Few States Act on Parity Improvements This Year

Few states have taken action to upgrade their health insurance parity laws this year as many wait for movement on a federal measure stalled in a congressional conference committee.

Among the few states to act on their parity laws, the most significant change was Illinois' addition of two eating disorders to the mental illnesses that health insurers are required to cover.

“It's very hard to get these mandates passed in Illinois, so we felt very good about the whole thing,” said Meryl Camin Sosa, executive director of the Illinois Psychiatric Society (IPS).

The measure (HB 1432) amended the state's parity requirement to include anorexia nervosa and bulimia nervosa as “serious mental illness[es]” that insurers are required to cover at parity with other medical benefits.

The push to enact the legislation was led by the IPS, which had tried to have eating disorders included when the state enacted its initial health insurance parity law in 2002. The eating-disorders bill became the focus of the IPS's biennial advocacy day at the state capitol, and several of the legislators that Illinois psychiatrists lobbied eventually became cosponsors.

The measure had stalled in the Illinois General Assembly until the IPS and the coalition it led sought the support of Blue Cross and Blue Shield. The insurer, a powerful force in the Illinois legislature, agreed to support the bill if a provision requiring coverage of “eating disorders not otherwise specified,” such as binge eating, was dropped. The IPS and its allies agreed, and the measure passed both chambers of the state legislature by wide margins in May.

In Illinois and other states, opponents of the addition of eating disorders in state parity laws have criticized it over cost concerns and the belief that the illnesses are not as serious as other mental health conditions.

Proponents counter that the disorders severely affect the health of those who suffer from them. The mortality rate of anorexia nervosa, for example, is nearly 12 times greater than the rate due to all causes of death among females aged 15 to 24, according to Sheldon Miller, M.D., IPS president.

“Typical coverage for eating disorders by insurance companies fails to provide adequate reimbursement for even the most basic evidence-based treatment, as recommended by the American Psychiatric Association,” said Miller in testimony before a committee of the Illinois House in May.“ Routine denial by third-party payers for a full course of treatment for eating disorders is unfortunately common and has been shown to actually increase costs in the long term.”

The legislation was sponsored by Rep. Fred Crespo (D), a first-term representative and former high school girls' track-and-field coach. After learning the extent to which eating disorders were having a negative impact on the lives of the girls he coached, he vowed to make expanded access to treatment his first priority as an elected official, according to Sosa.

“We did everything we knew how to do,” Sosa said.

The only other state to pass a change to its parity law this year was Vermont, which made technical changes to what advocates consider one of the strongest parity measures in the nation. The Vermont legislation (S 114), signed into law in May, mandated that the state insurance commissioner step up enforcement of the existing parity law, among other provisions.

Among the few state legislatures that have not yet concluded their work for the year, only New Jersey appears to be considering further parity changes. A bill (A 2077) that passed an Assembly committee in March would add mandatory insurance coverage of alcohol and drug addiction treatment to the state's parity law.

Specifically, policies would have to cover detoxification and other treatments, screening and assessment, case management, medication management, psychiatric consultations, and individual, group, and family counseling.

New Jersey Republicans praised the intent of the bill but criticized its timing for adding an unknown additional financial burden on the state—which would have to add the benefit for its employees as well—during a time of tight budgets.

The national economic downturn and resulting lean state budgets were one likely factor in the low number of insurance parity expansions state legislatures considered this year, according to Paula Johnson, deputy director for state affairs in APA's Department of Government Relations. Another factor in the lack of state action on parity, she said, was that many states were awaiting the outcome of ongoing congressional negotiations over competing federal parity bills (HR 1424, S 558).

Senate and House Democratic leaders have both made resolving differences in the two bills this summer a priority. In June the ranking Republican on the Senate Special Committee on Aging, Sen. Gordon Smith (R-Ore.), pushed to add the Senate parity language to a bill to provide updates for Medicare. However, the likelihood that any parity measure will pass this year remains unclear.

Information on the Illinois measure is posted at<www.ilga.gov/legislation/BillStatus.asp?DocNum=1432&GAID=9&DocTypeID=HB&LegId=30223&SessionID=51&GA=95>. The Vermont measure is posted at<www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2008/acts/ACT142.HTM>. The New Jersey bill is posted at<www.njleg.state.nj.us/2008/Bills/A2500/2077_I1.PDF>. The text of the federal parity bills can be accessed at<http://thomas.loc.gov> by searching on the bill numbers, HR 1424 and S 558. ▪