State Leadership Conference
Almost 50 million Americans lack health insurance, and even more lack mental health coverage. A number of states have taken on the issue, with some--Maine, Vermont and Massachusetts--even going so far as to implement universal health care. Representatives of those states' psychological associations discussed the plans, and a representative of California presented proposed options for universal health care in that state, during a 2007 State Leadership Conference session on the topic.
Sheila Comerford, executive director of the Maine Psychological Association, described how Maine's Dirigo Health program, begun in 2004, originally aimed to cover the state's estimated 140,000 uninsured by 2009. The plan covers 80 percent of the fees for 40 outpatient mental health visits per year. The challenges Dirigo faces in reaching that goal include a significantly smaller than anticipated enrollment--only 13,000 are currently enrolled--premiums that are higher than when the program began and strong opposition to funding mechanisms, which include a 2 to 4 percent tax on insurance companies' gross revenues, Comerford said. In addition, Maine psychologists in the audience mentioned that they have yet to see payment from their clients covered under Dirigo.
However, Comerford added, there is still significant interest in the program. "Right now, they have to work on affordability, ongoing funding...and continued support of public, legislature and media," said Comerford.
Rep. Ruth Balser, PhD, house chair of the Joint Committee on Mental Health and Substance Abuse in the Massachusetts Legislature, explained how her state's law mandating universal health care--the first state law to do so, passed last April--requires all state residents who don't have government insurance or insurance through their employer to buy health care by July 1. If they cannot afford the insurance that is available, they will be subsidized by the government, said Balser, and the government is also working to create affordable plans for everyone. However, Massachusetts has yet to define affordability.
"The only way [universal health care] will work is if we get the affordability numbers right and the subsidy right," she said. "The most important thing was that there really was a political consensus in Massachusetts that we had to do this...We came out with a creative model, which we very deeply hope will work." Balser added that the Massachusetts health-care reform law requires that all new health plans offered as a result of the new law will have to maintain all existing state insurance mandates, including those that provide mental health and substance abuse benefits.
Milton J. Marasch, PhD, president-elect and insurance chair of the Vermont Psychological Association, discussed the Catamount Health plan, aimed at the state's uninsured and set to take effect Oct. 1. "It's not a universal heath-care plan, but it may be a step along the way," said Marasch. The state estimates that 24,000 of Vermont's approximately 60,000 uninsured residents will enroll. The program will be financed by premiums based on income, fees assessed to employers with uninsured employees, an increase in tobacco taxes and state funds. Marasch pointed out a potential risk: The reason the Catamount Health plan could offer lower premiums than traditional commercial plans is that the actuarial tables suggest that there is less use of medical services by the uninsured than by the insured. "Could it be because the uninsured can't afford to pay for those medical services?" he asked. "One of the things that remain to be seen is how do things actually pan out when the rubber meets the road."
As for the impact on psychologists practicing in the state, Marasch indicated that the plan, as it stands, appears to reimburse psychologists in a fair manner by using a formula based on Medicare's fee schedule, plus 10 percent. He also noted that the Catamount plan would allow fair access by providers to its panels, in accord with previously passed "any willing provider" legislation.
William L. Wallace, PhD, of the California Psychological Association Board of Directors, discussed two plans currently on the table to cover California's 6.5 million uninsured residents. Governor Arnold Schwarzenegger is championing a proposal for mandated commercial insurance, said Wallace. The governor's plan does little for mental health, claimed Wallace.
Sen. Sheila Kuehl (D-Los Angeles) is presenting a single-payer plan, which would be a public, not-for-profit policy. Her plan provides full coverage of mental health services, which is a form of parity but requires a primary-care provider referral, and the reimbursement levels are not yet known, said Wallace.
In conclusion, session chair Cheryl Fish-Parcham urged psychologists to testify and provide data to state governments on the cost-effectiveness of including mental health care coverage in insurance plans. Fish-Parcham is senior health policy analyst for Families USA, a Washington, D.C.-based nonprofit that advocates for quality, affordable health care. Added Comerford: "As each state picks up the issue of expansion of insurance, stay very focused on making sure that there is very comprehensive mental health and substance abuse coverage."
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