Bill Seeks to Close Gap in Coverage for State Employees

Andrew Kitchenman | January 23, 2013 | Health Care
Plans now exclude eating disorders, alcoholism, substance abuse, mental illness

The state’s public employee health plans would no longer be able to deny coverage to treat eating disorders, alcoholism and some other substance-abuse and mental disorders under a bill approved by a Senate committee.

The bill, S-1253, requires the State Health Benefits Program and the School Employees’ Health Benefits Program to treat alcoholism, substance abuse and other “non-biologically based mental illnesses” the same as other illnesses.

The measure would extend the state’s efforts to establish mental health “parity,” bill sponsor Joseph F. Vitale (D-Middlesex) said during a recent meeting of the Senate Health, Human Services and Senior Citizens Committee.

Under the 2010 federal Affordable Care Act, individuals and small businesses will receive mental-health coverage if they buy insurance through an exchange. In addition, federal law requires that private group health plans that offer mental-health coverage provide it on an equal basis with other health insurance. For instance, copayments, deductibles and the frequency of appointments for treating mental illness must be similar to those for other illnesses.

Vitale said federal law is flawed in allowing states to “opt out” of providing mental-health parity. The State Health Benefits Commission has opted out so far, although it has been considering offering parity.

“This bill would address that and say that the state cannot opt out and that everyone is entitled to the same coverage, whether it is for a physical illness or a mental illness, whether it is biological or – as some have called it – a non-biological treatment or illness,” Vitale said.

Current state requirements only cover conditions that are defined as biologically based under a 1999 law, including schizophrenia, depression, paranoia and autism. The proposed bill would extend those protections to eating and anxiety disorders, and disorders resulting from sexual abuse and assault, as well as alcoholism and substance abuse. Bill advocates say that there is no scientific distinction between biological and non-biological mental disorders.

Local governments have opposed efforts to expand state mandates that would add to the cost of insurance, but bill supporters said the benefits of the measure outweigh its costs.

The bill was backed by the advocates for the disabled and public worker unions, as well the state associations for hospitals, nurses, social workers and psychologists. The New Jersey League of Municipalities opposed the measure.

Barbara Mirsky, whose daughter Lisa has an eating disorder, said she has struggled to get insurance coverage for necessary residential treatment.

“I’m just your everyday mom who happens to have a daughter who has for 25 years struggled with an eating disorder,” Mirsky said.

After being told by medical specialists that their daughter would die if she left residential treatment, Mirsky and her husband spent their life savings and refinanced their house to help their daughter. After receiving the residential treatment, Lisa’s condition has improved and she is living on her own.

Mirsky noted that her son David has juvenile diabetes.

“How sad is it that my daughter would say, ‘I wish I had David’s disease, because at least if I had David’s disease, the insurance would have covered it. Look what I’ve had to do to my parents and look at the financial toll it’s taken on my parents and my grandparents and my siblings, because the insurance wouldn’t cover it.’ ” she said.

Mirsky told legislators that if their children were facing a deadly illness, “you would pay every cent you had to keep them alive, but why did we have to do that?”

Russell Marx, a psychiatrist and board member of the National Eating Disorders Association, said eating disorders are the deadliest set of diseases in behavioral health. He added that binge eating – which can lead to obesity and diabetes — is also gaining official recognition as a mental disorder.

New Jersey Education Association representative Fran Pfeffer noted that national attention has focused on mental-health issues in the wake of the Newtown, Connecticut, shootings.

“We need to make sure there’s adequate coverage of mental healthcare, regardless of the cause of it,” Pfeffer said. She referred to a Council of State Government Report that found that some states actually saved money after offering mental-health insurance parity. Bill supporters said this is the result of averting the later cost of untreated mental illness, such as employee absenteeism and loss of productivity, as well as charity care and costs for related crime.

“If our priority is the health and welfare of citizens, of children and of the community at large, we need to make that a priority, regardless of the cost,” Pfeffer said. “Better mental healthcare could prevent the next tragedy.”

Candice Singer of the National Council of Alcoholism and Drug Dependence New Jersey said untreated addiction only becomes worse, leading to greater costs for the public.

“You’re not saving money, you’re only switching which pot of money you may be using,” Singer said. “When you treat addictive illness you save money in healthcare costs.”

She said people seeking detoxification treatment to deal with drug addiction have been turned down for insurance because the state plan doesn’t cover it. Randy Thompson of the New Jersey Association of Mental Health and Addiction Agencies also said providing earlier treatment would lead to a more productive workforce.

Timothy J. Martin, a lobbyist for the New Jersey Psychiatric Association, said psychiatrists don’t recognize the distinction in state law that the bill would eliminate. He said anorexia is a good example of an expensive illness to treat for which public workers aren’t covered.

“If you ask any physician, any university, any academic publication, simply put, mental illness of any kind is physical illness,” Martin said. “We do not now, we have not, nor will we ever recognize a distinction between a biologically and a nonbiologically based mental illness – they should all be treated the same.”

He added that as the state makes public worker insurance contributions more similar to those of private-sector workers, they should receive similar benefits.

Sen. Robert W. Singer (R-Monmouth and Ocean) expressed disappointment that the bill doesn’t affect workers covered by government bodies that self-insure. “There are thousands and thousands of government employees that are left out of this,” Singer said.

Dudley Burge of the Communication Workers of America Local 1032, a member of the State Health Benefits Commission, said only four local governments that self-insure do not offer mental-health insurance parity, with the largest being Middlesex County. He said the state is unique in the country in making a distinction between different types of mental illnesses.

Compulsive gamblers also would benefit from the bill, said Donald F. Weinbaum, executive director of the Council of Compulsive Gambling of New Jersey.

The Senate health committee voted 8-0 to release the bill, with two senators, Dawn Marie Addiego (R-Atlantic, Burlington and Camden) and Samuel D. Thompson (R-Burlington, Middlesex, Monmouth and Ocean) abstaining. The Assembly version of the bill has been referred to the Assembly Health and Senior Services Committee.

This article has been edited after it was first published