Op-Ed – National Health Plan, Timothy O’Clair, Parity, and Medicaid

A fantastic Op-Ed in the Altamont Enterprise showing the need for a national health plan for those living with a mental illness:

We need a national health plan that continues to provide for people battling mental illness

Timothy O’Clair, whose family lives in Knox, died 16 years ago this week. He has not been forgotten.

Congressman Paul Tonko, a Democrat representing the Capital District, said in a speech to Congress last week that Timothy O’Clair was a special person in his life, inspiring him to fight for change.

“I met Timothy when he was a 12-year-old boy on the baseball field where he exuded his charm and spunk that made any who knew him love him,” said Tonko as he commented on the Republicans’ plan for revamping health care.

“Timothy struggled with mental illness and mental-health disorders. And his family struggled along with him, fighting with insurance companies to get the care he needed…Where we all saw an extraordinary little guy in a fight for his own life, the insurance companies saw expenses in a ledger book. They put caps on his care and denied coverage for needed mental health treatment.

“When Timothy received the care he needed, he thrived…Things got worse for Timothy. In order to get him the Medicaid coverage he needed, Timothy’s parents were forced to legally disown him…Even that wasn’t enough. At 12 years of age, Timothy completed suicide.”

If the current health-care bill were adopted, even that Draconian measure — of families relinquishing their children so they could be covered by Medicaid, as so many were forced to do — would not work. According to an analysis from health-care economists Sherry Glied of New York University and Richard Frank of Harvard, the Republican plan, if adopted, could end coverage for 1.3 million people with behavioral-health needs.

Medicaid, which has long provided insurance — a safety net — for poor Americans would be undermined. The House of Representatives’ bill does away with the mandate for substance-abuse and mental-health coverage.

Under the Affordable Care Act, known as Obamacare, mental-health services and addiction treatment were newly defined as “essential health benefits,” so that Medicaid and other insurers were required to cover them. At the same time, Obamacare offered states billions of dollars to expand Medicaid to people just over the poverty line. Not only were more patients helped but, with matching federal dollars as a prompt, states expanded behavioral-health services.

We’ve covered too many suicides and too many deaths from drug overdoses not to see the absolute necessity for mental-health coverage. In 2009, after a vibrant Guilderland 16-year-old killed herself, Melanie Puorto, who was the director of the Suicide Prevention Initiative for the state’s Office of Mental Health, told us that more than 90 percent of the youth who kill themselves suffer from a diagnosable and treatable mental illness at the time of their death.

How can we, as a nation, not provide help to people who would die without it?

After Timothy O’Clair’s death, his family worked to pass legislation in New York that would not discriminate against those with mental illness, so that they would get the same coverage as those with physical illnesses. Paul Tonko was a state assemblyman then and a sponsor of the bill.

Timothy’s Law became effective in 2007, with a two-year sunset clause to provide for a study on its cost effectiveness. In May 2009, the state’s Insurance Department released an actuarial study that said the law had considerably increased mental-health parity at a nominal cost to employers. The law became permanent later that year.

Although no price tag has yet been released for the Republicans health-care plan, it’s clear the proposal would change the financial underpinnings of the Medicaid program, shifting more costs to the states. Now, the financial support from the federal government is open-ended; the new plan is to have a capped system with federal money issued on a per-capita basis.

Costs to deal with new epidemics like the one with opioids would be borne by the states, which could set limits. In the past, substance-abuse treatments and mental-health services have been the first to be cut when states are pressed for funds.

In his speech, Tonko said that the gains made with the Affordable Care Act came too late for Timothy O’Clair. “Timothy lived at a time where our nation’s credo was: If you get sick, you’re on your own,” said Tonko. “In the richest nation on Earth, a country founded on the ideal that we are all born with the inalienable rights to life, liberty, and the pursuit of happiness, that’s not good enough. The plan we have before us today takes us right back to those dark times. It will allow big insurance companies to discriminate against people like Timothy who need mental-health care.

“It will provide less help to low- and middle-income families … in order to pay for a $195,000 annual tax break for the wealthiest one-tenth of 1 percent. Even by the rosiest estimates, this plan will rip health-care coverage away from millions of people,” said Tonko.

He ended his speech by envisioning Timothy O’Clair “looking down from heaven… watching us to make sure the next Little Leaguer who needs our help is taken care of and that we do right by our friends and neighbors who are counting on us….”

We believe the actuarial analysis that was performed in New York State, and was a prerequisite to having Timothy’s Law become permanent, would apply to the rest of the nation as well. The cost is nominal; the benefits are great.

We need to help those who are most vulnerable among us to strengthen our society as a whole. If those with mental illness — and, yes, they are illnesses not moral weaknesses — are helped to become healthy, we all benefit. Kids like Timothy O’Clair, with the proper medical treatment, can grow up to be contributing members of our society.

We admire and respect the O’Clair family for fighting for change, here in New York, in Timothy’s name. And we hope, on the national stage, his story was heard through Congressman Tonko’s carefully chosen words. We hope the message resonates from here to heaven.

— Melissa Hale-Spencer