In the summer of 2009, the debate over President Obama’s health care plan reached a fever pitch. Supporters argued that only major reforms, including a public option, could hope to solve the health care crisis. Opponents railed against every proposal, often using fear tactics to garner public support for their position. For a look at the Obama plan from a personal perspective, see “Understanding the Obama Health Care Plan: Beyond the Hype and Spin.”
What About Mental Health Care?
What has been largely lost in the raging debate, though, is the concept of mental health parity. A massive reform in mental health parity laws was attached to the 2008 financial bailout, and the Obama health care plan pledges to make even broader strides. But what exactly is mental health parity, and how does it affect your current care?
Mental Health Parity Explained
Simply speaking, mental health parity states that psychological conditions must be treated equivalently to physical illnesses. Many, if not most, private insurance companies today greatly limit mental health benefits. A common practice is to limit the insured to three or six therapist visits per year. Other insurance companies assign separate deductibles to mental health treatment, reimburse a smaller percentage of total treatment costs, or assign higher co-pays for mental health care. Some insurers simply do not cover mental illnesses at all.
Under true mental health parity laws, phobias and other psychological conditions would be treated exactly the same as broken arms or other physical ailments. Your out-of-pocket costs could not be higher, separate deductibles would not apply, and your right to treatment would not be limited.
Current Legislation
The Mental Health Parity and Addiction Equity Act of 2008 was a major victory for Obama (who was a Senator at the time) and supporters everywhere of fair mental health coverage. Attached to the federal bailout bill, the Act passed with very little fanfare. Indeed, it was barely discussed, overshadowed by the massive economic stimulus to which it was attached.
The Act, which will officially go into effect on January 1, 2010, requires group health plans that cover 50 or more employees and offer both medical and mental health benefits to ensure that the mental health and substance abuse benefits are no more restrictive than the medical and surgical benefits. That’s kind of a mouthful, so let’s break it down.
Group health plans that cover 50 or more employees -- Small employers, defined as those who employ at least two but no more than 50 employees are exempt.
Who offer both medical and mental health benefits -- There is no requirement under the Act for a group health plan to provide mental health or substance abuse benefits at all. If you are not receiving benefits, then the parity law does not apply.
No more restrictive than medical and surgical benefits -- If your health insurance plan offers mental health and substance abuse coverage, then it must be provided at an equivalent level to your medical and surgical benefits. Deductibles, co-pays, and all other out-of-pocket expenses must be equitable to what you pay for medical treatment. In addition, restrictions on number of visits, frequency of treatments, and all other services provided must be comparable.
There are also certain exemptions for which a particular health plan may qualify. If your insurer participates in the Act for six months, and then determines that the cost is too high, a cost exemption may be granted. Note that an exemption must be based on a report prepared by a certified actuary and approved by the appropriate state and federal authorities. Nonetheless, this is small comfort if it is your plan that is exempted from parity requirements.
Expansion of Mental Health Parity Under Obama Plan
Specific details of planned expansion of mental health parity laws under the new health care plan have been difficult to find. Details will depend in large part on which of the many versions of reform is ultimately passed. However, in August 2009, President Obama held a series of Town Hall meetings across the country to discuss health care reform. In numerous forums, he expressed an ongoing commitment to broadening mental health parity, stating that it remains a primary concern.
Obama’s stated opinions expressed during Town Hall meetings mirror the information presented on his website, http://www.barackobama.com, since the days leading up to the November 2008 election. It is his stated belief that failure to provide mental health parity is a form of discrimination against the mentally ill.
The Bottom Line
At this writing (late August 2009), mental health parity remains a core component of proposed health care reform. The Mental Health Parity and Addiction Equity Act of 2008, which goes into effect in January 2010, goes a long way toward resolving the long-standing inequality between the treatments of mental and physical disorders. Nonetheless, there is still a long way to go.
If the proposed health care reforms are passed, mental health parity, along with other features designed to provide affordable and reasonable health care for all, may become a reality. Nonetheless, the country remains sharply divided in its opinions of the proposed changes. I invite you to share your opinion on the proposed public option at Readers Respond: Opinions on Public Health Care Plan.
Do you currently have mental health care coverage? Will you benefit from the new mental health parity laws that take effect in January 2010? Use the link below to sound off at Readers Respond: Current State of My Mental Health Coverage.
Sources:
Obama ’08 Health Care FAQ. 2008. Retrieved August 22, 2009 from http://www.barackobama.com/pdf/Obama08_HealthcareFAQ.pdf
American Psychological Association: Summary of the Wellstone-Domenici Mental Health Parity and Addiction Equity Act of 2008. Retrieved August 22, 2009 from http://www.apapractice.org/apo/in_the_news/parity_summary.html
