Tucked inside the economic bailout approved last week by Congress is a provision that will improve mental health care for millions of Americans. It’s long overdue.
Beginning in January, health insurance companies must offer equal coverage for mental and physical illness. No longer will they be allowed to charge higher deductibles for people seeking psychiatric care or impose stricter limits on care provided for mental health problems.
Insurers rarely make coverage distinctions for even the most expensive physical illnesses; they cover kidney failure the same way they cover liver failure. As long as doctors can justify hospitalizing a patient with heart disease, insurers cover the cost of care.

Not so when it comes to mental health. Policies often strictly limited the number of days a patient could be hospitalized for psychiatric care. Even if all parties agreed that a seriously mentally ill patient required continued inpatient care, the patient may have been discharged because the insurance company no longer would pay.
Psychiatric patients have committed suicide after being discharged like that. It’s impossible to imagine a heart patient at risk of sudden cardiac death being turned out of a hospital under similar circumstances.
Insurance companies also often have made patients pay a larger share of the bill for mental health treatment, and they have charged higher co-payments for seeing a psychiatrist or therapist than for seeing a family doctor.
Those limits have been based on an outmoded dualism that sees mental illness as distinct from physical sickness.

The reasoning behind this view was that physical illness and the treatments prescribed are objectively verifiable, while psychiatric illness and its treatments are more subjective and subject to abuse.
Opponents of providing equal coverage for mental and physical illness — sometimes called mental health parity — have raised the specter of people with relatively minor emotional symptoms suddenly being entitled to an unlimited number of therapy sessions.
That’s not what has happened in states such as Missouri, which already has  a mental health parity law on the books. Those laws have added only modestly to increases in health insurance premiums. The Congressional Budget Office has estimated that the parity requirement in the bill approved last week will increase premiums by an average of two-tenths of 1 percent.
Business groups, which were among initial opponents to parity laws, have found that modest premium increases have paid off in higher productivity in states with such laws. But state laws don’t apply to millions of Americans whose health insurance is governed by federal law.
In the nearly 15 years since advocates first proposed mental health parity laws, scientific discoveries have begun to show the biological basis of many serious mental illnesses. That has undercut further the justification for separate treatment limits and higher deductibles for mental health care.
Allowing such distinctions in the face of such overwhelming evidence only stigmatized those with mental illness and prevented thousands of seriously ill people from getting the care they needed. The change in federal law enacted last week will correct this injustice.

Post-Dispatch illustration by John Shew