What is Parity?

If you or someone close to you doesn’t suffer mental illness, you may have little idea what parity is or what these concerns are about The issues are large and go to the very foundation of our society. The major issue is equal health treatment for all groups in our society – parity.

If you look at the benefits in most health insurance policies you will find that mental illness is covered differently. For instance, many insurance companies only limit the number of visits a year for someone seeking mental health help. There may also be a dollar cap such as a $10,000 lifetime cap or a thirty-day per year inpatient cap. Yet the benefits for other illnesses, such as heart or lung disease, are less likely to be limited.

Why is this? No one is really sure, but I suspect it is because many years ago mental illness was believed to be a character flaw that people could overcome if they tried hard enough. Currently there is considerable scientific evidence that many of the serious mental illnesses, such as schizophrenia or major depressives illness, are truly diseases of the brain in the same way that heart disease is a disease of the heart It has been demonstrated many times that people just can't overcome these mental diseases by simply changing their life or living better. It often takes medication and other kinds of therapy, and even surgery in some rare cases. In spite of this, insurance companies are strongly resisting parity. Is this reasonable? The insurance industry says that parity will increase the cost of insurance greatly. This of course frightens businesses, which often have to bear the brunt of insurance costs. Others say that the treatment of mental illness is not very successful, and thus mental health treatment is like throwing money down a rat hole. However, neither of these arguments holds water.

Several other states have passed panty laws requiring insurance companies to cover mental illness in the same way they cover other physical illnesses. In Vermont and North Carolina where this occurred actuarial studies have been done. The study in North Carolina indicated a 0. 90/o increase in premium or $1.01 per member per month. Vermont’s data showed a l.l% increase or $1.12 per member a month. Maryland implemented parity in 1995 and the most experienced managed care company in Maryland reported an increase in costs the first year, with a return to pre-parity costs the second year.

How successful is mental health treatment? For some of the serious disorders such as manic depressive disorder or major depressive disorder there is an eighty percent success rate. Compare this to the forty percent success rate for coronary angioplasty (balloon surgery) for which most policies usually provide unlimited coverage.

In light of the above information why do insurance companies continue to resist parity? I can bring it down to one word, "discrimination " They know that people with mental illness often are not able to communicate effectively for themselves and don’t have a strong voice or lobby. Imagine the howls of indignation from the business community or other groups if benefits for cardiac disease were capped in the same want, that mental illness is now.

So what can you do? First of all talk to your state legislators as well as your national congressmen and advocate for strong parity bills. The bill in the Iowa house is rather weak- It only applies to large Businesses and there are still some caps allowed by this bill. Secondly, check your own insurance policies and see what they cover for mental illness. Mental illness can strike anyone. Insist that your company buys insurance that covers mental illness adequately and fairly.

We live in a society that is supposed to be free of discrimination. If we are truly civilized, we have to be sure that those who aren’t as fortunate receive the same benefits and rights as the rest of us do. I encourage everyone to contact your legislators and advocate for parity for the mentally ill.

Jerry L. Lewis, MD, FAPA, Board Certified Psychiatrist