Defeat on Mental Health Clause Lamented by Jewish Providers

Jewish agencies involved with mental health care are lamenting the defeat of a congressional measure that would have made it easier for people with mental illnesses to seek treatment.

The provision, which would have required insurance companies to provide the same coverage for mental illnesses that they provide for physical ailments, was dropped this week as part of a compromise between House and Senate Republicans over a popular health insurance bill.

Jewish mental health care providers, who treat thousands of people each year for mental ailments, had pushed hard for the mental health “parity” provision in hopes of expanding their clients’ access to mental health services.

“We’re very disappointed,” said Bert Goldberg, executive vice president of the Association of Jewish Family and Children’s Agencies, the umbrella groups for the 145 Jewish family social service agencies throughout the United States and Canada.

“It looked as though the tide was moving in the right direction,” he said.

In practical terms, the defeat of the measure means that many of those in need of treatment for mental illnesses “will simply have to suffer in silence with their current problems, needs and disabilities and wait another couple of years to receive adequate attention with an adequate reimbursement system,” said Martin Hochbaum, director of the American Jewish Congress’ Commission on National Affairs.

Now, health insurers may impose arbitrary limits on visits to psychotherapists and hospital stays.

Mental health care advocates had been optimistic about passage of the provision after a bipartisan group of senators, led by Pete Domenici (R-N.M.) and Paul Wellstone (D-Minn.), succeeded in inserting it into the health care bill, which then passed the Senate in a surprising 100-0 vote.

But the legislation became increasingly bogged down in recent weeks by sharp disputes over whether to include medical savings accounts in the legislation.

As part of the compromise and in the face of cost concerns, House Republicans axed the mental health parity provision and instead inserted language calling for a study of the proposal.

Diana Aviv, director of the Council of Jewish Federations’ Washington Action Office, dismissed the study as “a way of deferring commitment that ought to be made” to those in need of treatment for mental illnesses.

A study, she added, will only confirm what is already known about problems accessing mental health care.

Jewish providers say they have been confronted by the problem for years.

“Increasingly, we were hearing from clients they they were finding it difficult to meet their bills,” Goldberg said.

Faced with prohibitive costs, those in need of treatment are left with little recourse.

“It ends up that if the individual family can’t pay for it, then the community has to pay and we just don’t have the funds,” Aviv said.

As the debate over parity for mental health care played out on Capital Hill over the last several weeks, a new picture began to emerge of the pervasiveness of mental illness.

A landmark study conducted by the National Institute of Mental Health found that about 22 percent of all Americans suffer from some form of mental illness – whether it be anxiety, depression, severe cognitive impairment, antisocial personality, schizophrenia or hypochondria.

Although they have no statistics, Jewish mental health care providers say those numbers likely hold true for the Jewish community as well.

When prominent lawmakers such as Domenici and Wellstone, both of whom have close relatives who suffer from mental illness, began speaking out in the Senate about obstacles to treating such diseases, mental health care advocates hailed the attention as long overdue.

“The fact that it’s on the agenda in a real serious way was very heartening, and I believe it will come up again,” Goldberg said. “This is the beginning and we will prevail with time.”

But ultimately, concerns about the costs of mandating parity were enough to scuttle the plan.

House Republicans worked to kill the Senate proposal when a Congressional Budget Office report estimated that as many as 800,000 Americans could lose their insurance if the government required equal coverage for mental and physical ailments.

Moreover, it said parity would cost employers an estimated $11.6 billion in 1998 – a cost the report said would ultimately be carried by workers through higher premiums, reduced wages and coverage, or the elimination of all health coverage.

Meanwhile, the fate of the compromise health care bill, originally designed to make it easier for workers to maintain their health insurance if they change or lose their jobs, remains unclear. An eleventh-hour push to reach consensus before Bob Dole left the Senate for good on Tuesday produced a bill that Sen. Edward Kennedy (D-Mass.), one of the bill’s two main sponsors, called a “travesty” and promised to fight.

Final action was expected before the end of the month, and President Clinton has made it clear that he will veto the bill in its current form.