The Challenge Of Health Care Reform

This week we saw an example of why meaningful health care reform will be so difficult to achieve, no matter who is elected in November. On Tuesday, the state legislature’s Insurance and Real Estate Committee conducted a hearing on Senate Bill 309, titled “An Act Concerning Certain Health Insurance Mandates.” The stated purpose of the proposed legislation was “to reduce the cost of health insurance by removing certain mandates.” Sounds reasonable, right? Cheaper health insurance without the complicating interference of state mandates. It sounds great until you actually read the bill.

Senate Bill 309 strips requirements from existing state law that health insurance companies cover mental health services of all master’s level therapists and counselors. The proposal would limit coverage to services provided by MDs and PhDs. If this bill were ever to become law, it is unlikely that insurance premium payers would see any of that cost savings. When was the last time you saw a health insurance premium go down? The savings would accrue, of course, to the health insurance companies themselves, improving their profitability but not necessarily mental health care for their policyholders.

This would be accomplished in two ways: coverage for psychotherapy and mental health counseling would be drastic reduced by making the majority of therapists and counselors ineligible for third-party payments from insurance companies. And by limiting insurance coverage to already overbooked doctors, the insurance companies are more likely to end up paying for less expensive drug therapies rather than psychotherapy. (A British study released this week raises questions about the effectiveness of antidepressants on all but the most severe cases of depression.)

This legislation, if enacted, would effectively close down the counseling program of Newtown Youth & Family Services along with the mental health programs of all the family service agencies, child guidance clinics, residential treatment facilities, and nonprofit community health centers in the state. These groups rely heavily on master’s level therapists and clinicians to meet the growing demand for mental health services in the state. Without insurance payments for these services, most would be out of business in short order.

We trust state legislators will deliver this proposed legislation to the scrap heap where it belongs, but we are discouraged that such bills get raised in the first place — discouraged, but not surprised. In the 2006 election cycle, the insurance industry contributed $486,545 to candidates for elective office in Connecticut. (The two co-chairmen of the Insurance and Real Estate Committee, Democrat Senator Joe Crisco and Democrat State Representative Brian O’Connor, got $2,500 and $3,500 respectively.) This year, we expect that figure will be even higher. Notwithstanding all the hopeful talk in the air about health care reform and expanding health insurance coverage to everyone who needs it, we should have no illusions about how difficult a challenge that will be. The insurance industry has bought and paid for a seat at the table, so we can expect more health care “solutions” that serve the needs of the industry above every other need.