Tuesday, July 17, 2001
Health insurance gap cited
By Travis James Tritten
Enquirer Columbus Bureau
Russell Porter's son was a good student and an avid tennis player.
That would change in his junior and senior years in high school.
His grades plummeted because he couldn't take tests. He became withdrawn and depressed. Doctors concluded the 18-year-old was suffering from schizophrenia and severe depression.
Medicines that cost 800 to $900 a month have helped Mr. Porter's son, who is now 32 and asked not to be named, stay out of the hospital and lead a healthy, productive life.
As a part-time college professor, the son has no health insurance to help shoulder the price of treatment. He cannot find an insurer willing to cover him. He still relies on his father to help cover the costs.
He knows he's completely dependent on us, Mr. Porter said.
Critics say private insurers and employers discriminate against the mentally ill, offering only expensive private plans, imposing limited doctor visits, larger co-payments and lower lifetime treatment caps compared with typical health insurance plans.
State lawmakers are now aiming to close the insurance gap, over the objections of insurance companies. But legislators say equalizing mental health coverage with coverage for other medical conditions would increase insurance premiums by less than 2 percent.
Ohio Department of Health statistics show the need:
One in five Ohioans is affected by mental illness each year.
Ninety-five percent of insurance policies will not cover the cost of treating serious mental illness.
Untreated mental illness indirectly cost Ohio $3 billion in 1996 and was linked to homelessness, job loss and suicide.
Treatment for depression and schizophrenia is often more successful than treatments for heart disease and diabetes.
A bill sponsored by Rep. Lynn Olman, R-Maumee, and scheduled for hearings this fall, would reclassify treatment for mental illness and substance abuse, requiring health insurance policies
in Ohio to offer it as basic health care services.
Ohio law now defines treatment for diseases such as schizophrenia and severe depression as supplemental health care, meaning most insurers provide little or no coverage.
Because consumers must spend extra for such coverage, many decide to cut corners and go without, said Pat Bridgman, associate director for the Ohio Council of Behavioral Healthcare Providers, a special-interest group that lobbies on behalf on mentally ill consumers.
Care for the severely mentally ill can run as high as $27,000 for three months of in-patient treatment, said Pam McClain, vice president of Talbert House, a Cincinnati halfway house for recently released mentally ill and mentally retarded ex-convicts .
Most health insurance plans will on average provide only $500 to $1,500 of those mental health care costs. But those that receive such help are an exception, Ms. McClain said.
Most patients who come to Talbert House first go through the criminal justice system for offenses related to their mental illness or addiction. For many it is the first time they have been treated.
The majority (of patients) don't have private health insurance, she said.
Health insurance providers continue to balk at attempts to equalize health insurance coverage. They say they do offer different insurance plans, but consumers should have the right to choose what coverage they need.
Mental health coverage is available for those who wish to purchase it, said Kelly McGivern, spokeswoman for the Ohio Association of Health Plans.
Ms. McGivern said state mandates would only make it more difficult for consumers to get the coverage they need.
Still, many don't have the money or adequate coverage to take advantage of such choices.
The limits and caps in most insurance policies mean that most people with serious mental illnesses lose their coverage, ending up indigent and dependent on public services and benefits, said Michael Hogan, director of the Ohio Department of Mental Health.
Many more Ohioans who go untreated end up on the street or in the criminal justice system, said Pam Argus, associate director of the Coalition on Homelessness and Housing.
More than one in three homeless people suffer from mental illness and substance abuse, Ms. Argus said.
People's lack of access to treatment can make a huge difference in their lives, she said.
Mr. Olman says better private insurance coverage would also benefit the state by saving money on social programs and prisons, which often treat mental illness retroactively.
If they are part of the penal system, we are paying for it, Mr. Olman said.
Under Mr. Olman's bill, better coverage would mean an increase in insurance premiums in Ohio. But a study released in May found that expanded health coverage could be provided at a minimal cost.
The independent study, ordered by the Ohio Legislative Services Commission, found that increasing mental health and addiction coverage would result in a 1 percent to 1.5 percent increase in Ohioans' insurance premiums.
With the issue of cost out of the way, legislators really have no reason not to eliminate the existence of insurance discrimination, Mr. Olman said.
But while lawmakers debate the issue, Mr. Porter hopes his son someday will be able to get health insurance that will allow him to be financially independent.
Said Mr. Porter: There's no trouble getting it if you can pay for it.
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