Insurance parity works

For a shamefully long time, Oregon lawmakers bought the insurance industry's claim that requiring "parity" — coverage of mental health and substance abuse equal to that for other medical treatment — was just too expensive.

So it wasn't until 2005, after 35 other states had passed parity laws, that legislators finally heeded the pleas of Oregonians devastated by mental illness and addiction, and approved the nation's strongest parity law. To the bitter end, parity foes warned of massive costs and people being kicked off insurance plans.

It didn't happen. A powerful new study by a group of researchers led by K. John McConnell, a health economist at Oregon Health & Science University, has found that Oregon's parity law did not prompt a stampede to costly mental health or addiction treatment.

In fact, a comparison of four years of cost data for more than 100,000 people subject to parity and nearly 19,000 people whose self-insurance plans were not subject to the law found that there were similar increases in spending on mental health and substance abuse for both groups. The study concludes: "Expenditures attributable to the parity law were ... close to zero."

That finding is a reaffirmation of Oregon's parity law, and more broadly and timely, an answer to those who insist that national parity legislation that took effect last year is unaffordable and wrongly prevents managed-care organizations from putting sideboards on mental health and substance abuse treatment.

Oregon's experience with parity deserves wide attention. Almost every other state hedged — weakened — its parity law by allowing managed care providers to use their "tools" — evaluating medical necessity, requiring prior authorization, reviewing utilization — to restrict care and blunt cost increases.

The federal parity law follows Oregon's lead, but insurers are still fighting to persuade Congress to amend the law and allow managed-care controls of mental health treatment.

The Oregon study is a powerful argument that Congress ought to leave well enough alone. Oregon's law is doing exactly what was intended, providing essential mental health and addiction coverage for a small but significant number of people who would have been limited to just a handful of office visits or inpatient stays under the old discriminatory policies, and forced to either go without care or pay virtually all of the costs out of pocket.

In a series of editorials that later was awarded the Pulitzer Prize, we told the stories of Oregon families trapped in these discriminatory policies. Some were driven into bankruptcy; others faced an even more wrenching choice, giving up custody of their mentally ill children so that the state would pay for their care. Before parity, Oregon required these families to lose everything, including their children, to get treatment for mental illness.

Thankfully, that is now history. But there are still people who do not acknowledge or accept that a person suffering from a mental illness deserves the same kind of insurance protections as someone with cancer. There are still people making the argument that insurers and managed-care organizations can't afford to stop discriminating against persons with mental illness.

They're wrong. Oregon has demonstrated that a fair and humane insurance system is no more expensive than a cruel and discriminatory one. And our state has set this standard: Mental illness, wherever and whoever it strikes, should be cared for with the same urgency and compassion and insurance coverage as any other health issue.

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