A six-year struggle by one Missouri state representative to require insurers to cover treatment for eating disorders has sparked a national conversation on how the industry deals with afflictions that are both physical and mental.
Rick Stream, a recently retired member of the Missouri House, began fighting in 2008 to change regulations regarding eating disorders to address all aspects of treatment. Currently, insurers in the state typically cover treatment only when an individual reaches 80% of his or her ideal body weight.
Critics of this practice argue that while that percentage is not helpful for anorexic patients, it is even worse for those with bulimia. Because bulimics practice binge eating, followed by “purging,” they can maintain a normal weight despite being unhealthy.
What’s more, patients struggling with eating disorders need treatment on two fronts—psychological therapy in addition to nutritional treatment.
“Losing weight is just a symptom,” Missouri resident Judy Clifford, mother to a daughter with an eating disorder, told Saint Louis Today. “The eating disorder is not about the food…a lot of it is hardwired into a person’s brain.”
Stream knows this well. His daughter, Katie, died in 1995 after a battle with bulimia that left her potassium levels so low, her heart stopped beating.
His proposed legislation, now being championed by state Sen. David Pearce, would require insurance companies to cover eating disorders according to guidelines from the American Psychological Association. That means covering visits with therapists, dietitians and psychiatrists.
The proposal would not be overly onerous to insurers. According to one actuarial analysis, such a requirement would increase premiums between 0.04 and 1.22%--roughly four cents to $1.22 for someone with a $100 monthly premium.
“In reality, it’s less expensive to follow these guidelines and provide comprehensive treatment than having people not receive treatment” and end up in a hospital,” said Dr. Heidi Strickler, a director with Castlewood Eating Disorder Treatment Centers in St. Louis.
Missourians and industry represntatives are uncomfortable with the “mandate” language, however, and argue that provisions in the Affordable Care Act—which leave state taxpayers liable for footing the bill on a mandated service deemed ‘nonessential’—could mean the bill will cost up to $87 million, a far cry from the $12,500 currently estimated.
“When we’ve got legislation we really don’t know the impact of, that can be a slippery slope, no matter how noble or important,” Rep. Don Gosen, who opposes the bill, told Saint Louis Today.
