Preventative parity

How much would policyholders celebrate if their insurance rates dropped 1 or 2 percent? Probably not at all, but if they were to increase by that much while significantly expanding mental-health and substance abuse coverage, the effect, according to the King administration, would be “imprudent.” The fear of higher costs on top of already high costs is understandable, which is why savings through expanded coverage is so important and why the anemic effort by state agencies to look for savings is so disappointing.

LD 1627 would have health plans offer mental health and substance abuse benefits that are at least as comprehensive as those offered for other covered conditions. It would also require insurance coverage of residential treatment facilities and home health services and prohibit exclusion of mental health and substance abuse benefits because of a pre-existing condition. It is an extensive change that recognizes what physicians already know: many illnesses previously considered “mental” are now properly identified as biological and can be treated as effectively as diabetes or clogged arteries. But it is not an expensive change.

Recent results from a parity study of the Federal Employees Health Benefits Program showed that this change increased fee-for-service plans by 1.64 percent and HMO plans by three-tenths of 1 percent, with an aggregate program increase of 1.3 percent. That adds up to annual added costs for the federal employees of about $12 for self-only enrollment and $52 for family enrollment. And, importantly, these low figures do not include overall savings.

Maine agencies were directed to investigate potential savings under LD 1627, but in the report by the Bureau of Insurance the summaries of these investigations were a disappointing mish-mash of bland speech by an administration that appears to simply not want this parity bill. For instance, the Department of Corrections helpfully pointed out that “virtually all adult offenders lose their benefits.” But what it did not include is what the savings would be if the hundreds of untreated mentally ill prisoners had gotten treatment, stayed out of trouble and saved Maine $25,000 a year in incarceration costs. Certainly it is true that prison savings doesn’t directly lower benefit costs, but Mainers would likely accept lower taxes as being just as welcome.

A three-year study of one large U.S. company, according to a 2000 report from the National Institutes of Health, reported that 61 percent of work absences were due to psychological problems. Treatment for these problems is by no means free, but its low cost for a broad benefit – increased productivity, fewer sick days, the avoidance of worse illnesses – make parity a good buy. Compare the cost of alcohol-treatment counseling vs. treatment for liver disease.

The Legislature’s Banking and Insurance Committee is uncertain what to do with LD 1627. Its members know it is a valuable bill and they know the governor opposes it. In his State of the State speech Tuesday, the governor spoke about the savings that could be found in prevention, by having a good diet and exercising regularly. LD 1627 is access to preventative medicine that eating vegetables and jogging won’t provide. It fits in exactly with his remedy for health care savings and deserves both his and the Legislature’s strong support.