Health Association in New York State, Inc.
Friday Fax from Albany
The Truth Will Set You Free: With origins in Biblical times, the adage, “The truth will set you free,” has been around for a long time. For me, one of the most vivid memories of its utterance is that of former Arizona Governor Bruce Babbitt, campaigning for the Democratic Presidential nomination in 1988. He stood on stages across the country, held his arms out, and told prospective voters, “The truth will set you free.”
On behalf of supporters of Timothy’s Law, my goal is to do that.
The truth is, the small business community and state legislators are being sold a bill of goods, in relation to the impact of the passage of legislation which would prohibit insurers from discriminating against mental illness and chemical dependency in health insurance, known as parity.
The truth is, according to an October 2003 study by the Commonwealth Fund, nearly 10 million Americans without health insurance, almost 30% of the uninsured, work for huge corporations. These people are largely our retail and service workers at our supermarkets, our big box department stores, and the chain retail stores in malls. They are America’s working poor, who are often holding down two low-wage jobs for the purpose of feeding and sheltering themselves and their families. The percentage of uninsured workers at these companies with 500 or more employees actually grew between 1987 and 2001, from 25% to 32%.
The proportion of uninsured working in mid-size and small companies actually declined, according to this study.
The impact of economic change in our nation is part of the cause of the decline in access to employer sponsored health insurance. Stagnant wage growth at large companies, the decline in manufacturing and decreased unionization contributes about 60% of the loss in insurance coverage.
Small businesses are only marginally related to the growing number of uninsured in our nation.
According to a study by the Texas Insurance Department, done recently enough to include the cost of mental health parity in that state, the total cost of mandated benefits for Texans make up 6.5% of the total cost of health insurance there. Insurance companies pay health care providers for the treatment they provide. With that in mind, less than 25 cents of every dollar paid to providers goes to mental health services. Thus, it is evident that the cost of parity could not exceed a 1-2% (1/4 of 6.5%) increase in the total cost of an insurance premium.
Yet, the insurers are running around with 10 year-old studies that ignore the penetration of managed care -- mechanisms that will continue to require all treatment, even under Timothy’s Law, to be medically necessary. They discount the May 2002 study, by PricewaterhouseCoopers, of Timothy’s Law, which sets the cost of that legislation at $1.26 per member per month. This is in line with all of the studies, all of the experience in other states, all of the experience with the federal health insurance program, indicating that the cost of eliminating discrimination against mental health and chemical dependency is 1-2%.
The federal government’s Substance Abuse and Mental Health Services Administration, an arm of HHS, just completed a study of the Vermont parity law, which is the model for Timothy’s Law. The experience in Vermont was that some companies actually saved money, and others saw a decrease in inpatient expenses, and small increase in outpatient expenses. Again -- 1-2%.
Yet, the health insurers and business community are already trying to convince state legislators that the Vermont study is irrelevant for our purposes and that New York and Vermont are very different. Here is a news flash - Senate Majority Leader Joseph Bruno represents Rensselaer County. Drive all the way east, across the Senator’s district, and you come to a sign - “Welcome to Vermont”. But for an arbitrary and invisible line, Senator Bruno’s district is just like Vermont.
We have not been able to convince the senate, or defeat the arguments of the health insurance industry, that the facts are on our side; credible study after credible study. Part of the answer might be that, recently, Paul Macielak, President/CEO of the Health Plan Association, the lobbyists for New York’s health insurers, told an audience, “I don’t care what the studies say.”
What do health insurers really want? It sounds like they want to eliminate all mandated coverage - emergency room services, in-patient maternity, etc. But, they know they can’t do that - If insurance was truly useless, would anyone buy it?
What they want is “flexibility” - the ability to sell insurance policies to people based upon what “they want to pay for.” Naturally, people “want” coverage for every possible type of health care need. It isn’t “want”, but rather “covering services that people are able to pay for.”
Keep in mind, as stated earlier, a large proportion of the currently uninsured have no coverage because of our changing economy. Service and retail workers in both large and small companies have no health insurance. They are the working poor, and the under-employed. They are also the uninsured.
The solution, according to the health insurers, is to sell them the maximum in minimal coverage they can afford. Under-paid, under-employed, under-insured -- The creation of a permanent underclass of working people in America. According to HPA’s own argument, people in NYC and the metropolitan suburbs are willing to pay for more inclusive coverage. The truth is it is largely the upstate New York constituency of the NYS Senate Majority that insurers are targeting for underclass status.
But, back to the issue at hand. Why are health insurers losing money? Well, here is another truth. Although premiums continue to rise, they aren’t losing money. The three major health insurers in the Albany area all made a substantial profit for the first half of the year. Yet, they will increase premium costs, and edge up the costs being passed through to consumers.
Another truth you might want to know is about insurance generally. Insurance companies don’t make the bulk of their profits off of premiums. Their profits (and losses) come from how they invest premium dollars in the financial markets. Insurance companies are among the largest corporate investors, behind pension funds, and when the market declines, as they have over the last three years, insurance companies lose money.
The final truth is that lost productivity and societal cost greatly outweighs any increase from passing Timothy’s Law. According to federal estimates, the cost to our economy each year for lost productivity for untreated mental health and chemical dependency needs exceeds $100 billion. How does this happen? On the most personal level, Tom O’Clair lost more than 800 hours of work trying to help his son. Those 800 hours equal six months of lost work time, over about a four year period. Eight hundred hours of lost work, or $1.26 a month.
The O’Clairs had to relinquish custody of Timothy into foster care, so he could get the treatment he needed. When a child goes into foster care, they are automatically eligible for Medicaid, and their treatment is paid, not by insurance companies, but by taxpayers - in New York State, it is paid by county property tax payers. According to a study by the federal government’s General Accounting Office, in states and counties making up approximately ½ the population of our country, 12,700 children went through custody relinquishment in 2001 to obtain needed mental health care. According to the GAO, the cost of these custody relinquishments is hundreds of millions of dollar per year.
Custody relinquishment in New York State means going to Family Court, and telling the judge, in front of a vulnerable child in need, that you cannot take care of that child any longer, and cannot provide for their medical mental health needs. That is what the O’Clairs had to do - with Timothy sitting in the courtroom, they had to tell a judge that they were parents who couldn’t take care of him anymore.
Or they could have paid $1.26 per month.
The truth is, our state cannot afford to delay the passage of Timothy’s Law any longer.
Go West, Timothy: As the TV cameras rolled, newspaper reporters took notes intently, and radio station reporters held their microphones, Tom O’Clair once again selflessly shared the horrific story of how he and his wife Donna lost their son Timothy to suicide 2 ½ years ago to a crowd of hundreds gathered in Buffalo. And, once again, Tom brought many of those gathered to listen at the Unitarian Universalist Church in Buffalo to tears as they sympathized with the O’Clairs, some of them remembering the loss of their own family members to suicide, and all enraged at the fact that the barriers to mental health services that exist in health insurance have not been torn down.
Organized largely by the Mental Health Association in Erie County, many people left the rally feeling empowered after hearing Joe Glazer speak about what they could do to help Timothy’s Law become a reality in New York State. Many left with a Timothy’s Law button on their lapel to call or e-mail their State Senator and Senate Majority Leader Bruno in support of Timothy’s Law, to go to the Timothy’s Law website to get more information about parity, to send $1.26 to Senator Bruno or to write a letter to the editor of their local newspaper.
The following Buffalo News article features a Western New York family facing difficulties getting mental health services and the rally held on Tuesday.
of young stirs advocates of law on mental illness parity. By Gene
Jessi Tutt never will forget how terrified she was.
Her son Ben, diagnosed with bipolar disorder, had overdosed on alcohol, enough to register a 0.36 percent blood-alcohol reading. While still in the hospital two years ago, he confided that he felt as if someone had put his life into a blender and forgotten to turn it off.
"I don't recognize even the tiniest shred of myself," he told his mother. "I don't know who I am. It hurts too much to care."
What really terrified his mother was that the Snyder teenager was being released from the hospital in late November, still suffering from the extreme mood shifts, paranoid and delusional thinking and impulse-driven behavior that mark his illness.
"I prayed all day, every day - from the time he got out of the hospital to the end of December - that he would not need to be hospitalized, because we didn't have any more hospital coverage for the year," she said. "To this day, it infuriates me that he was put at such great risk."
The reason: New York remains one of only 17 states that do not mandate what is called "mental health insurance parity."
People suffering from bipolar disorder or schizophrenia typically have an insurance coverage limit of 30 days in the hospital and 20 outpatient visits per year. Patients with leukemia, heart disease or diabetes have no such limit. That is why mental health advocates such as the Tutt family are pushing hard for what would be known in New York as "Timothy's Law."
On Tuesday, Thomas and Donna O'Clair of Schenectady will be in Buffalo to support the proposed law, named in memory of their son. When the O'Clairs exhausted their insurance coverage for Timothy's frequent mental health treatment, they had to put him in foster care so he could be eligible for Medicaid.
Shortly before he turned 13, Timothy took his own life.
"Had this (law) been implemented years ago, we're sure Timothy would still be here with us," Thomas O'Clair told The Buffalo News in May. "It's so unfair - not only to children, but to anybody suffering with a mental health issue to not be allowed the frequency of care needed."
That is the cause that the O'Clairs will bring to Buffalo on Tuesday, during a noon news conference and rally at the Unitarian Universalist Church, 695 Elmwood Ave.
"In our country, where we prize justice and fairness, why do we treat an accepted illness differently than other illnesses?" asked Roger E. Stone, executive director of the Mental Health Association of Erie County. "Why do we discriminate against people suffering from mental illness? I think it's stigma."
The proposed Timothy's Law passed the Assembly in a landslide vote in June, but Stone and others have said that it remains bottled up in the State Senate by the insurance and business lobbies.
Broader insurance coverage, the type that would be mandated under Timothy's Law, would cause health insurance costs to climb, forcing even more New Yorkers to lose their health insurance benefits, opponents say.
"You have people who want increased or expanded benefits," said Paul F. Macielak, president of New York Health Plan Association, which represents the health insurance industry. "The result will be an added cost, and that cost will cause another family to lose its health insurance."
But supporters of the new legislation say that similar laws in five other states have led to increases of less than 1 percent in insurance premiums. Stone pointed to a recent actuarial study indicating that mental health parity in New York would increase the average insurance premium by only $1.26 per person each month.
"I don't think that study has much credibility," Macielak replied.
"It's insurance, and you have to make it cost-effective so people can afford it. You can't have everything."
Tutts know all about fighting to get their insurance to cover mental health
"They aren't morally deficient," Jessi Tutt said about people needing mental health treatment. "They aren't weak. They have a brain illness. They shouldn't be put at risk because companies want to safeguard profits, especially in a country like America."
Ben Tutt, now 20, is dealing with his mental illness, taking the proper medication and attending Erie Community College.
"If he were physically ill, people would have brought us casseroles; the community would have rallied behind us," his mother said. "But mental illness is so isolating. With mental illness, you can't even tell people."
Finally, the Planning Process Begins: Thursday afternoon brought a long sought discussion amongst stakeholders throughout New York’s mental hygiene system. For years, MHANYS has believed that such a dialog was necessary to begin the process of determining what New York’s mental hygiene system will look like in the future. And the leadership that has finally brought this about came from none other than the Chairman of the New York State Assembly Committee on Mental Health, Mental Retardation and Developmental Disabilities, Peter Rivera.
Chairman Rivera plans to bring the larger workgroup together on a monthly basis, with several subgroups meeting monthly as well, to work toward a final agreed upon goal to be established 1 year from now. We will include periodic updates in the Friday Fax on the workgroup’s progress throughout the upcoming year.
Capitol Hill Update: Senate Commitment to Take Up Wellstone Parity
In an exchange on the Senate floor, Domenici and Kennedy, however, reported that they had secured a commitment from Sen. Judd Gregg, R-N.H., chairman of the Senate Health, Education, Labor and Pensions Committee, that that committee would make it a priority to consider parity legislation early next year, thus clearing a longstanding roadblock and setting the stage for what could be Senate passage early in 2004.
NMHA will continue to work with Senate and House leaders to make enactment of a strong mental health parity law a reality. Early Senate passage of parity legislation would, of course, represent only a first step, and is likely to require a major push to win the support needed in the House of Representatives. Such support will probably require convincing House Leaders that full parity can be achieved without significant cost to employers.
Continued grassroots’ engagement will surely be critical if we are to prevail.
Follow-up on Last Week’s Friday Fax Section ‘Timothy’s
Law Goes Metro’:
On November 5, Tom O'Clair took a day off from his job as a mechanic at the Thruway Authority to travel from his home in Schenectady to downtown Manhattan. He was to be the star speaker at a press conference on behalf of a new bill about mental-health care. Shortly after 2 p.m., Tom stood in front of the steps to City Hall, next to a poster of Timothy, his 12-year-old son.
"Timothy had been diagnosed early on as having attention-deficit/hyperactivity disorder and as being depressed," Tom told an audience of two reporters and four supporters. "He was hospitalized twice. The first time, he put the entire family at risk by throwing rags into our furnace at home. That same evening, we got him admitted to Four Winds psychiatric hospital in Saratoga."
Tom, 43, said he and his wife, Donna, had been trying to get help for Timothy since he was in third grade. "We were really limited in the amount of treatment he could get, with 20 outpatient visits per calendar year and 30 inpatient days per calendar year," Tom said. "This really caused us to have to budget our doctors' visits.
"If he was having a particularly good week, we didn't have to worry about it. If he was having a bad week, we might have to see the doctor twice. When his insurance ran out anytime through the years, whether it was halfway through the year or early on, it then became our financial responsibility to cover the appointments. This caused a great financial burden on the family."
Over the years, Timothy's troubles worsened, and the medical bills grew. "Timothy could go from a happy, laughing little boy in a matter of seconds to having a knife to his chest, threatening to do himself harm," Tom recalled. "His second hospitalization came after he had choked himself to the point of passing out in school."
By then, the O'Clairs had given up custody of their son. This seemed the only solution to their financial woes, since Timothy was now eligible for Medicaid. Timothy spent the next seven months in a residential-care facility, then returned home. Six weeks later, Tom said, "he took his own life, seven weeks before his 13th birthday."
Tom has told this story so many times that his tone is matter-of-fact and his eyes remain dry. For the last nine months, he and his wife have crisscrossed the state, telling the story of their son's suicide to hundreds of strangers. They've been to Syracuse, Albany, Binghamton, and Rochester; they've attended rallies, picnics, and even an event at a zoo.
All of this is in support of "Timothy's Law," a bill named after their son, which would eliminate insurance companies' limits on mental-health treatment. The law would require insurance plans to cover the care of mental illnesses the same way they cover physical illnesses.
Mental-health activists in New York State have been trying to establish parity between physical- and mental-health coverage for many years. This year, however, they have a new weapon: Timothy's story. For the first time, the parents of a suicide victim are helping lead the charge.
Thirty-three states across the country have already enacted some version of mental-health parity. In New York State, Timothy's Law was approved by the state assembly on June 4, but has yet to pass in the state senate.
Supporters of the bill insist it would increase employers' monthly premium for health insurance by only $1.26 per person. Opponents dispute this figure, and maintain that Timothy's Law would drive costs so high that the number of uninsured people would inevitably increase.
As the O'Clairs have attracted attention in newspapers across the state, the New York Health Plan Association, a lobbying group for the insurance industry, has fought back. In letters to various editors, president Paul F. Macielak acknowledges that stories like Timothy's "tug at our emotions," but he warns against "using emotion as a means to enact legislation that will ultimately hurt, not help, families like the O'Clairs."
Meanwhile, Tom O'Clair remains committed to his cause. His speech in front of City Hall was preceded by Councilmember David Weprin's announcement of a proposed resolution urging the state legislature to pass Timothy's Law. Tom plans to return to New York City in a month to testify at a council hearing. In the meantime, he'll continue barnstorming the state, recounting the events that led up to the day his 12-year-old son hanged himself in his bedroom closet.
Homes Group Sues State Over Medicaid Payments. By Joel Stashenko Associated
Press, November 12, 2003
The Empire State Association of Adult Homes and Assisted Living Facilities argued in the suit that 74 adult homes have closed over the last four years because of insufficient Medicaid payments, and it predicted that more would fail unless the money is provided.
"For too long, the state has treated adult home residents as afterthoughts and given them only bare-bones financial support," said Lisa Newcomb, executive director of the association. "Our vulnerable citizens need and deserve more."
Newcomb said the disabled and elderly residents of her members' homes qualify for Medicaid-funded help with daily living tasks such as eating, dressing and bathing. But the state has ruled them ineligible, she said. The state argues that the residents don't qualify because they require "some" assistance, but not total assistance, according to the association.
The 74 adult homes that have failed forced more than 3,500 New Yorkers to seek residence in sometimes "inappropriate" settings such as nursing homes, hospitals and psychiatric centers at a far higher cost to taxpayers than the additional Medicaid money the suit is seeking, Newcomb said.
The association's lawsuit was filed in state Supreme Court in Manhattan.
William Van Slyke, a spokesman for the state Health Department, defended the state's spending on adult homes.
"(I)t's clear from the investigations of the Commission on Quality of Care for the Mentally Disabled that there's more than enough taxpayer funds being distributed to adult homes in New York," Van Slyke said. "It's also clear that these homes are not using the money for the services to provide the best care."
Another prong of the suit challenges the state's refusal to increase the Supplemental Security Income payment of $28 a day since 1988. The association contends that the money was intended to help aged, blind and disabled individuals pay for housing, food, activities and personal care and is grossly inadequate to meet the average expenses of caring for adult home residents.
By not increasing the benefit level, the suit contends the state is not meeting its constitutional obligation to care for the needy. The adult home association said about 15,300 adult home residents, or about 40 percent of the population of adult homes in New York state, rely on the SSI benefits.
"New York pays less for around-the-clock care for elderly and disabled adult home residents than it costs to keep a dog in a kennel," said Jim Kane, owner of the Adirondack Manor Home for Adults in Queensbury, about 60 miles north of Albany.
next time, we remain,