Will Health Reform Provide Coverage For Eating Disorders?

Our guest blogger is Katrina Womble, an intern at the Center for American Progress.

Last week, February 26 to March 3, was National Eating Disorder Awareness Week. The National Institute of Mental Health defines an eating disorder as an “illness that causes serious disturbances to your everyday diet, such as eating extremely small amounts of food or severely overeating.” In the United States, up to 24 million people of all ages and genders suffer from an eating disorder, such as anorexia or bulimia.

Although eating disorders have the highest mortality rate of any mental illness, only 1 in 10 men and women with eating disorders receive treatment. This low incidence of treatment for eating disorders is often the result of inadequate protections in federal and state laws. The federal mental health parity law only requires health insurance plans that already offer mental health coverage to provide the same level of benefits for mental illnesses as for other physical illnesses and diseases. This law does not mandate that group plans must provide mental health coverage and the law also allows states to determine which mental illnesses will be covered.

While some state laws provide comprehensive coverage for all mental illnesses (such as Arkansas), some states limit the coverage to “serious mental illnesses” or a specific list of “biologically based” mental illnesses (like Iowa’s does). These categories have been used by states and insurance companies to restrict or exclude individuals, including those suffering from eating disorders, from receiving life-saving treatment.

Most states only offer coverage for those individuals who meet all of the criteria for a diagnosis of anorexia nervosa (excessive food restriction) or bulimia nervosa (binge eating followed by purging). Health insurance plans do not typically cover individuals who have been diagnosed with an ‘eating disorder not otherwise specified’ (EDNOS) even though this diagnosis is more common than anorexia or bulimia. This means that a female patient who meets all of the diagnostic criteria for anorexia except that she is still having her period could be diagnosed with EDNOS and would not receive coverage for her eating disorder.

There is also significant variation in private insurance coverage of eating disorders. For example, companies can refuse coverage if a person’s body mass index (BMI) is not “low enough.” While the Substance Abuse and Mental Health Administration (SAMHSA) has determined that a BMI of 17.5 is a “strict indicator” of anorexia, Magellan Behavioral Health Inc. requires an individual to have a BMI of 16 or below before they deem hospitalization to be medically necessary. Anthem Blue Cross has even stricter eligibility standards, requiring an individual to have a BMI of less than 15 to qualify for acute inpatient hospitalization. This means that a 5 foot 6 woman would be considered anorexic by SAMHSA if she weighed 108.5 pounds, but she would have to weigh a mere 99 pounds (Magellan) and 93 pounds (Anthem) to be eligible for treatment depending upon her health insurance provider. Alternatively, the Federal Employees Health Benefits Plan, one of the options that states could use to base their benchmark plan off of, allows doctors to determine when a patient is in need of medical treatment for their eating disorder.

The inclusion of mental health coverage in the Affordable Care Act’s (ACA) 10 essential health benefits (EHB) is an important step towards providing comprehensive health care coverage to all Americans. However, the HHS has issued proposed regulations that allow states to choose a benchmark plan from among the three largest small employer plans, the three largest state employee plans, the three largest Federal Employees Health Benefits Plans, or the largest HMO plan offered in a state. This means that states can adopt a benchmark plan based on a state employer plan that may exclude coverage for eating disorders.

These disparities in coverage for eating disorders across state laws and insurance plans emphasize the need for the federal government to adopt a national benchmark plan for EHB that includes comprehensive mental health. For CAP’s formal comments to HHS Secretary Sebelius on the proposed EHB regulations, click here.