Mental-health insurance gaps found in Iowa

BY HOLLY HINES | JULY 30, 2009 7:11 AM

Most insurance providers will pay for a broken wrist or a tonsillectomy in Iowa. They’ll also pay for depression medication. But try to persuade them to pay for any mental-health problem not on their short list, and you may be out of luck.

Now, national and state officials — Iowa’s included — are rethinking mental-health insurance coverage laws.

In early 2010, Iowa lawmakers are scheduled to discuss two bills that, if enacted, would require insurance providers to offer more complete coverage for a wider range of mental illnesses.

Iowa law at present only recognizes seven disorders, a fraction of those listed in the more than 800 page-long Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.

This would bring mental-health insurance benefits — such as inpatient and outpatient treatment — up to par with physical-health benefits.

Legislators in Massachusetts recently expanded their list of mental disorders that are covered.
Sen. Joe Bolkcom, D-Iowa City, would like to see similar bills passed in Iowa.

“People ought to have the same mental-health coverage as they get for their broken legs and sprained ankles,” he said.

However, pushing the bills through the state Senate may be difficult, he said, because “insurance lobbyists are fighting tooth and nail to kill the bills.”

Most insurance providers are against mandates requiring them to pay for more treatment, many officials agreed.

Some are concerned the added expense would lead to unemployment given the nation’s unstable economy, said Steve Blanchard, the assistant to the head of psychiatry at the UI Hospitals and Clinics. Costs for insurance providers could increase 1 to 3 percent if the bills pass, and more employees could be laid off as a cost-cutting measure, officials said.

Some believe covering treatment for more mental illnesses would actually decrease insurance providers’ overall expenses.

For many patients, improvements in mental health led to improvements in physical health, said Greg Gulliskson, a psychologist with Iowa City-based Anderson, Arnold, & Partners L.L.P.

If professionals can treat more mental illnesses, costly physical health concerns may arise less often, he said.

Rep. Dave Jacoby, D-Coralville, agreed Iowa laws should be expanded.

“As progressive as we think we are, we’re still light years behind regarding treatment of [some] disorders,” he said.

In 2005, the Iowa Senate passed a bill requiring up-to-par coverage for biological disorders, which are defined as conditions with a detectable genetic presence in the brain.

This mandate includes conditions such as schizophrenia and bipolar disorder but omits others, such as post traumatic stress disorder and substance abuse.

Steve Estes, the CEO of MECCA, 430 Southgate Ave., said he supports expanding coverage for those seeking substance-abuse treatment, but only to a certain point. Estes is responsible for managing a non-for-profit substance-abuse and behavioral-health center that serves six counties, including Johnson County.

Meanwhile, the distinction between biologically and non-biologically based conditions is still scientifically unclear.

For example, many professionals argue eating disorders — which aren’t recognized by the Iowa mandate — have a strong biological aspect.

Gulliskson said this blurry line is a reason he supports expanding Iowa’s scope of mental illness coverage.

“People should have the freedom to address emotional and psychological concerns as they address other medical concerns,” he said.

A national mandate taking effect next year may increase this freedom for some.

In October 2008, then-President George W. Bush signed the Mental Health Parity Act, which requires federally funded insurance providers to offer mental-health coverage up-to-par with physical-health coverage.

Insurance providers that aren’t funded nationally won’t be affected by the change.

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