Insurance Executives Win; Citizens and Mental Health Advocates Lose

At the end of May, Governor Dannel “Dan” Malloy stunned healthcare advocates when he vetoed an important bill that would have required insurance companies to provide data about how much substance abuse coverage and related mental health care they are actually providing Connecticut residents.

The legislation was a product of a major study conducted the Connecticut General Assembly’s bi-partisan Program Review and Investigation Committee.  While insurance companies already report some utilization data, the Committee’s investigation determined that companies were not providing the information necessary for policymakers to determine whether patients were getting the substance abuse treatment and mental health services that they need and deserve.

Considering that the cost of appropriate substance abuse treatment and mental health services is far cheaper and more effective than dealing with the resulting emergency room visits, potential suicide attempts, violence and incarceration that can result from inadequate treatment, the bill was extremely appropriate.

With strong support from Democrats and Republicans, the legislation passed the Program Review and Investigation Committee 11 – 0, the Insurance Committee 15 – 2, the Connecticut State Senate 35 – 0 and the Connecticut House of Representatives by a vote of 143 – 0.

But then, in an apparent gift to insurance executives, who have been extremely generous to Malloy’s political fundraising efforts, the Governor reversed course and vetoed the bill.

Now, according to House Speaker Brendan Sharkey, the Democratic-controlled legislature will not override any of Gov. Dannel P. Malloy’s vetoes, including the important substance abuse and mental health bill.

The General Assembly’s decision to simply give in and give up the fight to ensure a better and fairer health insurance system for Connecticut is a sad one.

As the CT Mirror reported at the time Malloy vetoed the bill,

“Gov. Dannel P. Malloy has vetoed a bill opposed by the insurance industry that would have required carriers to report information about the substance abuse treatment they have covered and their networks of mental health and substance abuse treatment providers.

Malloy said he supported the objective of the measure, which was intended to increase the amount of information available about substance abuse treatment and coverage, but was concerned that it could lead to inaccurate information being gathered.

Malloy took issue with that last requirement, saying in his veto message that it’s unusual for state law to require private entities to “report on activities to achieve public policy objectives,” and that he worried about the precedent it could set.

In defense of his veto, Governor Malloy actually said that he is opposed to requiring private entities to “report on activities to achieve public policy objectives.”

Malloy’s statement is absolutely absurd considering that private businesses that are engaged in public purposes MUST regularly “report on activities to achieve public policy objectives.”  Just ask the electric companies, the water companies and all the other private entities that serve the public good.

Insurance companies that provide health insurance to Connecticut residents must be held accountable for their actions and the bill Malloy vetoed would have done exactly that.

As Jeffrey Walter, the president of the Rushford Center and an expert on substance abuse treatment, explained in his testimony in favor of the legislation,

“The legislation might not be necessary were it not for the fact that behavioral health is treated differently by the insurance industry than virtually any other health care specialty….care for psychiatric and substance use disorders [are] denied at a rate that far surpasses my other part of the health care system.”

The Connecticut Psychological Association added,

“The provisions…increase transparency related to coverage decisions and complaints, which will facilitate evaluation of the review process, including compliance with federal parity law, which requires equal treatment of medical and behavioral health providers and conditions, as well as network adequacy.”

And Connecticut’s State Health Care Advocate, Victoria Veltri, explained,

“Expanding the data that insurers report to the Insurance Department concerning member utilization of services for the treatment of substance use, co-occurring and mental health disorders will provide additional needed clarity to the issues concerning consumer access to treatment for these conditions.”

Malloy was wrong to veto this bill and the Connecticut General Assembly is failing to do its job by refusing to even consider overriding Malloy’s veto.

You can read more about the bill in this CT Mirror story: http://ctmirror.org/malloy-vetos-substance-abuse-treatment-bill-opposed-by-insurance-industry/?hvid=4ILvLG

Paid for by Pelto 2014, Ted Strelez, Treasurer, Christine Ladd, Deputy Treasurer, Approved by Jonathan Pelto

Does it really only cost $30,000 to get Governor Malloy to veto a good bill?

(Correction:  Please note the $30,000 figure used in this article is donations form all insurance companies.  However, a re-review of the campaign finance data reveals the actual amount insurance companies gave the Connecticut Democrats’ federal account was in excess of $40,000)

Over the past few months Governor Malloy and his political operatives have raised more than $30,000 from major insurance companies and their corporate executives.  The funds were deposited into the special Democratic State Central Committee account that will be used to augment the $6.2 million that Malloy will be getting from the State’s public financing system.

Then late last week Governor Dannel “Dan” Malloy stunned healthcare advocates when he vetoed an important bill that would have required insurance companies to provide data about how much substance abuse coverage and related mental health care they were actually providing Connecticut residents.

The legislation was a product of a major study conducted the Connecticut General Assembly’s bi-partisan Program Review and Investigation Committee, a committee I chaired in 1993 during the last year I served in the Connecticut House of Representatives.

The Program Review and Investigation is the only committee charged with fully investigating major public policy issues and developing comprehensive solutions.

In this case, the committee produced a comprehensive report entitled, “Access to Substance Use Treatment for Privately and Publicly Insured Youth.”  Phase I of the report, and its corresponding legislative initiatives, was adopted on December 18, 2012.  Phase II of the report was adopted on June 7, 2013.

This past legislative session, one of the legislative proposals arising out of the report, was introduced in the form of House Bill 5373, An Act Concerning the Reporting of Certain Data by Managed Care Organizations and Health Insurance Companies to the Insurance Department.

The bill was a common sense, first step toward ensuring insurance companies actually pay the bills they are supposed to be paying.

Jeffrey Walter is an expert on substance abuse issues and the president of the Rushford Center, one of the Connecticut’s leading private, non-profit behavior health providers.  In his testimony in favor of the legislation, Walter said,

“The legislation might not be necessary were it not for the fact that behavioral health is treated differently by the insurance industry than virtually any other health care specialty….care for psychiatric and substance use disorders [are] denied at a rate that far surpasses my other part of the health care system.”

The Connecticut Psychological Association testified,

“The provisions…increase transparency related to coverage decisions and complains, which will facilitate evaluation of the review process, including compliance with federal parity law, which requires equal treatment of medical and behavioral health providers and conditions, as well as network adequacy.”

Connecticut’s State Health Care Advocate, Victoria Veltri, concluded,

“Expanding the data that insurers report to the Insurance Department concerning member utilization of services for the treatment of substance use, co-occurring and mental health disorders will provide additional needed clarity to the issues concerning consumer access to treatment for these conditions.

And the Connecticut Council of Child and Adolescent Psychiatry explained,

“We believe that transparency will best serve the public and private sectors while, most importantly, serving our children and families with quality service options.”

Malloy’s Department of Insurance DID NOT take a position on the bill, although the lobbyists representing the insurance industry opposed the bill claiming that reporting the required data would be a burden.

Legislators across the political spectrum dismissed the insurance industry’s claim.

The Program Review and Investigation Committee approved the bill 11 – 0.

The legislature’s Insurance Committee, which generally supports the insurance industry, approved the bill 15 – 2.

The Connecticut State Senate approved the bill 35 – 0 and the Connecticut House of Representatives voted 143 – 0 in favor of the bill.

As the CT Mirror reported last week,

The bill would have required insurers to report information on substance abuse treatment coverage to the Connecticut Insurance Department, for inclusion in the department’s annual consumer report card on health insurance carriers. The insurers would have been required to report information including:

  • The estimated number and percentage of members who get treatment for a substance use disorder and the level of care provided
  • The median length of covered treatment
  • Claims expenses
  • The number of in-network providers who offer substance use disorder treatment and percentage accepting new patients
  • The number of providers and facilities that treat mental health and substance use disorders and sought to join the carrier’s network, were accepted or stopped participating in the network
  • Factors that might negatively impact members’ access to treatment for substance use disorders, including screening procedures, the supply of health care providers, limited capacity among treatment providers and reimbursement rates.

But the CT Mirror added,

“Gov. Dannel P. Malloy has vetoed a bill opposed by the insurance industry that would have required carriers to report information about the substance abuse treatment they have covered and their networks of mental health and substance abuse treatment providers.

Malloy said he supported the objective of the measure, which was intended to increase the amount of information available about substance abuse treatment and coverage, but was concerned that it could lead to inaccurate information being gathered.

Malloy took issue with that last requirement, saying in his veto message that it’s unusual for state law to require private entities to “report on activities to achieve public policy objectives,” and that he worried about the precedent it could set.

Wait, What? —- Governor Malloy said he is opposed to requiring private entities to “report on activities to achieve public policy objectives.”

But of course Malloy knows, as does every other public official, that the insurance industry and every other state regulated industry is required to report significant amounts of information that is designed to allow public officials and public agencies to “achieve public policy objectives.”

That is the very reason that certain industries are regulated.

But in this case, Malloy vetoed an important bill that was primarily designed to help improve access to substance use treatment for privately and publicly insured youth because he said it would require the insurance industry to require private entities to “report on activities to achieve public policy objectives.”

Come on…

One would think that along with the $30,000 in campaign contributions the insurance industry could have, at least, come up with a better sounding explanation rather than urging Governor Malloy to use what is nothing other than an absurd and outright lie.

You can read the CT Mirror story here: http://ctmirror.org/malloy-vetos-substance-abuse-treatment-bill-opposed-by-insurance-industry/?hvid=4ILvLG

We all know – Mental Health is less important than Physical Health…

No, wait, the law is clear! Insurance Companies Must Cover Mental Health and Physical Health the Same

Right?  Ah…Wrong!

The Story of Tuition Refund Insurance:  100% for physical illness, 60% for mental illness (and it gets worse).

Here is an interesting lesson about how far we’ve come (or not) it comes to recognizing the way our laws deal with mental health issues.

Since the start of time, health insurance companies provided far greater benefits for treating physical conditions than for mental health issues.  Not only was there a widespread stigma against the notion of “mental health problems” but with little to no health insurance coverage for mental health conditions many people chose not to seek treatment or only availed themselves of the most limited help.

Advocates called for “Mental Health Parity”, a profound shift in policy that would require insurance companies to treat physical health and mental health equally when it came to benefit levels.

Thanks to the courageous leadership of people like Former First Lady Rosalynn Carter, outstanding advocacy work by mental health activists, and society’s growing awareness about the importance of mental health treatment, the shift toward “mental health parity” has been gaining broad-based support over the last twenty years.

At last count, at least 23 states have adopted comprehensive mental health parity laws that mandate that insurers treat mental health the same way they treat physical health.

In 2008, the United States Congress took a giant step forward on the issue by passing the Paul Wellstone
and Pete Domenici Mental Health Parity and Addiction Equity Act.  The law “prohibits insurance plans from placing limits or costs on mental health and substance abuse services that are more restrictive than those imposed on medical and surgical services.”

While Connecticut was one of the states that had already adopted a mental health parity law, the new federal law went even further in some key areas.

As a testament to how our society has changed (or at least how the market has changed), even America’s health insurance industry supported the new federal legislation.

Physical and Mental Health must now be treated equally, or so I thought.

And then the other day I received a mailing from the bursar’s office of the university my daughter will be attending in September urging me to purchase their preferred “Tuition Refund Plan”, an insurance program that will minimize the financial loss should a student be forced to withdraw from school for health reasons.

As the mailing explained, “The cost of education today is a substantial investment, one which is likely to be your second largest next to a home purchase.  If you are hurt or become ill and cannot complete the term, you stand to lose thousands of dollars.”

And following that clear statement of fact, the brochure informs the reader that (luckily for us) a company called A.W.G. Dewar has been providing a Tuition Refund Insurance Plan since 1930.

For only $441 I can sleep easier knowing that, if my child has to drop out, we won’t lose the tens of thousands we’ve invested in this year’s school payments (oh, and as long as she drops out prior to the 4th
week of classes).

But here is the kicker…

“Injury & Sickness Withdrawals:  100% of the insured term tuition or tuition, room and board charges, less any refund or credit due you from the college, will be refunded provided your physical condition is certified by a licensed physician and forces you to completely withdraw from classes.”

“Mental Health Withdrawals:  60% of the insured term tuition or tuition, room and board charges, less any refund or credit due you from the college, will be refunded provided you are confined in a hospital for two consecutive days during the term and have completely withdrawn from classes for any condition whose diagnosis is found in the DSM-IV Manual.”

So if a licensed physician says a physical injury or illness prevents the student from returning to school… the parent gets 100% of the money back.

But if the problem is related to a “mental health issue” the child must be “confined in a hospital for two consecutive days” and even then the “condition” must be one listed in the DSM_IV Manual.

Another company in the same market, Markel Insurance, provides 100% for physical and 75% for mental health issues.

Not a lot of parity in either case.

Meanwhile, a case in Vermont may point to change on the horizon.

Last year, Vermont state regulators determined that their reading of the mental health parity laws means that tuition insurance plans offered in Vermont must provide the same coverage regardless of whether the student must drop out due to a physical or mental condition.

In response, the University of Vermont said it would work with Dewar Insurance to develop a policy that would provide “80 percent coverage for both mental and physical health withdrawals.

Meanwhile, when a reporter with the Burlington Free Press asked the Dewar Insurance president about the policy he explained that the two tiered system was based on the fact that there were more claims for mental illness than for physical illness and that to provide a 100 percent refund for mental health reasons would make the policy so expensive that few would purchase it.

And as to the hospitalization requirement, the Dewar’s president said “while it sounds onerous, we have waived it frequently.” (oh, okay?)

While it is unclear how the Vermont policy is being handled for the academic year starting in September, the policy we were offered most definitely continues to 100 percent/60 percent refund rate.

Perhaps we should see how the Insurance Department in Connecticut (and New York) deal with a complaint.  Anyone up for joining me?

After-note:  Just discovered the NY Times did a story on this very topic a few days ago… http://www.nytimes.com/2011/07/23/your-money/student-loans/a-tuition-refund-policy-that-pays-less-for-mental-illness.html