Heads they win, tails you lose.
Depending on which Seattle news paper you read, you might have noticed an article that said Thousands of people could lose mental health coverage, or that millions might gain mental health coverage. Strangely enough these really are two sides of one coin.
In Washington State, Medicaid covers mental health. Most private health insurance policies only have the barest of coverage. As a result, people with severe mental health problems can very quickly end up on Medicaid. However, in this age of governmental belt tightening, the state feels they no longer have the money for this coverage.
This is a real shame, because people who are mentally ill have a hard time getting by without treatment. It should not be rocket science to say that if a person has a mental illness, it effects how he or she sees the world, and this has a very direct bearing on someone’s — anyone’s — ability to hold down a job and pay the bills. This is not an issue of pulling ones self up by the bootstraps, because they can’t necessarily tell that there are any boots. By some estimates, 20-25% of the homeless are mentally ill. If you want to solve homelessness, you have to treat mental illness. Although it is difficult to obtain figures for the number of convicted criminals who are mentally ill, there is evidence to support the idea that treating mental health issues among prison and parole populations reduces recidivism, or repeat offenses. Since reducing homelessness and crime are both societal priorities, it should be a no-brainer that mental health is an issue to address.
So, the Washington state legislature finds themselves in the unenviable position of not being able to afford services that would cost substantially less if there were insurance parity. The obvious answer is to mandate insurance coverage of mental illness.
However, before we gloat over having found such an obvious solution, let’s deal with why insurance companies do not already provide this coverage. First of all, it’s expensive. Rates will have to go up to provide this coverage, even if only a small percentage of the covered individuals need it. And since, as the saying goes, things are tough all over, this means that more employers will opt for cheaper, less comprehensive coverage for their employees, or that more employees will decide to take their chances with no coverage. The great irony is that these people might well end up on the new, improved, reduced mental health benefit Medicaid.
The other reason for the lack of coverage is buried decades ago. There was a time when mental health coverage was abused by authority figures, parents, and mental hospitals. A trouble maker could be labeled mentally ill, and taken out of the picture for a while. The hospital was happily compliant, as long as the insurance company paid up. It was the 80s version of boot camps for troubled teens, and it wasn’t a new phenomenon then. Insurance companies decided that it was easier to drop the coverage than to sort out the fraud from the actual necessary care.
Getting medical help to the mentally ill is a good thing, but we must tread lightly in how we provide it.