SAVINGS THROUGH PARITY

Gov. Angus King last year vetoed a bill to provide equal insurance coverage to mental health, saying Maine could not afford it. Gov. John Baldacci last month vowed to support the same bill, saying, “It’s the right thing to do and it will end cost shifting and save MaineCare dollars.” The difference is based on differing priorities and short- vs. long-term views of paying for health care, but Gov. Baldacci’s stance will not only prove the more accurate, it will be essential to overhauling coverage.

The Legislature’s Insurance Committee is expected today to hear LD 566, An Act to Ensure Equality in Mental Health Coverage – commonly called parity. Its members will hear that providing parity, according to work done by the state Bureau of Insurance last year, will add between four-tenths and eight-tenths of 1 percent to insurance premiums, a couple of dollars a month. But by shifting people who otherwise have private insurance off Medicaid dollars for mental-health coverage, the state budget will save $10 million, a considerable amount in a tough budget year.

More important, people needing help will get treatment sooner. According to the Maine Kids Count 2003 Data Book, Maine in 2001 spent $37 million on hospitalizations for kids suffering from mental-health or substance-abuse problems, with Medicaid paying for $28 million o f that. For children ages 13 to 17, illnesses such as major depressive disorder, manic disorder and bipolar disorder collectively were easily the top reason for hospitalization, well ahead of the next most common reason, appendicitis. As Trish Riley, the director of the governor’s Office of Health Policy and Finance, recently observed, by the time many of these children are using Medicaid dollars for this type of care they are functionally disabled and in need of extensive help.

The average 2001 cost per child for hospitalization for mental health was $22,000, according to Lynn Davey, the Kids Count director. There is little reason to expect adults are less expensive. Yet early treatment would be. If instead of delaying care until coverage kicked in for crisis, children and their families could receive the broad ranges of services needed to keep them healthy, they would be far better off and Maine’s health care bill would drop. In that sense, the $10 million booked as savings by the Baldacci administration is too conservative.

LD 566, presented by Rep. Ben Dudley of Portland and co-sponsored by many others, would require that all health plans covering groups of 21 or more include 11 categories of mental illness as defined in the Diagnostic and Statistical Manual of Mental Disorders. The bill also requires coverage for residential treatment and home-support services. Plans covering smaller groups are not affected. The bill has a cost in a system that sees huge cost increases each year, but making a distinction between mental and physical health makes no sense. Just as heart attacks are covered no matter how costly health insurance becomes, so too should mental-health conditions, which increasingly are found to have as much a biological basis as heart disease.

Gov. Baldacci has outlined plans for overhauling health care coverage, a much overdue yet huge challenge. He cannot do this by allow the current practice of shifting privately insured patients to Medicaid because the practice ends up creating many more cases than need be becoming acute. Besides the needless suffering that creates, it is too expensive a way to run a system. Parity solves improves treatment and allows for further reform of the larger health care system.