Parity in health insurance is hard won, and we need to keep it

I don’t post much politics on this blog, but this one issue is relevant to mental health concerns.

Last week, the Congressional Budget Office released their analysis of H.R. 1628, the bill to repeal and replace Obamacare.

However, the agencies estimate that about one-sixth of the population resides in areas in which the nongroup market would start to become unstable beginning in 2020. That instability would result from market responses to decisions by some states to waive two provisions of federal law, as would be permitted under H.R. 1628. One type of waiver would allow states to modify the requirements governing essential health benefits (EHBs), which set minimum standards for the benefits that insurance in the nongroup and small-group markets must cover. A second type of waiver would allow insurers to set premiums on the basis of an individual’s health status if the person had not demonstrated continuous coverage…

And the CBO explains why reintroducing preexisting conditions for people who don’t demonstrate continuous coverage would, over time, result in the community-rated premium group being basically a group of people who have preexisting conditions, with premiums too high for most such people to afford. But I’m leaving the preexisting condition issue out of this post, important though it is for people living with mental illness, to attend to the other part of the proposed waiver system, the one that allows status “to modify the requirements governing essential health benefits.” One of those requirements is the requirement that mental illness be covered like any other illness. This is a battle that has been hard won. I recall a DBSA conference where a man spoke about an argument that he had made for parity. He said he took two medications out of his pocket, and said:

This is for my ass. This is for my brain. My insurance company pays for the first, but not the second. So you can see that they think my ass is more important than my brain.

If this bill passes, as much as a sixth of the population may go back to the days when their asses are treated as more worthy of medical care than their brains.


Proposition 61

For the November 2016 election, we get to vote on 17 propositions. It can be hard to make up your mind about so many. One proposition, for better or worse, may affect many people who live with mental illness, through it’s effect on pharmaceutical prices. I’m not going to tell you how to vote; I see good people and organizations coming down on both sides on this one. But I am going to talk a bit about how to figure out how to vote. What would this proposition do, what are the pro and con arguments, and what sources of information can help you?

The first place that we can look to learn about the propositions, of course, is the California ballot pamphlet. Conveniently, for those of us who sometimes misplace things, you can also find the ballot pamphlet online at the California Secretary of State web site. Here is a link to the ballot pamphlet section on Proposition 61.

In the ballot pamphlet, you can find the full text of the proposition, a legislative analyst’s summary (which gives you an idea of the effect of the proposition that those of us who aren’t lawyers would have trouble getting from the text of the law), and ballot arguments that are submitted by proponents and critics of the proposed law. But it’s rather long, and can take a while to read all this information for 17 different propositions. If you don’t want to read through the whole ballot pamphlet (or even the whole pamphlet leaving out the text of the proposed laws), there are simpler summaries. One is actually in the pamphlet (see the first page of that link I gave, and just jump to the longer sections after reading that. Another is supplied by the League of Women Voters. Here is their information on Proposition 61, including official links to support and opposition.

Another way to evaluate propositions is to look at who endorses or opposes them. For this, you can find a handy chart by California Choices. California Choices does a round up of ballot endorsements by a wide range of organizations and papers each election. (California Choices’ page rounding up information about Proposition 61 is here.) Or, if you’re interested in the money trail, you can check out what Ballotpedia has to say about Proposition 61.

OK, I’ve talked a lot about sources, but I haven’t told you what’s in the proposition, or what the pro and con arguments actually are. Here’s a brief description from the ballot pamphlet:

Prohibits state from buying any prescription drug from a drug manufacturer at price over lowest price paid for the drug by United States Department of Veterans Affairs. Exempts managed care programs funded through Medi–Cal. Fiscal Impact: Potential for state savings of an unknown amount depending on (1) how the measure’s implementation challenges are addressed and (2) the responses of drug manufacturers regarding the provision and pricing of their drugs.

The crux of the controversy between pro and con (and there appear to be organizations and people I respect on both sides) comes down to “(2) the responses of drug manufacturers”. Proposition 61 is aimed to ensure that drug manufacturers lower their prices, for certain purchases the state makes, to those supplied to the US Department of Veterans Affairs. The connection to mental illness and mental illness advocacy, here, is the fact that some people on Medi-Cal require psychiatric medications, and Medi-Cal programs that don’t involve managed care are covered by this proposition. And lower prices for the state could also mean lower co-pays for patients. Proponents argue that the proposition will lead to lower prices and an end to price gouging like the EpiPen price hike. But, since the proposition dictates what the state can do, not how drug companies will respond, lower prices aren’t the only possible consequence. Opponents of the measure argue that it could, instead, lead to higher prices for veterans (if drug companies decide to raise prices for the US Department of Veterans Affairs rather than lower prices for the state of California), or, alternatively, that pharmaceutical companies could simply refuse to sell some medications at the lower prices, thus forcing the state to restrict what drugs it covers. The end result, say opponents, could be to increase drug prices and reduce patient access to needed medicines.

Whose argument do you believe? You can follow the links I’ve supplied (or add your own sources), weigh the arguments, see who’s supporting each side, and make up your own mind.


Words Have Power

Words have power. They can hurt but they can also heal.

This is something I read and modified from the dbsalliance website. I also made a youtube video

People living with mental illnesses often experience symptoms like feeling hopeless, empty or worthless. You may want to say something to make the person feel better, but not know what to say. Are there comments you should avoid?

If your loved one is experiencing ongoing thoughts of suicide or is in immediate danger, contact a doctor, got to a hospital emergency room, or call the National Suicide Prevention Lifeline at
1-800-273-TALK (8255)

Remember to take care of yourself so you are able to be there for your loved one. Find support for yourself with understanding friends or relatives or in therapy of your own.

As a friend or family member of someone with a mental illness your support is an important part of working toward wellness. Don’t give up hope.

Treatment for mental illness does work, and people with mental illnesses can and do live productive and thriving lives.

What you say

Some things could be hurtful:

It’s all in your head

We all go through times like this
Look on the bright side
You have so much to live for
What do you want me to do? I can’t change your situation
Just snap out of it
You’ll be fine. Stop worrying

What could help:

I understand you have a real illness and that’s what causes these thoughts/feelings
I may not be able to understand exactly how you feel but I care about you and want to help
When you want to give up, tell yourself you will hold on for just one day, hour, minute-whatever you can manage
You are important to me. Your life is important to me.
Tell me what I can do now to help you
You might not believe it now, but the way you’re feeling will change.

When are remarks “remarkable”?

Not long ago I was listening to the Heidi and Frank show on the radio. They were doing a show on OCD. I don’t listen often and hoped maybe it would be okay. After all, it was mental health awareness month, at the time.

No. It was a comedy bit. I realize that is their job. but they were making fun of callers and people they know. Calling them “Freaks and “Weird”.

I rarely respond to those types of things but I contacted the radio station and NAMI. I didn’t expect to hear back from the station. NAMI told me they don’t deal much with that diagnosis and to contact an OCD foundation. I passed on the info and let it go.

Now I see this article:

Mike Huckabee and Schizophrenia; NAMI Calls for Apology Over Supreme Court Remarks on Iowa Radio Talk Show;-NAMI-Calls-for-Ap

I understand Mike Huckabee is a Presidential candidate. Is that what makes him a good example of stigma? He called a man with no mental illness (Supreme Court Justice Roberts) “schizophrenic”. I don’t think that compares with calling someone with a disorder “Freak”.

I do think he should be called on it, like others in the media. The choice  just seems arbitrary.

Unseen Contributor to Teen Mental Illness?

It has been bothering me for a few years now. The surge in young teens who seem absorbed in mental illness.

I first noticed it after I’d had my iphone for a while. Probably over a year after (I was 18 when I got it). I’d been diagnosed when i was 17, and was probably 19 when I noticed. I was on instagram when I got the random desire to see if there were posts about mental illness on there.

And what I saw horrified me.

Kids as young as 12 were posting horrible photos. Typically it was just the cliche depressed quotes over and over again. But there were also photos of other things… there was “thinspiration” where people would post skinny girls who were their “goal” look in terms of thinness. And then there was the pencil test to determine if you really are thin or not, so people posted pictures of those. And pictures of thigh gaps. But I can’t relate to eating disorders, never had one and don’t think I ever will. Then there were ones that flooded my search and were even triggering to me- self harm photos. They were everywhere. I was horrified.
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Caretaker Dominance in Mental Health Discussions

A few days ago, at the Orange County Mental Health Associations “Meeting of the Minds”, I attended a workshop on caretaker-patient-provider partnerships sponsored by our local NAMI. The material was very interesting and I sympathized with the panelists. Caretakers, they pointed out, can be a helpful part of the team that brings the patient to a place of recovery. They deserve to know what they can do to help the patient and this doesn’t mean that they have to know all the patient’s “dirty little secrets” as they characterized them.

But a few things struck me: First, at least a third of the panelists promulgated a “no fault” model of mental illness. This belief has been spread without challenge or acknowledgement of the studies that link the onset of mental illness to emotional abuse and bullying by NAMI. Though one speaker did allude to this, most of them adopted the model as applying in all circumstances, including their own. I can’t say for sure if they were telling the truth — I give them the benefit of the doubt — but I also know of plenty of abusive parents who use the shibboleth to hide their own history of family violence.
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Marya Hornbacher Again

A few weeks ago, I took a survey by Marya Hornbacher, author of Madness: A Bipolar Life, which probed my feelings about mental illness. She has written back with more questions. Here they are with my answers:

Do you consider mental illness a chronic physical disease? Please explain your response.

There’s no other explanation for it. I have tried willing myself into better moods or trying to stop my impulsiveness, but they were just too massive a problem for mere force of mind. It was like trying to prevent my cold from generating mucous or insisting that my pancreas produce more insulin. I tried, believe me, I tried to stop the tidal wave of emotions that consumed me but they kept rolling over me and I drowned. When I stopped seeing it as a character flaw and began treating it as a disease of my brain, I got on medications. While my nasty habits didn’t vanish overnight, the moods that drove them achieved a halcyon state in which I was not thwarted in my efforts to change. Just as my heart medications lowered my blood pressure, so, too, my mood stabilizers calmed me.

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