Four New Jersey legislators recently focused a health issue affecting thousands of the state’s residents: insurer treatment limits and denials for people with an addiction or mental illness. Senate Legislative Oversight Committee members Robert Gordon, Teresa Ruiz and Barbara Buono spent a good portion of July 18 listening to expert and personal testimony on this long-standing problem. Earlier this summer, Senator Robert Singer and former Congressman Patrick Kennedy held a forum at Stockton College to make the case a final rule on the federal addiction and mental health parity law, needed to help end insurer non-compliance. These four New Jersey lawmakers, along with long-time parity champion Senator Joseph Vitale, deserve the state’s deep appreciation for responding to a problem that has been terribly costly to the state in the lives it has claimed and in the increasing amount of public dollars it has required.
The Senate committee heard testimony from experts and from two panels of patients and their families. These witnesses described what is known as “medical necessity,” a ploy regularly used by insurers to deny treatment. Simply put, health insurers refuse treatment for patients by asserting that a higher level of care such as inpatient treatment is not medically necessary, even if the patient has had assessment indicating a more intensive level is warranted.
Should the patient or their family try to argue that the patient does indeed need the more extensive care, they will encounter the health insurance bureaucracy. The labyrinth of this process often leaves patients and their families so bewildered and frustrated that they eventually give up trying to have their treatment covered, likely the outcome the insurers were counting on.
By taking on insurance denials and restrictions, the lawmakers are assisting citizens who need care as well as attending to the state’s budget. The details of the immense fiscal costs of treatment denials were presented to the Senate panel by New Jersey Association of Mental Health and Addiction Agencies Executive Director Deb Wentz. She said untreated and undertreated addiction cost the state $262 million each year, the largest amounts arising from criminal justice, child welfare, other health problems resulting from addiction, and lost worker productivity. Ms. Wentz said that of the more than 800,000 residents of the state who need treatment for addiction, only 7 percent of them receive it.
This issue is also being confronted at the federal level. Senator Singer and Patrick Kennedy held a hearing in mid-June on the Paul Wellstone Pete Domenici parity law and urged people to step forward to advocate against insurer non-compliance with the law. Kennedy stressed that too few have lent their voice to the issue in the public arena owing to the stigma surrounding addiction and mental illness. One witness at the Senate committee hearing, Wayne Debolfsky, captured this fact. People affected by these diseases, he said, “have suffered too long in the dark and in silence. They have suffered in silence, Debolfsky said, because their “illnesses are shame-based.”
Clearly the challenges for advocates of insurance reform are considerable, yet there is reason for some optimism that people in the state (and across the country) with behavioral health problems will not have to battle through the insurance gauntlet to access proper treatment. Nationally, the Obama Administration is insisting that the final rule on the federal addiction and mental health parity law be in place by the year’s end. New Jersey is among the states expanding Medicaid as part of health care reform, enabling more people to access care. And certainly another reason to hold out hope is that a group of New Jersey lawmakers saw fit to spend the better part of a summer’s lifting the issue into the light.