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DJ Jaffe

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Health Care Reform Keeps Mentally Ill Uninsured

Posted: 09/24/09 10:54 AM ET

In answer to a question in Portsmouth, New Hampshire, President Obama publicly unequivocally asserted his desire to include treatment for mental illness as part of healthcare reform. And he has mobilized public opinion against the discriminatory practices of private insurers.  But when it comes to discrimination against the mentally ill, the federal government’s own program puts private insurers to shame. And Obama has yet to support the one bill, H.R. 619, that could fix it.

 Hello, Mr. President,…(M)y question is if every American who needed it has access to good mental health care, what do you think the impact would be on our society?

A: THE PRESIDENT: Well, (applause), mental health has always been undervalued in the health insurance market. And what we now know is, is that somebody who has severe depression has a more debilitating and dangerous illness than somebody who's got a broken leg. But a broken leg, nobody argues that's covered. Severe depression, unfortunately, oftentimes isn't even under existing insurance policies.

So I think -- I've been a strong believer in mental health parity, recognizing that those are serious illnesses. (Applause.) And I would like to see a mental health component as part of a package that people are covered under, under our plan. Okay? (Applause.)

I wish it were “Okay”.  Private insurers have largely ended discrimination against the mentally ill due to the passage of the Mental Health Parity Act of 2007. It forbids large group health plans from imposing treatment or financial limitations on mental health benefits that are different from those applied to medical or surgical services. That’s parity.

But for individuals with serious and persistent mental illnesses like schizophrenia, employer based insurance is largely irrelevant because employment is often impossible due to the severity of their illness.  

For the severely mentally ill, unable to get employment--and the insurance that comes with it; or afford private insurance that would discriminate against them anyway, Medicaid remains their only safety net. And it’s a shameful failure.

Medicaid, with some technical exceptions, refuses to cover long-term treatment for the mentally ill ages 18 to 64. If you have a disease or illness in any organ other than the brain, and need long-term care, Medicaid pays. But if the illness is in your brain, Medicaid does not. It’s an obscure provision called the “Institutes for Mental Disease (IMD) Exclusion.”

This is government-sanctioned discrimination against the mentally ill. The effects of refusing to reimburse for long term care have been horrendous and Obama should eliminate the IMD Exclusion now.

According to  “The Shortage of Hospital Beds for Mentally Ill Persons,” in 1955 (ten years before Medicaid) there were 340 public psychiatric beds available per 100,000 U.S. citizens. By 2005, the number plummeted to a staggering 17 beds per 100,000 persons. Some of that is due to improved treatments, but much of it is due to states kicking patients out of long-term care—where they were Medicaid ineligible—and forcing them into communities, where states could get federal reimbursement for half the cost of their care. (Disclosure: I am on the board of Directors of the Treatment Advocacy Center, which underwrote the report, and I assisted Dr. E. Fuller Torrey, the report’s author and the world's leading voice on mental illness research and reform.)

Where did the mentally ill who were kicked out of hospitals go? Today, over 150,000 live on the streets, 231,000 individuals with severe psychiatric disorders live in jail or prison.  5,000 take their own lives every year.  Think of the money that could be saved if they were given treatment rather than the boot.

To write this wrong, and force the federal government to do what they forced private insurers to do--cover the mentally ill--Congresswoman Eddie Johnson and Representative Raj Grijalva introduced H.R. 619, which would eliminate the IMD exclusion and thereby let the government provide long-term care for those with mental illness the same way they provide long-term care for those with other illnesses. Elimination is supported by the National Association of State Mental Health Program Directors, the National Alliance for the Mentally Ill, and almost all who know the issue.

The largest and neediest group of uninsured Americans could very well be those with mental illness. If President Obama really believes in equal health care for all, he should eliminate the IMD exclusion in Medicaid law now by incorporating HR 619 in health care reform. That’s reform I can believe in.

 
 
 

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12:55 PM on 10/15/2009
Thank you so much, DJ, for dealing with this topic. I live in a country where health care is free and readily accessible to everyone. And for this I am extremely grateful. But my heart goes out to all my NAMI friends in the United States who have no alternative but to go on Medicaid to have coverage. It is a shameful state of affairs and all Americans should be ashamed of the fact that so many mentally ill citizens are receiving substandard care. I am so grateful for good people like you who have taken the matter to heart and are doing what's necessary to effect change. From the bottom of my heart, and in the name of all persons suffering from mental illnesses, I THANK YOU! And a big thank you goes to the Huffington Post for having the guts to address sensitive issues like mental illness. Well done.
08:01 PM on 09/29/2009
Eliminating the historical federal bias against payment for people hospitalized with psychiatric disorders is the enlightened way to go. The evidence is clear that mental illnesses are BRAIN disorders as much as Alzheimers, epilepsy, and stroke. But I wish we had even one really good psychiatric hospital in Western New York, public or private. When I'm advising families for care of their mentally ill sons or daughters, the first thing I tell them is to go out of the area if they can.
07:57 PM on 09/29/2009
Eliminating the federal bias and exclusion from medicare payments is certainly an enlightened proposition
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HUFFPOST BLOGGER
DJ Jaffe
Founder, Mental Illness Policy Org.
05:10 PM on 09/29/2009
UPDATE ON IMD EXCLUSION

Per Ron Honburg and Andrew Sperling who have been working hard on this issue at NAMI, Senator Snowe introduced an amendment to the Finance Committee Chairman’s Mark that would create a demonstration project of $75 million for 8 states to allow non-governmental psychiatric hospitals to receive federal Medicaid matching payments for acute psychiatric treatment.

This Amendment stems from a similar bill that was introduced earlier this year by Senator Snowe, S. 1130. http://www.thomas.gov/cgi-bin/bdquery/z?d111:SN01130:|/bss/111search.html|

In my own personal opinon the bill is not nearly what is needed because the serously mentally ill who need long-term care are cared for by state hospitals, not private ones. The bill should include state hospitals.

A better bill was the one introduced the last few years by Congresswoman Eddie Bernice Johnson of La, HR 619, which would have repealed the IMD exclusion in its entirety. But congress wouldn't budge That’s the bill that should be included in heatlh care reform.

It was Amendment #D1

Thank you to Ron Honburg and Andrew Sperling at NAMI for giving this their best shot!
02:10 PM on 09/25/2009
We can't even get insurance to cover dental.
HUFFPOST COMMUNITY MODERATOR
BruceHNV
05:02 PM on 09/24/2009
Unfortunately, until "whining" is no longer a mental illness, this remains a fraught issue. I have met and had long conversations with people who were "100% disabled" due to a "mental Illness," and quite frankly, there was nothing about their condition which would have prevented them from being productive members of society if they so chose.

That's not to say that things like schizophrenia are not genuinely disabling, but "anxiety disorder" in an otherwise totally functional adult is, I'm sorry, not a disability. I've even met "profoundly depressed" people who were nothing of the sort. How do I know? Because they were complaining to me about not having access to their medications for months, yet they had no activity, appetite, sleep, behavioral or other markers for the "disease" beyond a certain laziness and a willingness to take advantage of the kindness of others. They may have been "depressed" at some point in the past, but SSI was paying them to cling to a continuing diagnosis.

Sorry, "mental illness" is whatever the persons making money off it say it is. Hence, the definition keeps growing and growing, as does the "diagnosed" population.
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HUFFPOST SUPER USER
jwald1
Badges? I don't need no stinking badges!
07:23 PM on 09/24/2009
Many "profoundly depressed" people show no, or very little signs of it, to the outside world. How many suicides have come as a total shock to family and friends? Most college students that kill themselves are in fact over achievers. There will always be people that figure out how to play the system, but you should not be so quick to judge.
08:28 PM on 09/24/2009
Read the book,mental illness is not sustainable.
HUFFPOST COMMUNITY MODERATOR
BruceHNV
08:52 PM on 09/24/2009
Not judging. Just observing - which is what I am trained to do.

"Depressed" people recover at a greater rate with sunshine, activity, conversation and a sound diet, (and relapse less) than they do on medication. There's evidence this may even be true of schizophrenia. http://www.moshersoteria.com/ How many "diseases" can you say that about?

Since when is suicide a symptom of anything? It's a deliberate act - often a vindictive one. Factually, there is no medical or scientific basis to pathologize it.. The very existence of the vast majority of mental "disorders" is pure opinion and conjecture, "validated" by a bunch of people with degrees who are making a living by saying so. There is plenty of evidence that drugging people to cure an imaginary "imbalance" increases suicide rates, and almost NONE that it reduces suicides. That's the science. Those are the statistics.

Every "mental" condition which finally gets a medical diagnosis and related medical treatment immediately gets reclassified as medical - not psychiatric. Hence, if medicine can diagnose it and cure it, it's covered. If it remains in the opinion-based field of theory and conjecture, payers cannot be blamed for being skeptical.
01:36 PM on 09/25/2009
Unless you have walked in their shoes...
You are ignorant about mental illness. I'm not saying that some people do not take advantage of the system. Most people with mental illness serious enough to be considered a disability struggle with the ability to work. Often they can work for short periods of time then the stress causes a relapse. They have good days and bad days. Poor attendence makes it hard to hold a job. Not to mention the stigma trying to get a job. You cannot see confusion or fear in people that have learned to hide it well. Psyche medications are not consistant with their effectiveness and can have diffucult side effects.
People on disability can work and be paid. And they want to work because they can't live on what disability pays.
The limits put on coverage also limit the effectiveness of the treatment received.
He is constantly shuffled from one hospital, doctor and treatment plan to another. It is the same as no care at all. In fact it is more traumatizing than just It is a tragedy waiting to happen.
HUFFPOST COMMUNITY MODERATOR
BruceHNV
02:22 PM on 09/26/2009
You accurately describe the behavioral symtpoms. You mistake that there is medical science behind the proffered treatments. Limitations on their effectiveness are as much a result of guesswork as coverage caps.

I know a woman on five, count 'em five, psychotropic meds. SSI, Medicare etc. pay for everything. Three of these are guaranteed to cause her eventual liver disease, tardive dyskenisa, and a very high risk (near certainty) of iatrogenic diabetes. Per the literature four of them, in two different combination sets, should not be taken together. She's a walking chemistry experiment. And everyone who knows her/knew her before the meds swears that the only difference between her then and now is that then she was productive, creative, capable, often cheerful, but jittery, (and sometimes abused by her husband, who's now in prison) and now she's wooden.

In my experience, disabled people who work (on the books) have genuine limitations - (hemiparisis, missing limbs, congitive deficits, crippling arthritis) and a desire to overcome them. The desire has been medicated out of our girl above. Her disability is her treatment.
HUFFPOST COMMUNITY MODERATOR
BruceHNV
02:22 PM on 09/26/2009
hemiparesis
04:53 PM on 09/24/2009
Kudos to Don Jaffe for keeping Mental Health issues in the Spotlight. I lost my brother to Mental Illness and know only to well how it can bring down entire families while taking away any hope of this person contributing to society. They (including many returning veterans) would only bring society down with them. Everyday there are more and more solutions for these people. Medications and Group Therapies just to name a few. Thanks Don.
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HUFFPOST PUNDIT
TRex86
Enjoying life in West Ohio
04:36 PM on 09/24/2009
The California experience is sadly typical. Governor Reagan dismantled a superb system of public mental hospitals, which formed a sophisticated network with local community resources to assure care for the mentally ill across the spectrum of need. Within a decade the state swarmed with street people, defenestrated from their former resources. Within a generation the jail system had become the mental health provider of choice. In Los Angeles six times as many people get mental health care in jail as from the designated system. Nothing says more about our shocking neglect of the sick that our approach to mental illness. Our stature as a civilized country remains in doubt so long as we tolerate this brutalization of people who cannot care for themselves. On the streets they are raped, beaten and murdered. They drift into substance abuse for want of medications (and end up in prison). They die of exposure. A sliver of the billions we spend killing people in the Middle East would fix this problem. Have we no shame?
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HUFFPOST SUPER USER
jwald1
Badges? I don't need no stinking badges!
07:25 PM on 09/24/2009
Very well said.
03:31 PM on 09/24/2009
While the Congress passes parity to ban discrimination against the mentally ill by private insurers, Congress itself continues to practice that very discrimination by not covering the mentally ill with Medicaid!!! It's time to stop discriminating against people with mental illnesses and let Medicaid cover treatment for schizophrenia and bipolar disorder the same way it covers all other illnesses. Too many people are not getting the treatment they need and deserve because of the IMD Exclusion.

Read more at: http://www.huffingtonpost.com/dj-jaffe/health-care-reform-keeps_b_293917.html?view=screen
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HUFFPOST SUPER USER
PallinAround
In search of truthiness
03:19 PM on 09/24/2009
Providing coverage for mental health treatment is one case where I believe very, very strongly that we would see HUGE cost savings. As it is now, people with serious mental health issues who have no care are a huge BURDEN on our society. They cannot be productive (i.e., employed and TAX PAYING citizens) because of their very legitimate health issues and, as such, they create a very expensive burden for those Americans who are healthy enough to work. Right now, it is a case of the insurance companies refusing to cover anything and everything they can so that their profits are maximized while people suffer needelessly and working Americans can foot the bill to provide warehousing-type care for the people who could otherwise be functioning, productive members of society. This should NOT be happening in America and anyone who isn't outraged about it isn't paying attention!
01:51 PM on 09/25/2009
I have a friend on the street now because his Medicaid HMO dill not allow him to be in a hospital for more than 2 weeks. He has been in 4 in the last 6 weeks. Each with a different doctor, medications. At this point he can just be written off because he will walk into oblivion or into a car.
02:48 PM on 09/24/2009
"The largest and neediest group of uninsured Americans could very well be those with mental illness."

Ya think? See it every week with all violence.
(Also, as I've said before, we don't have a gun problem, we have a mental health problem in this country).
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HUFFPOST SUPER USER
gerald4
licensed mechanical and electrical engineer
02:46 PM on 09/24/2009
How much extra would Mental Health insurance coverage increase the cost of your Insurance policy premium?

Can anyone afford the Insurance policy premium increase?
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HUFFPOST SUPER USER
PallinAround
In search of truthiness
03:32 PM on 09/24/2009
Or to look at it in a rational way: How much would Mental Health insurance coverage decrease the obscene profits of the insurance companies while restoring enough health and functionality to a large group of the population to allow them to be productive, tax-paying citizens?

Can any of us really afford NOT to hold the insurance companies accountable for this?
03:42 PM on 09/24/2009
Your current insurance likely covers mental health. Legally they must. Insurance companies often only cover a certain percentage though.

Insurance premiums going up is what is happening and that will continue to happen without check unless needed reforms are put in place. From my experience, in the last 15-20 years premiums have climbed higher (as well as deductibles) and coverage is less and less.
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HUFFPOST SUPER USER
PallinAround
In search of truthiness
04:56 PM on 09/24/2009
Anyone being HONEST has had that same experience, Beegood. They cover less and less, yet premiums and deductibles skyrocket. I am past child-bearing years now (thank goodness!) but when I talk to young couples, it is pretty much criminal for what they have to pay to have a regular delivery without any complications (and these are people WITH insurance). GOP family values at work!
01:58 PM on 09/25/2009
Get real. Nobody can get well given the care limits. Treatment can take months or years.
It takes at least a month for an antidepressant to start working, but you can only be in the hospital for 2 weeks.Outpatient care is also just as poor. Often the nedded drugs aren't covered. If reatment is discontinued because of insurance the patients (otherwise known as victims) are just set up to relapse because the medication wasn't that good after all.
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HUFFPOST PUNDIT
jsgaetano
Legum servi sumus ut liberi esse possimus
02:23 PM on 09/24/2009
There can't be health care reform without including mental health.
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HUFFPOST SUPER USER
jwald1
Badges? I don't need no stinking badges!
12:40 PM on 09/24/2009
I believe Carter had started to address some of these problems, but they were tossed when Reagan came into office. Some what ironic, considering what was to befall Ronny. Rosalynn Carter is still involved:
The Rosalynn Carter Fellowships For Mental Health Journalism

"Informed journalists can have a significant impact on public understanding of mental health issues as they shape debate and trends with the words and pictures they convey. They influence their peers and stimulate discussion among the general public, and an informed public can reduce stigma and discrimination."

- Former First Lady Rosalynn Carter

This could be a organization worth looking into, to help get the word out there.

On a personal note, I have a friend who developed schizophrenia many years ago. Her parents were well off, and she spent time in private hospitals. She has used up all the insurance is willing to pay. She receives $160.00 a month from SSI, and food stamps. She lives at home with her 80 year old mother, and I often wonder what will happen to her, when her mother is no longer there to take care of her.
02:36 PM on 09/24/2009
On your 'personal note,' I keep wondering when the psychiatrists
and psychologists are gonna get off their high horse and really
start studying such illnesses instead of following in lock-step
the pat textbook label scenarios.

So many psychiatrists and psychologist in the SSI, Medicare and
Midicaid merry-go-round look like offices with a revolving door
that churns out patients with prescriptions in their hands. No
attempts are made at treatment, just issue a prescription. It's
almost a "Don't let 'em leave without one!" atmosphere. That
prescription proves the doctor saw the patient and can be turned
in to SSI, Medicare or Medicaid for reimbursement of their time.
07:49 PM on 09/24/2009
Psychologists don't write prescriptions.
Psychiatrists are an entirely different breed.
Psychologists, typically, spend about 9 years studying psychology, and put in two to three years of internship before they can be licensed. Psychiatrists, typically, spend three years studying psychology and two years in internship.
Psychology, and psychologists, are not part of the reason why healthcare, and health, in America stinks.
Please get your facts straight.
02:03 PM on 09/25/2009
Psychiatrists are compensated at a very poor rate so it is not a preferred choice among the best in the medical field. There is a terrrible shortage of good psychiatrists. The ones that are good are overwhelmed and burnt out. Imagine how frustrating it is to have so many patients n the road to recovery only to relapse because of insurance limits.
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HUFFPOST SUPER USER
PallinAround
In search of truthiness
03:37 PM on 09/24/2009
I have a family history of clinical depression and have suffered with it myself. When I did not have health insurance (because I was self-employed and couldn't afford it), I could not afford the $180 or so per month for the anti-depressant medication that I needed, thus could not work or otherwise contribute in a meaningful way to society. Once the anti-depressant hit generic status and I can now obtain it for $4 per month, I am perfectly fine with my one pill per day, I hold a good, steady, satisfying job and I am a productive - TAX PAYING - member of society again. If you don't help people with the costs of treating mental health issues, they are merely a DRAIN, financially and in resources, on our society, when it doesn't have to be that way.
12:02 PM on 09/24/2009
I cannot believe people want government controlling mental healthcare and that 1955 is being used as an example of when things were "right". I do not want to return to the days of butterfly nets, straight jackets and padded rooms for anyone who doctors deem ill.
HUFFPOST COMMUNITY MODERATOR
propitiousmoment
the journey is the destination....
12:19 PM on 09/24/2009
For gods sake, it is not "government controlling" health care or mental health care. It is an insurance policy like any other insurance policy - like, for instance, Medicaid. It should include mental health services. I guess you'd rather see them on the streets, eh? Or rotting in jail. It's probably their own fault they're sick anyway. Obviously any new insurance plan would provide for whatever current treatment types and styles are available now, if mental health services were included in the plan. What an extraordinary jump to an unwarranted conclusion. Are you by any chance the source of the "death panel" claims?
pissedmichael
The name was an accident, please excuse
12:38 PM on 09/24/2009
Butterfly nets were a cartoon and the other presumptions, while somewhat true, were Hollywood inspired exaggerations. Remember, the differences in treatment and in attitudes for what constitutes treatment bear no resemblance to those of 55 years ago, and government involvement does not necessarily mean a return to archaic methods. That is a huge leap.