Awaiting reconciliation with the Senate version of the bill.
The Legislation:
The Paul Wellstone Mental Health and Addiction Equity Act mandates that group health plans provide mental health and substance-related disorder benefits that are at least equivalent to benefits offered for medical and surgical procedures. The legislation renews and expands provisions of the Mental Health Parity Act of 1996. While that bill requires only financial equity for annual and lifetime mental health benefits, this legislation also compels parity in treatment limits and expands all equity provisions to addiction services. Thus, the bill not only requires that the deductibles, co-payments, and out-of-pocket expenses applied to mental health and addiction services be no more stringent than those applied to medical and surgical services, but also mandates that limitations on frequency of visits, number of visits, and days of coverage for mental health be no more restrictive than those applied to medical and surgical services. All mental health and addiction disorders that are listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders would be subject to the act’s parity requirement. Additionally, if a health care provider offers out-of-network benefits for medical and surgical procedures, the provider must also make such benefits available for mental health and addiction disorders. The equity requirement applies only to group plans that cover 50 or more employees and includes a single-year exemption for plans that experience a high spike in premiums after implementation. The act does not preempt state laws that provide stronger mental health and addiction benefits protections.
The bill also includes measures banning discrimination on the basis of genetic information by employers and insurers and provisions protecting the privacy of genetic data.
The Middle-Class Position:
The Middle Class Supports. While the Federal Employees Health Benefits Program has recognized the importance of providing equal coverage for mental health disorders and medical and surgical procedures since 1999, millions of middle-class Americans who are insured by other plans still struggle to afford mental health care services. Although approximately 26.2% of Americans older than 18 suffer from a diagnosable mental disorder and although mental disorders are the leading cause of disability in the United States for individuals ages 15-44, the General Accounting Office found that 87% of health care plans impose more severe restrictions on mental health benefits than they do on medical and surgical benefits. The Mental Health and Addiction Equity Act improves upon the financial parity requirements of the Mental Health Parity Act by preventing group insurers from inhibiting beneficiaries’ access to mental health services by restricting frequency and number of office visits and days of coverage. Such restrictions force individuals seeking mental health care to pay for expensive services out-of-pocket. The legislation not only does much to remedy the discriminatory practices of insurers, but will increase access to mental health care services for middle-class Americans already struggling with high health care costs. The Congressional Budget Office estimates that health insurance premiums will increase by only .4%. The Parity Act also helps to dispel the misguided notion that mental health care is less important than medical and surgical services.
From the Experts:
“Far too often, patients with mental illnesses such as depression, anxiety, or substance-use disorders are required to pay higher co-payments, allowed fewer doctor visits or days in the hospital, or forced to pay higher deductibles than those with other illnesses and injuries...Enactment of comprehensive mental health parity legislation will save lives, improve the nation’s health and well-being, and increase economic productivity. Research has shown that enactment of mental health parity results in no significant cost increase to health insurance plans or beneficiaries. In short, the costs of not passing parity legislation are too high to ignore." –Carolyn Robinowitz, M.D., President of the American Psychiatric Association (March 5, 2008)
“There is simply no basis for discriminatory insurance practices that set arbitrary limits and inequitable cost-sharing burdens on Americans who need mental health treatment…Mental health disorders are every bit as debilitating, and just as treatable, as cancer and diabetes. It’s high time that we recognize this by passing strong federal parity legislation.” –David L. Shern, Ph.D., President and CEO of Mental Health America (March 5, 2008)
Beyond this Bill:
After the passage of the Mental Health Parity Act, the General Accounting Office found that virtually no employers had dropped mental health benefits or health coverage altogether. The Mental Health and Addiction Equity Act will likely have similarly negligible effects on total coverage. Yet, insurance companies will inevitably continue to devise plans that limit mental health benefits, just as they did after the 1996 parity act. Congress must remain vigilant for such disingenuous and discriminatory practices to ensure that mental health services remain accessible and free from stigma.
Percent of Americans ages 18 and older who suffer from a diagnosable mental disorder in a given year: 26.2
Percentage of people who commit suicide who have a diagnosable mental disorder: 90
Percentage by which the cost-sharing for addiction benefits exceeded that for medical or surgical benefits, according to a 2007 Health Affairs study of employer-provided benefits: 46%
Out-of-pocket savings per user of mental health and substance-abuse services in the best of seven plans studies by the New England Journal of Medicine before and after the implementation of parity in the Federal Employees Health Benefits Program: $87.06
Percentage of insurance plans that contained at least one plan feature that was more restrictive for mental health benefits than for medical and surgical benefits two years after the implementation of the Mental Health Parity Act: 87
Date on which President Bush announced that “health plans should not be allowed to apply unfair treatment limitations or financial requirements on mental health benefits”: April 29, 2002
Approximate success rate for the treatment of depression, according to the National Institute of Mental Health: 80
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