Proposal bans lifetime cap on substance-abuse coverage

By Lynda Arakawa
Advertiser Capitol Bureau

Private health insurers would be prohibited from imposing a lifetime cap on substance-abuse treatment under a bill being considered by the House Health Committee.

Drug-treatment advocates and others yesterday supported House Bill 2103, which would repeal a provision in the law that allows health insurance companies to limit substance-abuse treatment to two episodes per lifetime. They said substance abuse tends to be a chronic disorder that can require ongoing treatment.

But the bill drew opposition from HMSA, the state's largest health insurer, and the Chamber of Commerce of Hawai'i, who said it was unnecessary.

The House Health Committee is scheduled to make a decision tomorrow.

State Health Department director Chiyome Fukino said in written testimony that covering two substance-abuse treatment episodes per lifetime is "inconsistent with the nature of addiction."

"From a clinical standpoint, it should be likened to hypertension or diabetes — conditions which require intervention if the client is to attain and maintain recovery," Fukino said, adding that restrictions shift costs to publicly financed programs.

Marion Poirier, chairwoman of the Equal Insurance Coalition, said the limitation keeps many people out of treatment so they can preserve benefits.

The Hawai'i Medical Association said there must be a balance in providing benefits. "They can't be unlimited and forever," the group's officials said. "Yet, they must be less restrictive than current law allows."

HMSA officials said such mandates are inflexible and raise healthcare costs for consumers. They said very few HMSA members require treatment beyond what is currently available.

"The small number of members that do reach their lifetime limit are able to appeal for additional services if needed," they said.

HMSA suggested that if the committee passes the bill, it should bring private coverage limits in line with the state's QUEST program, which offers two treatment episodes a year.

The Chamber of Commerce of Hawai'i also opposed the bill, pointing to a 1997 state auditor's report that concluded parity in coverage was not warranted for mental-health and substance-abuse services.

State insurance commissioner J.P. Schmidt said the state auditor is preparing another report on the topic and suggested the committee wait for it before acting.

Reach Lynda Arakawa at larakawa@honoluluadvertiser.com or 525-8070.