Opinion: Protecting patients central to physical, behavioral health reforms

By Michael Lott-Manier

For just a moment, forget the politics of health care reform they wont go anywhere, I promise. Picture a low-income family able to stay safe and whole, because a parent can afford to see a therapist for anger. Think about what it would be like if fewer people ended up in prison, and more of them in jobs, because they were able to get help for mental illness and addiction earlier in life.

Your friend was struggling to stay in treatment for depression, but kept falling out when her yearly allotted visits were through; now she can remain in therapy for as long as she needs, and youre not worried anymore about checking in with her every morning. Imagine a future where alcoholism takes fewer lives, where fewer mothers and fathers overdose in front of their kids; where suicide is no longer the second leading cause of death for Coloradans under the age of 35.

These days its impossible to dodge the back-and-forth political potshots over health care reform. To watch dueling cable news and opinion channels, or even worse, scan Twitter feeds, one could be forgiven for thinking that America is on the brink of splitting in two over the Affordable Care Act. All this hostility obscures the fact that at the core of these reforms are the health and health care of all Americans almost half of whom will experience a mental health condition in their lifetime.

Most of us working in health policy dont use the full acronym of the 2010 U.S. Patient Protection and Affordable Care Act,PPACA, and instead use the conveniently short and symmetrical ACA. It is vital to remind the public, however, about aspects of the law encompassed by those two words: patient protection.

More to the point, given recent announcements by insurance companies that they are canceling policies held by hundreds of thousands in Colorado alone, it is vital to understand how this landmark legislation protects all of us by extending and strengthening parity for mental health and substance use disorder services.

On Nov. 9, the U.S. Departments of Labor, Treasury, and Health & Human Services released final rules on mental health and substance use disorder parity, as required by the bipartisan U.S. Mental Health Parity and Addiction Equity Act of 2008. These long-awaited rules give comprehensive definitions of mental health and substance use disorder (collectively, behavioral health) benefits that most insurers must provide beginning in 2014, and must be a part of all new health plans sold in state and federal exchanges.

Originally, the parity act applied only to large group health plans. Health reform has expanded those protections to small group and individual plans. Starting next year, over 60 million American adults who are uninsured or whose previous health plans did not include behavioral health benefits will be able to afford professional counseling, psychiatric medications and substance abuse treatment many for the first time in their lives.

Whatever your opinions may be about the Affordable Care Act and mental health parity mandates, these policies affect your rights as a consumer and can protect you from discrimination and mistreatment by insurers.

Parity in the U.S. and Colorado

Though health insurance is unlike any other type of underwriting, it is still insurance. An insurer creates a specific product a health plan or policy and sells it to governments, companies and individuals. In order to minimize liability and maximize profits (or revenue, in the case of nonprofit insurers), insurance companies tend to be as restrictive as possible when it comes to the benefits they agree to include in their products.

In my last opinion piece for Solutions I described the deadly stigma associated with mental health. Insurers historically have been able to exclude mental health benefits from their plans because of the segregation of brain and body that this stigma fosters. That discrimination denying consumers equal coverage for physical and mental health conditions has spurred politicians from both parties and across the country to take action.

In 1996, mental health advocates won a major victory with the first Mental Health Parity Act, which required insurers who offered mental health coverage to be no less restrictive in annual payments for general treatment of mental health than they were for medical and surgical benefits. The following year, Colorado State Rep. Moe Keller, who is now Mental Health America of Colorados vice president of public policy, passed Colorados first state mental health parity law, which went further, requiring large group insurers in the state to offer treatment for six major types of mental health diagnoses.

Health insurance companies quickly found ways to work around federal and state laws passed in the 1990s. Some insurers who previously had covered mental health simply eliminated those categories of coverage to avoid parity regulations. Others, unwilling to turn away paying customers, used a variety of means to narrow their provider networks. By having fewer psychiatrists and counselors in-network, insurers paid less while shifting more of the cost to consumers.

In 2007 Keller, then a state senator, extended parity protections to include coverage for substance use disorders, eating disorders and post-traumatic stress disorders. By this time, the movement toward integrating physical and behavioral health to improve overall outcomes had gained traction in the world of care providers, strengthening the case for more comprehensive parity legislation.

The 2008 federal parity law, championed by a bipartisan alliance of the late Sen. Edward Kennedy, his son, former Congressman Patrick Kennedy, and former Sen. Pete Domenici, extended the protections of the 1996 parity act to substance use disorder treatment and required that insurers not impose stricter limitations on behavioral health benefits than they do on those for physical health. For example, insurers cannot charge a higher co-payment for a substance abuse counseling visit than for a comparable physical health visit or require pre-authorization for psychiatric medication when its not required for other types of medication.

The five years it took the federal government to issue final rules for the full implementation of the parity law shos how much this law will change access to behavioral health services. To put it very simply, starting in July of next year, a major barrier between millions of Americans and affordable behavioral health care will start to go away. Fulfilling the promise of parity will require careful monitoring of insurers, well-informed consumers and rigorous enforcement by state and federal insurance regulators.

Equal Coverage under the Law

Weve learned recently that health plans covering thousands of Coloradans are being discontinued by insurers because they do not meet Affordable Care Act requirements, including parity for behavioral health. The individuals and small businesses affected by these changes now have the opportunity to shop on Colorados health benefits exchange for new, affordable plans that can no longer discriminate against behavioral health conditions.

These changes have caused momentary turmoil for some, and have been the subject of political attacks by others. No reform on the scale of these laws will work perfectly at first and change can be hard, but it would be a grave disservice not to remember why people have struggled for these reforms for so many years.

We dont have to all agree on Obamacare to agree that treating your mental health your brain just like any other part of your body is the right thing to do. There is not a family in America that hasnt had to deal with the effects of a mental health condition or substance use disorder. The expansion of consumer protections to more Americans through the Affordable Care Act is not about government mandates or taking away individual liberties. Its about protecting all of us who buy insurance in order to access carenot just some of us. Parity, after all, is another word for equality.

Michael Lott-Manier is the public policy and advocacy specialist at Mental Health America of Colorado.

Opinions communicated in Solutions represent the view of individual authors, and may not reflect the position of the University of Colorado Denver or the University of Colorado system.