Mentally Ill Struggle With Lesser Insurance

David Harkins, a 55-year-old who needs medication to help with his bipolar disorder, lives with a college student in a private dorm near USF.

JAY NOLAN / Tribune

By CATHERINE DOLINSKI The Tampa Tribune

Published: Jul 25, 2007

TALLAHASSEE - Mental illness threw David Harkins' life into reverse.

At 19, he was managing the basketball team at Florida College, where he received his associate degree in 1971. He got married, had children, became a computer support specialist and bought a home.

"Now I'm back to washing towels for a living," said Harkins, of Tampa, who is 55 and living in a private dormitory with a college student. "I make less than $9 an hour."

Harkins is bipolar, relying on prescription drugs to control his severe mood swings.

But because Florida is one of a handful of states that allow health insurers to cover mental illnesses at lower levels than they cover physical disorders, patients like Harkins must do what they can to maintain their psychiatric treatments and drug regimens.

While Harkins hopes to work full-time again, there's no guarantee that employer-provided insurance would cover his mental health care costs. So he limits the hours he works, to keep the federal disability benefits that subsidize his treatments and drugs.

His options may expand greatly, however, if lawmakers succeed in putting mental illnesses on par with physical disorders. This spring, nearly 100 lawmakers co-sponsored a state parity bill that failed to reach a vote.

Meanwhile, parity bills that have languished for a decade in Congress are gaining new traction. A U.S. House committee approved parity legislation last week that would require equal coverage of mental illnesses nationwide, and sponsors hope to see it on the House floor by this fall. A similar Senate bill passed through committee in April.

"Our source of our nation's greatness and strength is its unique promise of equal opportunity for all," Rep. Patrick Kennedy, D-R.I., said via email. "It's up to all of us to insist that the country make good on that promise for everyone, including Americans living with mental illnesses and addictions."

Patients like Harkins are watching closely, hoping that insurers in Florida will soon have to treat their needs like everyone else's.

"Some say people who use mental health [coverage] abuse it," Harkins said. "Well, some people are going to abuse anything, and they ought to be put in jail. If I don't get my medicine, I'll go cuckoo."

Bill Rooted In Personal Experience

More than 40 states have laws requiring insurers to cover mental and physical illnesses equally, if they cover mental health at all. Florida law sets minimum benefits for mental health coverage, but not parity.

The bill's chief sponsor, Rep. Ed Homan of Tampa, gathered 91 House co-sponsors for his parity bill this year, which Dennis Jones, R-Seminole, sponsored in the Senate. The proposal, which Homan has already refiled for 2008, requires parity of insurers that offer policies with mental health benefits.

Homan is a doctor, but his understanding of mental illness is personal: His mother's father suffered from depression and committed suicide, and his 39-year-old son, John, struggles with bipolar disorder without health insurance.

"People don't appreciate bipolar depression till they have had to live with it," Rep. Homan said. "My oldest son has been fighting it since high school. He went to the University of Florida on a President's Scholarship. … He worked for a big architectural firm. Right now, what he's doing is delivering newspapers for the St. Pete Times. Getting a job, and keeping it, is tough. As he describes it, 'a cloud descends on me.'"

The parity bills cleared their first committee stops but did not reach floor votes in the House or Senate.

Homan entreated House leaders to hear the bill at the Policy and Budget Council, to no avail. "Nobody ever said, 'You'll never get this passed,'" he said. "But it was not a leadership issue. We noticed the speaker's brother is a lobbyist for BlueCross BlueShield, and it was BlueCross BlueShield lobbying against the bill."

House Speaker Marco Rubio said his brother did not influence or even speak to him about the bill. Rubio has no position on it, he said, but it remains controversial because of the potential cost impact.

Requiring parity will increase health insurance costs for all consumers, said Paul Sanford, BlueCross BlueShield of Florida's lobbyist who led the opposition. "Only those that are going to use [mental health coverage] will buy it, which runs up the cost of both plans."

Cost, Definitions Raise Concerns

If parity boosts insurance costs, employers may drop mental health benefits altogether, warned David Hogberg, adjunct scholar at the conservative National Center for Public Policy Research.

That's unlikely, said Katharine Lyon, vice president of the Florida Council for Community Mental Health. Where there is parity, she said, "they find out there's less absenteeism, and employees are able to work better."

Several federal studies of parity mandates have identified premium increases at less than 1 percent up to about 5.5 percent. Sanford, of BlueCross BlueShield, said an increase of even a few percentage points could be the tipping point for many families to drop their policies.

Another problem is defining mental illness itself, Hogberg said. "I don't mean to minimize those problems, but they are a lot harder to get a handle on," he said. "I think that with parity, you will increase the use of mental health benefits, and increase the unnecessary use of them."

Bills Vary In Scope

Those arguments did not stop a parity bill from passing the U.S. House Education and Labor Committee on July 18 on a bipartisan vote of 33-9. The bill has two more committee stops; the Senate version awaits only a floor vote.

"It's about changing minds and breaking down stigma and opening up possibilities, even more then about impacting health insurance coverage," said Kennedy, lead House sponsor.

The House and Senate versions differ in details, with the latter version more narrowly defining mental illness and pre-empting tougher state parity laws.

"The Senate bill is the product of almost two years of discussions of many of the interested parties - mental health providers, insurers, hospitals," said Jeff Wollitz, federal BlueCross BlueShield lobbyist. "If a mental health parity bill is going to pass, we much prefer the Senate version."

Like Homan, several of the federal sponsors have personal reasons to champion parity. Kennedy has a history of depression and substance abuse. His uncle, Democratic Sen. Edward Kennedy of Massachusetts, is carrying the Senate bill, with Senate co-sponsor Pete Domenici, R-N.M., who has a daughter who has struggled with mental illness.

In Florida, Homan's bipolar son participates in a medical study to obtain his medication. He wants to enroll at the University of South Florida to resume the graduate study in architecture that depression forced him to abandon years ago.

He hopes, he said, that student health insurance will cover his mental health expenses. But according to the University of South Florida's Web site, the plan provides only limited coverage.

"Hopefully that would at least include getting the right medication," he said. "For now it's just one day at a time."

Reporter Catherine Dolinski can be reached at (850) 222-8382 or cdolinski@tampatrib.com.