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
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 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.