of younger people, while the Senate proposes a cap on premiums that are no more than three times higher for the elderly. The Senate also requires insurance companies to devote more of their income to medical claims by reducing their administrative overheads and spending at least 85 cents in every dollar on medical reimbursements.
Illegal immigrants: The House proposal allows illegal immigrants to purchase coverage from insurance exchanges, while the Senate version does not.
Abortion: In the House proposal, insurance plans can choose to cover abortion, but insurance exchange and public plans will exclude it. In the Senate proposal, health plans may choose to include abortion coverage, but states may elect to ban it. Moreover, people who do choose a plan that includes abortion will be required to pay the abortion component as a separate premium.
Out-of-pocket expenses: Both proposals limit out-of-pocket spending—in the House version, $5000 for individuals and $10,000 for families; in the Senate version, $5950 for individuals and $11,900 for families. These limits would be reduced for people with income less than 400 percent of the poverty level—around $88,000 for a family of four.
Paying for it: The House proposes to pay for reform via a 5.4 percent tax on very high income earners (families with a combined income of $1 million or more, and individuals earning more than $500,000), plus a 2.5 percent tax on medical devices sold in the United States, combined with savings in reduced aspects of Medicare. The Senate proposal is more complicated: a 40 percent tax on “Cadillac” insurance premiums, annual fees for pharmaceutical, medical device and insurance companies, savings against reduced aspects of Medicare, and a 10 percent tax on indoor tanning services.
In both cases, the proposed legislation is intended to be fully implemented by around 2014. The next step, however, is to reconcile the differences between the bills passed by the House and the Senate. Republicans and lobby groups are also expected to make the passage difficult.
Robin Stone, M.D.
Insight Psychiatry
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
Further reading:
Murray, S & Montgomery, L 2009 Senate passes health care bill, must now reconcile it with House, The Washington Post.
Pear, R 2009 Senate Passes Health Care Overhaul on Party-Line Vote, The New York Times.
December 17, 2009
Health Care Reform: Time to Stop Digging?
Health care reform leapt back into the spotlight this week when independent Senator Joe Lieberman announced that he wouldn’t support any proposal that includes an expansion of Medicare or a public insurance option. Lieberman agrees with the Republican line that an expansion of Medicare and tougher government controls on insurance providers would not only be inflationary, but analogous to a public insurance option which would potentially drive private insurance companies out of business. The American Medical Association (AMA) also opposes the expansion of Medicare, arguing:
Many physicians have been forced to stop accepting Medicare patients because of the program’s burdensome regulations and unstable payment system. Adding more patients to Medicare will force more physicians to make this difficult decision. Medicare payment rates have failed to keep pace with practice cost increases … Adding a new patient population to the program will only increase the cost shifting, raising premiums and health care costs for other Americans (2009).
Lieberman’s stance comes after the Democrats introduced a bill that attempted to break the current senate impasse by proposing a Medicare buy-in option for people aged 55 and over (currently 65+) and not covered by employer-provided health insurance, as well as a network of government supervised private insurance plans.
Lieberman’s opposition to the proposal deepens the political stalemate and threatens to dilute the reform. Meanwhile, the AMA’s position highlights the following conundrum: How will we, without increasing costs, extend coverage to more people (remember, nearly 46 million Americans are uninsured) while maintaining current health care practices?
One of the answers might lie in eliminating unnecessary waste. The existing health system encourages doctors to order expensive procedures and tests through financial incentives, a culture of defensive medicine, as well as patient pressure on physicians to be overly-thorough. A 2006 study that looked at 4,600 preventative health checkups found that 43 percent of them resulted in unwarranted urine, X-ray or electrocardiogram tests on asymptomatic people (Lagorio 2006). If every American were to undergo these tests at an annual checkup, the costs would run into hundreds of millions of dollars (Pho 2008).
There’s lots of talk about the cost of health reform, but what about the cost of not changing? According to the Urban Institute (2009), a nonpartisan research organization, if we make no major changes to the health system, the best case scenario is that by 2014—only five years from now—the number of uninsured Americans will reach 53 million. The worst case scenario is nearly 58 million. Insurance premiums, which have grown 131 percent in the last decade, will continue to grow. Poor affordability will necessitate an expansion of Medicare/Medicaid and further fragment health services.
What do they say about holes? If you find yourself in one, stop digging?
Robin Stone, M.D.
Insight Psychiatry
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
Further reading:
American Medical Association 2009 Health system reform bulletin, December 9.
Holahan, J et al 2009 Health reform: the cost of failure, Urban Institute.
Lagorio, C 2006 Needless medical tests costly, CBS News.
Pho, K 2008 My take: just say no to unnecessary tests, KevinMD.com.
October 16, 2009
Reforming the 'doctorless' health system
It’s old news by now that the Senate Finance Committee has approved legislation that would attempt to reform our health care system. The major features of the revised Baucus bill would include mandatory health insurance for nearly all Americans, taxes on “Cadillac” insurance plans, the creation of non-profit insurance cooperatives, special taxes on drug/ medical device makers as well as insurance companies, and elimination of “pre-existing condition” exclusions.
Republicans promise to make the bill’s passage through the Senate difficult, and hardline Democrats still have their sights set on a public insurance option. We can continue, therefore, to expect the negotiations to play out with the subtlety and finesse of a prize fight.
The vested lobby groups are certainly swinging harder than ever. The Washington Post revealed that the health sector has been spending money at a rate of $1.5 million a day (yes, a day) in an attempt to influence health care reform legislation. Really, who turns enough profit to invest that sort of money in politics? Apparently the biggest spenders were drug manufacturers, hospitals, and insurance groups. And if $1.5 million a day weren’t enough to buy political favor, the insurance industry also launched an ambush attack the day before the vote by releasing a report that suggested that reform could potentially increase insurance premiums. The Democrats labelled the attack scaremongering, and Obama said it confirmed that the legislation was heading in the right direction.
There’s a lot of talk about the vested interests of pharmaceutical manufacturers and insurance companies (rightly so), but what about the system’s users and providers? Where have the doctors and patients gone? Maybe I’m self-interested because I am a doctor and I work with patients, but I’d like know—while congressional committees are debating over insurance exchanges and gold-plated policies—where are the doctors and patients who collaborate on treatment plans?
Dr. Arnold Relman, writing in the New England Journal of Medicine, makes the obvious, but somehow overlooked, point that it’s doctors that make most decisions about the use of medical resources—the same doctors that have a strong financial incentive to maximize elective services and utilize new, expensive technology. This begs the question: how will the proposed legislation control inflationary health care costs as long as doctors are incentivized to use more services and resources? The existing system has encouraged a creeping entrepreneurial ethic into medicine. Physicians who work in hospital systems are rewarded for doing procedures and tests, and the yield from Medicare/Medicaid is comparatively higher for inpatient vs. Outpatient care. In many instances these programs don’t pay for outpatient wellness visits—only sick ones. Meanwhile, primary care providers may see 41 patients a day and receive little to no reimbursement for time spent educating patients about preventative health care. Likewise, some patients are happy to report to the emergency department, rather than a primary care provider, with an earache or head lice. (Yes, I’ve personally witnessed that). What will incentivize those people to purchase health insurance? A $750 annual penalty, I don’t think so (and then there is the “hardship” clause that would exempt people who are likely to be using the emergency department as primary care).
These are not just administrative issues; this is about the health care culture in our country. Surely cultural change must be pivotal in any real overhaul of our health care system, so shouldn’t the vested interests of doctors and patients—not only drug and insurance companies—be central to the debate?
Robin Stone, M.D.
Insight Psychiatry
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
Further reading:
Eggen, D 2009 At $1.5 million a day, health sector lobbying far outpaces oil and gas, The Washington Post.
Relman, AD 2009 Doctors as the key to health care reform, New England Journal of Medicine, 24 September, vol.361, no. 13.
September 10, 2009
Ideology and the Heath Care Debate
In October 2009, Physicians Practice will publish the findings of their annual survey. Nearly 1600 physicians were asked this year about what health care reforms they’d like to see. Among the top ten were ‘get the government out of medicine entirely’, ‘institute a single-payer system that has universal coverage’, and ‘cap insurance and pharmaceutical company profits’. The results highlight the ideological divide between those segments that’d prefer to see more government involvement in our health care system, and those that’d prefer to see less—much less! The ideological divide was no less evident in Washington on Wednesday night when President Obama addressed congress to explain some of the details of his plan for health care reform.
The President’s reforms propose to offer more choice, lower costs, and improved security for people who already have health insurance. Under the proposal, insurance companies would not be allowed to drop or dilute coverage. For the uninsured, the new plan proposes affordable coverage for individuals and small business owners. Among other changes, it’d be unlawful for insurance companies to deny an applicant coverage on the basis of a pre-existing condition. Other proposed reforms include pilot studies for changes to medical malpractice laws.
The President made it clear that, while alternative proposals were welcome, he would not lie down easily on a public insurance option, nor his concept of an insurance exchange. In his words, a public insurance option would provide better choice and competition for consumers. Dr Charles Boustany replied on behalf of the Republicans. He told the press that his party opposes a government-operated insurance agency, and argued that competition in the insurance market could be improved by allowing families and small businesses to purchase their insurance across state lines.
One political commentator described the presidential address as ‘vintage Obama’, highlighting what he saw as a veiled contradiction: ‘Complete command of the issue, excellent cadence and pace. The reach out, as expected, to the GOP to join him half way, while standing firm on his beliefs and denouncing what he saw as the "politics" of division’(Rudin 2009). Another agreed that the President failed to exhibit the attitude of compromise he was demanding. William McKenzie of The Dallas Morning News wrote:
[Under Obama’s plan] there's no guarantee you can keep your health plan. If your company stops offering coverage and you end up on a public plan, you could lose your doctor. Look at Medicare. Washington has been tightening up Medicare payments to doctors, so fewer providers are picking up seniors. The same phenomenon could happen under a public plan. If you end up on it, and your doctor chooses not to participate, you're out of luck. The president wants a public option so consumers can have more insurance choices. Well, they could get more options if he supported letting insurers and consumers connect across state lines. That way, we all could get plenty of choices and wouldn't have to worry about the headaches of creating a federal plan.
All this political crossfire overshadows the facts. The US has the most expensive health care system in the world—around 1.5 times more expensive per capita than the average of other developed nations. For every six dollars an American earns, they spend more than one dollar on health care (Gawande 2009). You’d think, therefore, that our nation would be exceptionally healthy. Instead, we’re ranked 42nd in the world for average life expectancy—just above Mexico—and we have the dreadful honor of being the fattest country on the planet (Ohlemacher 2007). Research reveals that 41 percent of working age adults in the US have a medical debt, or have a problem paying medical bills (Gardner 2008). A study published in the American Journal of Medicine found that nearly two-thirds of personal bankruptcies filed in the US in 2007 were caused by illness and medical expenses. More concerning, most of these people had insurance at the start of their illness, were middle class, university-educated, and owned a home (Healy 2009). Meanwhile, insurance companies and their executives are rewarded for the relentless pursuit of profits.
The Democrats and GOP have agreed on a middle ground when it comes to expanding insurance access for people with pre-existing conditions, and providing health care assistance for very low income earners. But the coming months will further tell if our representatives in Washington are able to conceive of the world in shades of gray by building a bridge of compromise between their ideologies—or if they are only capable of confusing and polarizing the constituency. The danger of not compromising on ideology is that we will continue to compromise our health.
Robin Stone, M.D.
Insight Psychiatry
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
References & further reading:
Beckel, A & Michael, S 2009 Ten health reforms docs want, Physicians Practice.
Gardner, A 2008 Medical debt sending many over financial brink, US News & World Report.
Gawande, A 2009 The cost conundrum: what a Texas town can teach us about health care, The New Yorker.
Healy, M 2009 Medical bills led to two-thirds of bankruptcies in 2007, study finds, Los Angeles Times.
McKenzie, W 2009 Obama's health care speech got it right and wrong, National Public Radio.
Rudin, K 2009 The President spoke. What did people hear? What will congress do?, National Public Radio.
February 8, 2009
Too bad United, maybe it’s Karma
United Healthcare recently settled a 350 million dollar suit, agreeing they had been systematically low-balling “usual and customary rates” and in the process shortchanging both patients and physicians. The agreement with NY state attorney Andrew Cuomo requires them to scrap their current reimbursement system for paying out-of-network claims, United has also pledged to spend 50 million to establish a new independent database which tracks appropriate payouts (this one to be managed by a non-profit).
AMA president Nancy H. Nielsen, MD, PhD said the artificially low UCR figures given to patients meant that they would assume their doctor was overcharging them, a factor that would not only cause tension in the doctor-patient relationship—but would encourage patients to seek care with an in-network (managed care) provider. Cuomo was quoted as saying that by underpaying for out-of-network services (over the past decade) United has effectively cheated thousands of their members and physicians out of hundreds of millions of dollars.
The new database is meant to be open to the public, posted on the web, so patients can easily see the prevailing payment for a given service in their area.
References: American Medical News, February 2, 2009
Insight Psychiatry
www.insight-psychiatry.com
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
February 5, 2009
Obama’s Stimulus Plan Falls Short on Healthcare
Joseph Heyman, MD Chair of the AMA board of Trustees recently released a commentary regarding healthcare reform under the new administration. The stimulus bill provides for expansion of medicaid, aid to those recently unemployed (expanded gap insurance or COBRA assistance) and increased medicare reimbursements. Consistent with the glitz and media hype of the administration, there’s also money allocated for healthcare IT (eg: presumably subsidies for electronic medical records).
The provisions contained in the bill are likely to change very little considering there is no suggestion of changing the actual system of how healthcare is administered. The age cut-off for medicare is 65, and only those who have actually had a position that offers employer-sponsored health insurance (and then lost it) are eligible for COBRA. Medicaid traditionally has been difficult for people to obtain, unless they are nearly destitute. So what about Joe the plumber? He makes too much for medicaid isn’t quite medicare age…and is still underinsured if employed/ or unemployed. It seems healthcare reform is an afterthought in the Obama administration, this is concerning given our current healthcare system’s contribution to the economic down-turn. Perhaps Obama should review how much of the GNP in this country is spent on healthcare.
References: Amednews.com “Physicians need one voice to fight for payment reform”
Robin Stone, M.D.
www.insight-psychiatry.com
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
October 10, 2008
Mental Health Parity Update
Compromise mental health parity bill passes after excluding provisions for coverage of all DSM diagnoses and exempting employers who have less than 50 employees, or who do not currently offer mental health benefits. The law does prohibit limits on number of outpatient treatment sessions per year, equalizes co-pays for mental illness and non-psychiatric specialist co-pays, AND provides for parity within out-of-network benefit coverage. The effective date has been reported as Jan 1st, 2010, (ironically the estimated date for revealing the reworked diagnostic manual for psychiatric providers).
U.S. Chamber of Commerce and AIP (America’s Health Insurance Plans) strong proponents of the senate version of the parity act, conceded with CEO of AIP, Karen Ignagni on the helm touting again the benefits of utilization review…errr I mean “innovative health strategies to improve health care.”
Does utilization review result in better treatment outcomes? I think the jury is still out on that one.
Source: Washington Post 10/10/08 article (Metro section) “Law Equalizes Coverage for Mental, Medical Illness: ‘Milestone’ measure could expand treatment services”
A summary of the Wellstone-Domenici Mental Health Parity and Addiction Equity Act can be found here. The Mental Health Parity Law is explained on this wiki.
Robin Stone, M.D.
www.insight-psychiatry.com
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
July 18, 2008
Score GW: Zero, Human rights: 1
The senate and house passed a law averting Medicare cuts and equalizing co-pays for mental health visits last week. Let there be light…I mean life. The law passed by a landslide making the law veto-proof (as GW stated that it was his intention to halt the bill—touting the “seniors must have choices” rhetoric once again). Choices, let see, if you are a Medicare beneficiary (and not allowed by law to pay out of pocket for healthcare) would you choose seeing a doctor…or going without. This is what their “choice” amounts to, why do you ask? Well the truth is that medical practices are closing their doors to Medicare patients. That should make you angry, after all, doctors make too much money as it is…right?
References:
AMA news bulletin 7/17
For more information: health.usnews.com
Robin Stone, M.D.
www.insight-psychiatry.com
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
The Healthcare dollar: getting what you paid for?
In today’s system about 30 cents of every healthcare dollar goes to administration. This is the highest rate for any country examined. The current healthcare system is defended by those who say we need “fiscally responsible” means of care delivery, but it is the system itself that is responsible for most of the excess costs. The system stays in place because it is also the source of profits for those who have absolutely nothing to do with actually providing care, but everything to do with making money off of it. The people developing standards of care are far removed from the day to day care of patients (they are employed by the insurance regime and necessarily concerned about the bottom line). How peculiar and unfortunate that quality standards are not placed directly in the hands of physicians—in a free market economy.
Let’s review the system we currently have–what are the primary goals? Hmmm…there will always be sick people…how can we make a profit off of them? Or, I know, let’s develop a system where the interaction between doctors and their patients is overseen by mid-level managers (with no medical training) Ah, but we better make billing procedures that encourage providers to perform more (possibly unnecessary) procedures so that we can charge both patient and purchasers (businesses that share the cost of health insurance) more. We’ll take a third off the top. Ah-ha the biggest rewards will go to those at the top of the organization…see July 15th blog entry for an idea of what the spoils are.
Robin Stone, M.D.
www.insight-psychiatry.com
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
July 15, 2008
Why is health insurance so expensive?
I came across these numbers for CEO compensation in an AMA newsletter and have to say they seem a bit egregious. Could these companies employ more people in this country for claims review if these salaries were different?
1. H. Edward Hanway, chair, CEO, Cigna
Base pay: $1,110,000
Bonus/Nondeferred incentive pay: $17,999,970
Stock awards: $452,886
Option awards: $4,626,316
Retirement/Pension contributions: $1,618,584
Other compensation: $32,021
Total: $25,839,777
2. Ron Williams, chair, CEO, Aetna
Base pay: $1,095,785
Bonus/Nondeferred incentive pay: $1,900,000
Stock awards: $5,309,197
Option awards: $12,887,276
Retirement/Pension contributions: $1,749,414
Other compensation: $104,162
Total: $23,045,834
3. Dale B. Wolf, CEO, Coventry Health Care
Base pay: $925,000
Bonus/Nondeferred incentive pay: $3,821,226
Stock awards: $1,688,743
Option awards: $7,846,664
Retirement/Pension contributions: $122,860
Other compensation: $465,330
Total: $14,869,823
4. Stephen Hemsley, president, CEO, UnitedHealth Group
Base pay: $1,300,000
Bonus/Nondeferred incentive pay: $3,635,000
Stock awards: $0
Option awards: $8,134,691
Retirement/Pension contributions: $0
Other compensation: $94,838
Total: $13,164,529
5. Mike B. McCallister, president, CEO, Humana
Base pay: $973,558
Bonus/Nondeferred incentive pay: $1,950,000
Stock awards: $0
Option awards: $2,438,685
Retirement/Pension contributions: $4,438,993
Other compensation: $511,321
Total: $10,312,557
6. Angela F. Braly, president, CEO, WellPoint
Base pay: $922,769
Bonus/Nondeferred incentive pay: $588,311
Stock awards: $2,160,159
Option awards: $5,240,149
Retirement/Pension contributions: $3,706
Other compensation: $179,677
Total: $9,094,771
7. Jay M. Gellert, president, CEO,Health Net
Base pay: $1,180,769
Bonus/Nondeferred incentive pay: $0
Stock awards: $1,425,243
Option awards: $949,406
Retirement/Pension contributions: $0
Other compensation: $130,812
Total: $3,686,230
Source: Company filings with the Securities and Exchange Commission
Source: article authored by Emily Berry, AMNews staff. June 23, 2008.
Robin Stone, M.D.
Insight Psychiatry
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
June 27, 2008
Mental Health Parity to Filibuster?
For those in the know, there are two bills that advocate for mental health parity; e.g.: the senate and house versions. The senate bill S 558 was passed last September, and the house passed it’s version “The Paul Wellstone Act” HR 1424 this March. Not surprisingly, there are key differences between the two bills. The most notable is the fact that the senate version does not allow parity for all diagnoses outlined in the DSM (the diagnostic manual psychiatrists and other mental health providers use). Reflecting on my own experience as an outpatient psychiatrist, the main gap in the senate version is the exclusion of equal benefits for treatment of addictive disorders, and probably eating disorders as well.
Big business and America’s Insurance Plans support the senate version. CEO and President of AIP states that the house bill will “turn back the clock on advances in the quality care and impose excessive costs on patients and employers. The (house bill) will undermine the progress that has been achieved in behavioral health benefits through coordinated-care strategies.” Coordinated-care strategies—otherwise known as pre-authorizations, utilization review and other tactics insurance companies use to deny benefits!
The CEO of AIP continues, “the (senate bill) is a balanced approach that would preserve access to health plans’ medical management (translation: deny benefits) and quality-improvement (translation: cost containment) programs.”
The (Bush) “administration has concerns with HR 1424, which would effectively mandate coverage of a broad range of diseases and conditions and would have a negative effect on the accessibility and affordability of employer-provided health benefits and would undermine the uniform administration of employee benefit plans… the administration strongly opposes House passage of HR 1424 or any legislation that expands benefits and remedies beyond what is included in the Senate-passed S 588."
Uniform administration of employee benefit plans, who are they kidding? There is nothing uniform in administering these plans, both patients and their physicians struggle on a daily basis to understand exactly what mental health benefits are available. Try calling an insurance company to advocate for your patient and see how much time it takes before you reach someone who can handle your query (or isn’t too difficult to understand because English is their second language)
James Scully, MD, medical director and CEO for the APA (American Psychiatric Association), called the passage "historic." "We're very pleased and applaud finally that, after many years — indeed decades — of trying to end discrimination against people with mental illness in the insurance world, this bill passed the House. It's long overdue, but we know it's been a long struggle to educate people that mental illnesses are real and diagnosable and treatable the same way as other medical illnesses."
Does Dr. Scully realize that the House AND Senate must pass this legislation e.g.: agree on which version to adopt? The differences in the two versions have caused division among even those who would support the concept of mental health parity and who have already said they would support the Senate bill. In a report Mar 6, WebMD noted that several conservative senators have threatened to block the House and Senate from meeting to reconcile the bills.
References/ links:
http://www.uschamber.com/issues/letters/2008/080304_wellstone.htm
For more information: www.politico.com/news/stories/0708/11805.html
Robin Stone, M.D.
www.insight-psychiatry.com
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
May 28, 2007
Mental Health Parity or Parody?
The senate voted on the latest mental health parity bill, passing it, but only after treatment for addictive disorders was excluded. A former managed care executive, and now psychiatrist jokingly referred to the bill, and it’s similar predecessors as MH “parody” bills. Perhaps it’s due to loopholes such as above, or the fact that there is no provision for excessive utilization review or other commonly used business tactics that put a strangled hold on physician reimbursement.
What kind of message is this sending to the public about the tremendous problem with addictive disorders? Could this be the result of our puritanical heritage, a culture of the individual rather than of societal good?
If the economic burden of depression in this nation is costing us 83 billion annually, imagine the toll of substance abuse and dependence.
Robin Stone, M.D.
Insight Psychiatry
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
April 19, 2007
Bill aims for mental health parity in Medicare
Imagine your grandmother who’s suffered multiple losses standing at the receptionist window trying to understand why her co-pay is higher for treatment of her depression or other mental illness.
AMA article discussing a bill that would reduce co-payment for Medicare beneficiaries seeking mental health treatment.
Insight Psychiatry
www.insight-psychiatry.com
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
April 9, 2007
What’s up with mental health “parity”?
If you are one of millions being treated for a mental illness, you may have noticed different co-pays, deductibles and treatment limitations apply when you are ready to settle the bill, as compared to out-of-pocket costs for any other medical condition. “Parity” refers to equivalent value as it pertains to insurance coverage for mental illness vs. other medical diagnoses. Physicians, other mental health professionals, some politicians and consumers alike have been hopeful legislation would end discrimination against people seeking help for mental illness. Federal mental health parity mandates would in all likelihood have other implications such as reducing the stigma of a mental illness diagnosis, which could in turn, encourage more people to ask for help when needed.
Senate Committee Approves Comprehensive Mental Health Parity Bill
Insight Psychiatry
Robin Stone, M.D.
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
