Uncovered; In Ohio, insurance pays much more for physical ailments than mental ones

By Encarnacion Pyle

Research for the stories in this package was conducted with the help of a Rosalynn Carter Fellowship for Mental Health Journalism. The fellowship program is run out of The Carter Center in Atlanta.

A babysitter sexually assaulted Matt Mikolic at gunpoint when he was in kindergarten. At age 7, he ran into traffic, jabbed pencils into his skin and threw himself into bed every night, yelling, "I want to die." By middle school, Matt had chased his younger brother with a knife and had tried to throw himself from the roof of his house. He had been hospitalized twice.

When doctors diagnosed bipolar, attention-deficit and post-traumatic-stress disorders in Matt, now 18, his parents were relieved to have health insurance, which they assumed would cover the cost of his care.

Then their younger son, Brian, now 16, also started showing signs of bipolar disorder, which causes alternating periods of mania and desolation.

They, too, sank into depression.

Soon, Susan Mikolic, 46, and her husband, Donald, 52, were paying as much as $500 a week so they could all see a psychiatrist. Most of it came out of their own pockets because of limitations on their insurance coverage.

"My husband and I are college-educated, professional people, earning goodwages, but a family can't keep up with bills like this on an on going basis," Mrs. Mikolic said.

Each year, insurance typically covers no more than 20 mental-health visits and 10 hospital days a year for hundreds of thousands of families. Maximum lifetime coverage for mental illness typically is $10,000, compared with $1 million for general-health coverage.

Advocates of more coverage for the mentally ill often point to Parkinson'sdisease and schizophrenia as examples of two illnesses that are treated differently. The two are linked by dopamine, a chemical in the brain that acts like a spark plug, initiating memory, mood and motor behavior. People with schizophrenia have too much dopamine; people with Parkinson's have too little.

But a Parkinson's patient usually enjoys full medical coverage, while people with schizophrenia often face limited benefits and increased co-payments.

"Poor will, poor spirit or poor choices are not invoked as reasons to limit coverage with Parkinson's disease," said Dr. SulRoss Thorward, a psychiatrist at Twin Valley Behavioral Healthcare, the state mental hospital in Columbus. "We're all familiar with Muhammad Ali and Michael J. Fox. No implications are made that this illness is the patient's fault."

Thirty-five states require mental illnesses to be covered the same as physical ailments. Some Ohio lawmakers have tried unsuccessfully for 18 years to prevent insurers from restricting mental-health coverage.

"We have found no reason based on biomedical or behavioral science why mental disorders should be treated differently from any other medical disorder," said Steven. E. Hyman, former director of the National Institute of Mental Health.

Insurance companies and small-business owners say equal coverage would drive up their costs.

"Legislators have considered bills mandating insurance coverage for diabetes, maternity hospital stays, birth control, osteoporosis, infant formula and mental-health parity," said William Fitzgibbon, director of the Ohio Chamber of Commerce's Small Business Council. "Although each mandate maybe viewed as an attractive, expedient solution for a particular health problem, the cumulative economic cost is staggering."

But advocates say the increases would amount to less than 1 percent, based on the experience of states that offer parity.

"The arguments against parity are only justifications for the discrimination of the mentally ill because they are seen as having less political clout and power than people without these illnesses," said Terry Russell, who retired as executive director of the Ohio chapter of the National Alliance for the Mentally Ill at the end of June. "Nothing could be more cruel orun-American."

Staggering financial toll

Over the past decade, the Mikolic shave dug a $500,000 financial hole.

They took out three home-equity loans but still ended up selling their $287,000 house in Willoughby, a Cleveland suburb.

"If my child had leukemia, we would not have lost our home. We would not be broke," said Mrs. Mikolic, a former nurse whoadvises educators about emotionally disturbed students.

"Mental illnesses are real medical conditions -- just like heart disease and cancer -- that affect more than 500,000 adults and children in Ohio every year, "said Laura Moskow Sigal, executive director of the Mental Health Association of Franklin County.

"It's not fair to the individuals and their families to be denied coverage. And it's not fair to taxpayers who must subsidize the ever-growing public mental-health system that steps in when people exhaust their private insurance benefits."

Denise Nichols, 46, of Maineville, northeast of Cincinnati, paid more last year for mental-health services than for treatment of several physical ailments, including a heart attack, hypertension and a torn ligament in herankle.

"I'm normally physically healthy, but I had a bad year," said Nichols, a social worker who has bipolar disorder. "My medical expenses totaled $47,478, of which I paid $1,673.

"My psychiatric bills only totaled $3,071, but I still paid $1,910."

When her son, Zachary, now 18, was treated for leukemia, insurance covered everything but his $10 co-pay.

Meanwhile, Nichols has spent an average of $8,000 annually for office visits and tests not covered by insurance because they relate to her mental illness.She owes her psychiatrist $28,000.

"I don't understand why insurance companies don't pay more for psychiatric care when studies show mental illnesses are often treated more successfully than common medical problems," she said.

Benefits of treatment

Studies by the U.S. Department of Health and Human Services indicate that doctor visits, medication and therapy reduce hospital stays, one of the most expensive forms of treatment at an average of $500 a day.

Sometimes a trip to the hospital can't be avoided but insurance companies won't cover it.

During a violent outburst in 2001, Meg Thompson's son, Leif, then 10, tripped his sister, Emma, who was 4.

Thompson, of the Northwest Side, called police. Officers took Leif to Netcare, Franklin County's 24-hour emergency mental-health center, and later to Ohio State University Harding Hospital.

The family's insurance company wouldn't approve the claim, but Thompson called her son's psychiatrist, who talked the company into changing its mind. Leif had been treated for depression. The next day, his bipolar disorder, obsessive-compulsive disorder and separation anxiety were diagnosed.

"If I had taken my son to the hospital with a sprained arm, they wouldn't have said, 'Sorry, we can't help you,' " Thompson said.

Sometimes, people go without treatment.

"Suicide, a common by product of untreated mental illness, claims more lives annually than homicide," state Rep. Jon Peterson said. Peterson, a Delaware Republican, and Sen. Robert Spada, a Republican from North Royalton, both introduced parity bills last year that have stalled in the state legislature.

Both bills would require employers to offer basic health insurance that includes coverage of "biologically based mental illnesses" such as bipolar disorder, major depression, schizophrenia and obsessive-compulsive disorder.

The bills would extend benefits now provided to state employees.

The state expected to spend $10.2 million on employees' mental-health services last fiscal year, which ended June 30. Physical disorders were projected to cost $345.8 million, said Ben Piscitelli, spokesman for the Ohio Department of Administrative Services.

Two years ago, Gov. Bob Taft called for a moratorium on new health-care mandates on businesses. He still opposes the parity bills, spokesman Mark Rickel said.

Unlike previous proposals, the bills wouldn't require coverage for conditions resulting from drug or alcohol abuse. They would allow companies to decline to buy mental-health services if the new coverage caused their insurance premiums to rise more than 1 percent over six months.

"We've compromised time after time," said Cheri L. Walter, chief executive of the Ohio Association of County Behavioral Health Authorities,which represents drug, alcohol and mental-health treatment providers statewide."The bills can't be watered down any more and still be useful."

Parity bills debated

But some business leaders say protections are needed because the percentage increase for some companies could be in the double digits.

"Companies with the most mentally ill employees in need of coverage will likely pass any increased costs on by raising co-pays and deductibles, lowering wages or discontinuing the insurance," Fitzgibbon of the chamber said.

Among businesses with 10 or fewer employees, 41 percent provide at least basic coverage, which by state law is $550 a year, said TyPine, who heads the 36,000-member National Federation of Independent Business-Ohio.

"Since 1986, the No. 1 concern of small-business owners -- above government regulations, paperwork requirements and even taxes -- is the cost of health insurance."

The legislation would cover only one-third of Ohioans who have insurance, Pinesaid.

Advocates say the bills would extend coverage to about 110,000 Ohio workers and their families. State and federal employees, as well as Ohioans on Medicaid or Medicare, receive some sort of parity. Large, self-insured companies are not subject to state parity laws but have to live up to federal requirements and are regulated by the U.S. Department of Labor.

Advocates also say the financial concerns haven't been borne out in states that have required parity for years.

Two-thirds of businesses in Vermont said parity had "little or no effect" on their costs. A New England Journal of Medicine study found that six out of seven federal health-care plans studied were no more expensive than conventional plans. And the Chevron Corp.found it saved $7 for every dollar it spent on mental health through its employee-assistance program.

Twenty states with parity laws have higher insurance rates than Ohio; 15 have lower rates.

The National Institute of Mental Health estimates the cost of untreated mental illness at $300 billion a year in the form of absenteeism, bankruptcy, crime,homelessness and poverty. In Ohio, the cost is projected at more than $6.5 billion a year, say the Ohio Association of County Behavioral Health Authorities and the U.S.surgeon general.

Spada was caught by surprise over Labor Day weekend2003 when his son James was hospitalized in a mental-health ward.

"I did not have a clue as to what to expect," he said.

Doctors later diagnosed bipolar disorder in James. With counseling, family support and medication, he finished a master's degree in economics and started working full time.

"It's time insurance companies treat a sick mind the same they would a sick heart," Spada said.

Copyright 2006, Used with permission from The Columbus Dispatch.