Congress lards up every appropriations bill with treats for campaign donors, favored constituencies and special interests -- federal lawmakers managed to pack more than 400 pages worth of goodies into last week's $700 billion economic rescue package, and no member of either party could have possibly known every detail of the bailout bill.
But earmarks and targeted tax breaks are one thing. Major health care reform is entirely another.
Buried inside the package is a new law that requires health plans to provide equal coverage of mental and physical illnesses. According to The New York Times, the law, which takes effect in 2010, is the result of years of advocacy, lobbying and negotiating between health policy experts, insurance companies and employers.
Currently, employers and group health plans can set separate, higher co-payments and deductibles and lower coverage limits for mental illness and addiction treatments. Many companies and plans offer no coverage at all because of the costs such benefits can impose.
The new law gives insurance companies and major employers a little more than a year to reconcile coverage differences and figure out how to pay for them (businesses with 50 or fewer workers are exempt from the law).
Mental illness can devastate entire households, and employers suffer untold amounts of lost productivity as a result of them. Certainly, companies have an interest in keeping their workers healthy and free from the symptoms of legitimate medical conditions.
The problem with doing so, however, has been an ever-growing number of syndromes and disorders classified as ailments. "The Diagnostic and Statistical Manual of Mental Disorders," published by the American Psychological Association, lists caffeine highs and sleep loss resulting from jet lag as mental illnesses. Grief can be classfied as depression. And there has been an explosion in the number of children diagnosed with behavioral and developmental disabilities.
Companies and insurers have found it nearly impossible to assess how much their claims might increase (and, conversely, how much they would need to charge policy holders) if they were required to apply normal deductibles and coverage limits to all of them.
The catalyst in getting the law passed was an agreement to drop a requirement that every condition in the afforementioned APA manual be covered. We'll see how long that lasts.
Regardless, this mandate -- however noble -- will make health care more expensive, even as politicians clamor to make medicine more affordable. It could be especially costly to Nevada providers if the law requires them to provide full coverage for gambling addiction treatments.
The law should have been presented and voted on separately from the bailout bill. Now, as with the economic rescue package, we won't know for certain how much we'll have to pay.