NCPA - National Center for Policy Analysis

Mandating Mental Health Coverage

June 11, 1999

The Clinton-Gore administration wants insurance plans to treat mental conditions on a par with physical conditions -- an arrangement known as "parity." Insurance companies would be required to pay for treatment of mental illnesses on the same basis as other medical conditions.

But experts say that experience under the Federal Employees Health Benefits Program -- the insurance program for federal workers -- demonstrates that parity won't work.

In the mid-1960s, the private insurance plans that make up the FEHBP offered broad an unrestricted coverage for treatment of mental disorders.

  • But when the high-option Blue Cross/Blue Shield Plan began attracting many federal employees with psychiatric conditions requiring costly treatments, limits had to be imposed on the number of days patients could remain in hospitals and the number of times they could see psychiatrists after discharge.
  • In the late 1980s, "behavioral health care" firms emerged to put a lid on costs by intensive review of how patients used services.
  • This rationing of care is what has prompted the parity movement.
  • Twenty-two states have passed parity legislation since 1990, including five so far this year -- and parity bills are pending in nine more states.

A number of experts argue that mandating mental health coverage is too costly and is not the way to go. Instead, they recommend Medical Savings Accounts, which would allow American workers to chose among competing plans and purchase a policy with pretax dollars.

Source: Steven S. Sharfstein (Sheppard Pratt Health System) and Sally Satel (Ethics and Public Policy Center), "'Parity' Isn't Charity," Wall Street Journal, June 11, 1999.


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