Roosevelt Institute | Cornell University

Weighty Issues: Equity for Eating Disorder Treatment?

By Angelica CulloPublished April 6, 2014

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While some claim eating disorders shouldn't receive the same medical attention as more tangible physical illnesses, eating disorder mortality rates are too high to be ignored. How can insurance and healthcare policy be modified to improve eating disorder treatment efficiency and outcomes?

By Angelica Cullo, 04/06/2014



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our daughter has an eating disorder and risks losing her life if she does not start treatment this month. What do you do to save your daughter's life if your insurance does not cover eating disorder treatment?  For some parents, saving their daughter's life means exhausting the entirety of their retirement savings.

With percentages as high as 20%, eating disorders have the highest mortality rate of any psychiatric illness. Since 1960, eating disorder prevalence has doubled, with the onset starting earlier and the disorders affecting more diverse ethnic and socioeconomic groups. With an estimated 11 million Americans suffering from eating disorders (although actual numbers may be higher according to the Eating Disorder Coalition) why are insurance coverage and funding for eating disorder treatment and research not changing proportionally to these statistics?

In 2008, the federal government enacted the Mental Health Parity Act (MHPA), which required coverage of mental and behavioral disorders that is equivalent to that of physical ailments like diabetes or a fractured bone. While many state governments currently uphold similar mental health parity laws, only a few require all health plans to cover anorexia or bulimia on the same basis as other mental health conditions. It should be noted, however, that this MHPA legislation does not require plans to cover mental health or substance abuse disorders; rather, if mental health conditions are covered by a given plan, this coverage must be equivalent to coverage for other physical health conditions.

As of 2014, mental health and substance abuse services must be included in the "essential benefits package" covered by all new health plans sold to individuals and small businesses under the Affordable Care Act. Many insurance companies currently cover inpatient, outpatient, or both, but few include residential programs. Each state and the District of Columbia falls into one of the categories: (1) "No policy" (States with no such laws or parity laws that don't include coverage of anorexia or Bulimia) - 23 states; (2) "Limited policy" (states that require eating disorder parity in limited way e.g., parity is only required for certain health plans, such as state employee etc.) - 18 states; and (3) "Meets policy" (states that require all health plans to cover anorexia and bulimia on same basis as other mental health conditions) - 10 states.

By covering inpatient eating disorder treatment but not providing residential options, many insurance companies send the message that people with eating disorders do not need psychiatric treatment to remain healthy. Patients deemed medically compromised just need physical stabilization and they can be on their way, right? This claim, however, is akin to cleaning up a spill but not fixing the leak; it is like treating an eating disorder patient for kidney failure or cardiac arrhythmia, but ignoring the causes of the eating disorder. Treating eating disorders only after they require acute care or hospitalizations usually necessitates expensive procedures that could have been averted. Furthermore, when a patient is medically treated and discharged for a medical complication such as kjdney failure, they may end up simply repeating the behaviors associated with their eating disorders because little to no therapy addressed the underlying issue that led to the kidney failure in the first place. Advocates and some doctors who treat eating disorders say that hospitalization, which insurers typically cover, might stabilize a patient and restore weight, but generally doesn't address underlying psychological issues that could provide long term remission and recovery outcomes. Outpatient treatment, which may also be covered, does provide counseling but not full time. But residential programs can serve as a happy medium between in- and out-patient programs.

When aggressive intervention is started early, full recovery is possible. One notable study by researchers at the University of California, Los Angeles, found that 76% of anorexic adolescents had fully recovered from the disorder within 10 to 15 years of their initial hospitalizations.

Changes in insurance coverage and healthcare policy can improve eating disorder treatment outcomes and reduce healthcare costs. Other states should enact mental health parity acts similar to California's, and should require private insurers under the Affordable Care Act to offer residential treatment coverage. At the end of the day, individuals who are diagnosed with eating disorders are in just as much danger of losing their lives as those who have cancer, so shouldn't healthcare coverage reflect this?