Health care reform likely to benefit patients with mental illness

Billings Gazette

by Cindy Uken

Those who suffer from mental illness will be well-served by the new health care reforms, according to Angela Kimball, director of state policy for the National Alliance on Mental Illness.

“Health care reform has been highly politicized,” Kimball said. “NAMI is not political. We have to speak up about it because that law and federal parity are helpful to those with mental illness.”

One in 17 people live with serious mental illness such as schizophrenia, bipolar disorder and major depressive disorder. More people with serious mental illness now reside in jails and prisons than in hospitals. That's where she said the health reform legislation will play a key role.

Kimball was in Billings recently to address the Montana State Conference on Mental Illness. Recent parity legislation recognizes that people with mental illness deserve the same access to health care as other patients.

The new laws “will help change how people experience mental health care,” she said. “Federal parity passed in 2008. It is not a perfect law. It has loopholes, but it's a step in the right direction.”

People with mental illness are dying an average of 25 years earlier than the rest of the population, largely of treatable medical conditions. Mental health care of chronic, severe conditions is substantially relegated to the public sector. In the private sector, mental health care is still often optional. And, when it is covered, it is often limited to prescription drugs, psychiatric hospitalization and office-based therapy, Kimball said.

“State-of-the-art care may be available for a heart condition, or even Parkinson's or epilepsy, but try to find it for serious mental illness in the private sector and you'll be disappointed,” she said.

Kimball is pinning her hopes for improved health care on the patient protections scheduled to go into effect in 2014, which include:

Anyone with a pre-existing condition cannot be denied coverage.

Annual limits will be banned.

Premium rates cannot be determined based on health status, gender and age to determine premium rates.

Renewal of coverage will be guaranteed.

“It's time to take away the financial incentives for not providing care and make all plans play by fair rules that benefit everyone,” Kimball said.

From 2008-2009, Montana's population was just less than 1 million. Nearly 150,000 residents were living in poverty and 153,500 were uninsured, including 25,500 children. Twelve percent of the state population was enrolled in Medicaid and just 18,000 children were enrolled in the state's Children's Health Insurance Program.

Under health care reform, Medicaid provides the foundation for broader coverage. The new law creates a national floor of coverage at 133 percent of poverty, about $14,000 for an individual and $29,000 for a family of four, for all individuals. Low-income to moderate-income individuals above the income thresholds for Medicaid may be eligible for subsidies to purchase coverage through new health insurance exchanges or marketplaces where individuals and small employers can get insurance.

To bolster new coverage options, the law requires almost all individuals to obtain coverage and requires employers to cover their workers or pay a penalty.

In addition, the new law makes changes to the health insurance market rules such as prohibiting insurers from denying people coverage or charging them more because they have a pre-existing medical condition.

By 2019, when health reform is expected to be fully implemented, the provisions in the health reform law are expected to achieve coverage for 92 percent of residents, resulting in a reduction in the uninsured of 32 million people and an increase in Medicaid coverage of about 16 million, Kimball said.

“Overall, many people with serious mental illness will became eligible for Medicaid,” Kimball said.