Mental Health: An Interview with Rep. Patrick Kennedy
Our family and others have long believed that mental, neurological, and related ailments should be treated on par with physical/biological disorders.
The Mental Health Parity Act of 1996 started the process by prohibiting health plans from offering lower annual/lifetime benefits for mental health than physical health. Unfortunately, as a result, many health plans complied with the law by imposing other treatment limits or requiring higher co-pays for mental health care.
Enter Rep. Patrick Kennedy (D-RI), the youngest child of longtime healthcare reformer Sen. Ted Kennedy (D-MA). Inspired, in part, by his own struggles with mental health/addiction issues, Rep. Kennedy became — along with the late Sen. Paul Wellstone (D-MN) and current Sen. Pete Domenici (R-NM) — one of the champions in Congress who worked to close the 1996 Act’s loopholes and thus ensure that the parity in coverage offered to Members of Congress and their families is offered to other Americans as well.
After a long fight, in which Kennedy and his colleagues drew close to their goal multiple times, they finally succeeded this year, with enactment of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act Of 2008.
Yesterday, I had an opportunity to speak briefly with Congressman Kennedy about this accomplishment and where he’d like to go next in advancing mental health care.
The Moderate Voice: The passage of this legislation represented a milestone in a long journey for you and many others. How does it feel to have finally succeeded?
Rep. Patrick Kennedy: There’s no way to completely dismantle the stigma associated with mental illness. But there was a way for us to change the law. And that’s what we did. And by changing the law, we began to dismantle the stigma because we made it illegal for people to discriminate. In doing so, we’re starting to change the practice of delivering mental health coverage and mental health services. For people like me who suffer from mental illness, this is about lifting the cloud of stigma and shame associated with our illness. As much as we have come forward as ‘stigma-busters,’ it’s hard to not feel the tinge of judgment that people make on mental illness.
This law is important, first, because people know they’ll get treated. It’s also important because they can feel better about asking for and demanding treatment — because they’re entitled to it.
TMV: What’s the most compelling argument you can make to someone who might be concerned about the private and/or public sector costs this legislation might create?
RPK: The CEO of Blue Cross/Blue Shield of Rhode Island testified in favor of this legislation. He also testified that the problem was not over-utilization but under-utilization of mental health benefits. We need people with mental illness taken care of because it saves us money. If someone is depressed or suffers from another mental illness, their other health care costs (could) quadruple. They’re at higher risk for heart disease, diabetes, and so on. You have to address their mental illness if you want to address their other ailments.
We heard testimony around the country that a significant portion of weekend intakes at emergency rooms are by and large for trauma cases due to drugs and alcohol. We deal with those cases as criminal justice problems rather than health problems. And we pay for those costs in other ways — in our criminal justice system and in our healthcare premiums.
Then, of course, you’ve got the issue of lost productivity at work. If you want proof of the merits of this legislation, consider that the top Fortune 100 companies have been providing generous mental health benefits for years. They’ve done all the studies and determined that it’s a plus for their bottom lines. They see their overall health care costs go down and productivity rates of employees go up when they offer robust mental health benefits. The proof is in the pudding.
TMV: As I understand it, the current bill is not a mandate to offer mental health benefits. Instead, it’s a mandate that, if an insurance company already offers mental health benefits, it must then offer them at parity with physical health benefits. Are you at all concerned that this requirement might discourage insurance companies from offering any mental health benefits?
RPK: No. If we had mandated coverage of (the entire diagnostic manual), this bill would not have become law. Part of our compromise was to let employers and insurance companies determine what they would cover, with medical necessity as the determinant of the day, not arbitrary selectivity.
Our fall back position is that we want the GAO to study the patterns of mental health coverage going forward … to see how widely mental health diseases are being covered. If the GAO determines those diseases are insufficiently covered, we’ll have to come back and shore up the law.
Also, we have very strong language in the law defining “medical necessity” and how to determine a patient’s eligibility for mental health coverage, so that when people sign up for coverage, they know what the grounds are for denying coverage, strengthening their ability to appeal arbitrary decisions.
TMV: What’s next? This legislation has defined your health care agenda for many years — what replaces it in the years ahead?
RPK: I’ve got a lot of plans, including for veterans’ health. Today, the VA measures almost every disease except certain mental illnesses such as addiction. As a result, we don’t have outcomes-based metrics to determine what’s working in terms of therapeutic interventions. If the VA was required to track large populations for mental health ailments, we could learn so much to help us develop outcomes-based metrics, evidence-based care. I will work to provide the opportunity for full physical and mental health screenings for every veteran coming out of the service. This will help avoid problems that crop up later. Prevention is the best cure.