Mental Health & Addiction Treatment Parity Is Smart – & Bipartisan
March 15, 2017 | Monica E. Oss
There have been many pieces of health care legislation over the past two decades that have shaped the U.S. health care system including, but certainly not limited to, the creation of Medicare Part D to provide prescription coverage for Medicare beneficiaries (see The Medicare Doughnut Hole – A Simple Concept With Complex Rules) and the more recent Patient Protection and Affordable Care Act (see PPACA Created A New U.S. Health & Human Service Map). I would also include the Mental Health Parity and Addiction Equity Act (MHPAEA) on that list (see Parity Is No ‘Magic Bullet’).
The push to provide consumers that have mental illnesses and addictive disorders with equal benefit coverage was an effort by advocates that lasted most of my professional career. It is a change in U.S. benefit policy that I believe was not only important for human rights, but fiscally smart as well. And, over the course of my career, I have written frequently about the topic: Report Finds That Parity Increases Total Health Care Costs By Less than 1% , Expert Panel Report: Current Parity Forecasting Models Overestimate Expected Costs Of Parity, Where Is Mental Health Reform In Congress?, Starting A New, Post-Parity Conversation About Stigma, Parity When All Things Aren’t Equal, and Costs of Parity Act Likely to Range From 0.9% to 3.7%: Parity Act Costs Dependent on Health Plan Structure.
I considered the final passage of parity legislation (however imperfect) and its broad application to be a step forward, with one of the results being the new-found focus on coordinated care management initiatives and the gradual end of silos in health care financing and service delivery (see The New Integrated Care Management Models – Winners & Losers and Going ‘Social’ – The Next Iteration Of ACOs). So, I was surprised to watch a recording of the exchange between U.S. Representative Joe Kennedy (D- Massachusetts) and a lawyer for Republicans on the House Energy and Commerce Committee — and to hear that the current proposal for health care reform would leave decisions on parity and essential health benefits up to the states. (To see the video, go to GOP Health-Care Bill Would Drop Addiction Treatment Mandate Covering 1.3 Million Americans).
Where we are with “reform” of our national health care policy and legislation is not clear. On March 6, 2017, two House committees — Ways and Means, and Energy and Commerce — released that current proposal, the American Health Care Act (AHCA), to “repeal and replace” the PPACA (see Congress Unveils American Health Care Act As Potential PPACA Replacement). As currently written, the AHCA eliminates the requirement that Medicaid alternative benefit plans cover the PPACA’s ten essential health benefits, one of which is mental health and addiction treatment. Recent reporting from the Washington Post notes that “nearly 1.3 million people receive treatment for mental health and substance abuse disorders under the Medicaid expansion” (see GOP Health-Care Bill Would Drop Addiction Treatment Mandate Covering 1.3 Million Americans).
Earlier this week, the Congressional Budget Office (CBO) released their cost report on the legislation and found while it would reduce federal spending by $337 billion by 2026, the plan would also result in 14 million consumers losing insurance next year — a number that rises to 24 million by 2026 (see Congressional Budget Office: American Health Care Act Cost Estimate). What that means for the AHCA’s future is not clear. But if it is passed, it could spell a big loss of essential coverage for all consumers with mental health and addiction issues.
We’ve had parity in behavioral health benefits under commercial plans for eight years and since then, the law has been expanded to include parity under health insurance marketplace plans and Medicaid managed care plans. I think this has been a positive development in terms of both health care cost and quality. And, whatever the path health care reform takes under the Trump Administration, I hope that we can make parity of coverage a bipartisan issue. It is good for consumers, good for the country, and it is the financially smart move.