Equal insurance coverage for eating disorders overdue

Anorexia nervosa and bulimia nervosa are the two primary eating disorders. Anorexia is characterized by excessive weight loss due to self-starvation. Bulimia is characterized by a secretive cycle of binge eating followed by purging. Both can lead to death or physical complications including osteoporosis, infertility, dehydration, electrolyte imbalances and heart and kidney problems.

It is estimated that 0.5 to 3.7 percent of females will suffer from anorexia during their lifetime. For bulimia 1.1 to 4.2 percent of females will be affected during their lifetime. Estimates are that only 5 to 15 percent of people with anorexia and bulimia are male. People most at risk for developing anorexia are ages 14 to 18; for bulimia, ages 20 to 25.

Warning signs of eating disorders include marked weight gain or loss not due to a medical condition; abnormal eating habits such as severe dieting, preference for strange foods, secret bingeing, and ritual or withdrawn behavior at meals; strong preoccupation with body image and weight; laxative, diet pill or diuretic abuse; fasting or self-induced vomiting; compulsive exercising; and feelings of depression, irritability or isolation.

A full course of treatment is effective for individuals and is cost effective. Research has shown that persons who stay in treatment until they reach 98 percent of ideal body weight are less likely to be rehospitalized (7 percent) than those who stay only until 76 percent of ideal body weight (62 percent) is gained. Persons who regain nearly all their ideal body weight have fewer persistent symptoms (19 percent) than those who regain less (57 percent). Costs to treat the persistent symptoms and rehospitalizations are greater than the cost of the lengthy initial treatment to reach 98 percent of ideal body weight (Baron, et.al., 1995).

The eating disorders anorexia nervosa and bulimia nervosa are classified as mental illnesses. The National Institute of Mental Health says that, “Eating disorders frequently co-occur with other psychiatric disorders such as depression, substance abuse, and anxiety disorders.” Persons with eating disorders have among the highest death rates of persons with any mental illness.

At least 5 million to 10 million girls and women and 1 million boys and men in the United States struggle with eating disorders according to the Eating Disorders Awareness and Prevention Inc. Writing in the 1995 American Journal of Psychiatry P.F. Sullivan stated that, “The mortality rate among people with anorexia has been estimated at 0.56 percent per year – which is about 12 times higher than the annual death rate due to all causes of death among females ages 15 to 24 in the general population.”

Most health insurance policies either do not provide coverage for any or all mental illnesses or they cover mental illnesses to a lesser extent than they cover medical illnesses. It is as important to have adequate mental health coverage as it is to have adequate physical health coverage. The 2000 Surgeon General’s Report estimated out-of-pocket costs for one incident of mental illness treatment to be $25,000. The same report estimated out-of-pocket costs for a medical illness to average $1,000 to $2,000.

At present the state of Maine law requires employers of more than 20 employees to provide coverage for some of the mental illnesses, but eating disorders are not included. In the first regular session of the119th Maine Legislature Rep. Joseph Brooks submitted a bill (LD 1158) to include coverage for eating disorders. The Banking and Insurance Committee tabled the bill and ordered the Bureau of Insurance to study the costs involved. The December 1999 Bureau report gave the costs in maximum increase percentage terms, not actual costs.

Opposing any increased costs, the Legislature did not pass the bill. Rep. Brooks submitted a similar bill, LD 482, in this session of the Legislature. The Banking and Insurance Committee has killed this bill, but has requested a cost study be done on another, more expansive bill that includes coverage of eating disorders. No further action by the legislature is expected on this issue until next year.

By combining other information contained in the Bureau of Insurance December 1999 study with the maximum percentage increase the actual expected cost for eating disorders can be calculated. Coverage for groups of more than 20 employees is approximately $6 per policyholder per year under fee-for-service plans and $2 per policyholder per year for managed care plans. We need to be sure our legislators know how little insurance coverage costs to properly treat people who suffer from eating disorders.

To help prevent needless deaths from these diseases our legislators need to be aware that they are not alone in addressing this issue. The National Alliance for the Mentally Ill maintains an updated Web site summarizing actions being taken in states concerning mental health insurance equality. This year 30 other states are addressing this issue.Action will soon be taken at the federal level as well.

“The Family Action Coalition met in Washington, D.C., recently to organize support for national mental illness insurance equality included in the Dominichi/Wellstone bill,” states Sheri Glazier, an eating disorders educator at the Acadia Hospital in Bangor. “The coalition was started by the family of Anna Westin, who died as a result of an eating disorder.”

Please contact your state legislators to ask for support of equal health insurance coverage for eating disorders.

Linda Bright is a Master of Social Work student at the University of Maine in Orono and a resident of Winterport.