Mental Health Insurance Coverage Parity Achieved in Vermont, USA!

MONTPELIER, Vt. (June 11, 1997 00:26 a.m. EDT) -- After Jim Wilkinson's son was diagnosed as a paranoid-schizophrenic, the young man quickly hit the $10,000 lifetime cap on his mental health coverage. If he had had, say, a heart condition, he wouldn't have maxed out his insurance until he had hit at least $1 million.

Vermont ended that distinction Tuesday with a law requiring insurance companies to offer the same coverage for mental problems that they do for physical ailments.

And the law defines mental health more broadly than in any other state so that coverage includes treatment of a full range of illnesses and alcohol and drug addiction.

"I've said many times that illness of the brain should be treated just like illness of any other organ," Gov. Howard Dean, a physician, said in signing the law.

Seven other states have made similar moves, said Robert Gabriele, vice president of the Washington-based National Mental Health Association, but most of those laws only apply to cases of schizophrenia, manic-depression or other serious maladies.

Gabriele said those other states' laws "actually promote discrimination" against people with less severe mental illnesses by implying that their ailments are less deserving of coverage.

"This is the model bill. This is the bill that we want to push for the rest of the country," he said.

The new law will end a strategy under which insurance companies frequently have capped lifetime physical health coverage at $1 million and, in the same policy, limited lifetime mental health coverage to $10,000.

That has meant that when mental illness strikes, "you not only have a major health problem, you have a potential economic catastrophe for your family," said Ken Libertoff, director of the Vermont Association for Mental Health.

Dean and others argued that the difference in coverage is in large part attributable to a historic prejudice against the mentally ill. "This bill begins to end the stigma in our society around mental illness and substance abuse," the governor said.

Kevin Goddard, spokesman for Blue Cross-Blue Shield of Vermont, said his company did not strongly oppose the bill, because "we've been moving in that direction anyway." But he said as a general rule, the insurance industry opposes any state-mandated coverage.

"We feel compelled to point out to people who buy health insurance that every time you mandate a particular kind of coverage you increase the cost of health insurance," Goddard said.

Libertoff sought to allay lawmakers' concerns on that score with a study by the accounting firm of Coopers & Lybrand that predicted the average increase in Vermonters' health insurance premiums would be 3.4 percent.

Libertoff also said that the trend towrad managed care will help keep mental health costs under control. "You won't have these endless therapeutic treatments like you saw in the old Woody Allen movies," he said.

And Gabriele said studies have shown that angioplasty, a common treatment for heart disease, succeeds in curing that disease 41 percent of the time, while the success reate for treating manic-depression is about 80 percent.

Wilkinson, who has used Medicare, Medicaid and Social Security to help pay for his son's $12,000-a-month hospital stays, now spends much of his time working in mental health advocacy.

"There's nothing like having a mentally ill family member to cause you to focus on mental illness and all the things that are related to it," he said.