Mental Health Parity Bill Passes
October 6, 2008 by Kristina Chew, PhD
Filed under Health
Included in the economic bailout bill signed by President Bush last Friday, October 3, was a new law requiring equal coverage of mental and physical illnesses. Go here to read H.R. 1424, SEC. 512. MENTAL HEALTH PARITY, Subtitle B–Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.
The October 5th New York Times quotes Dr. Steven E. Hyman, a former director of the National Institute of Mental Health, as saying that “it was impossible to justify insurance discrimination when an overwhelming body of scientific evidence showed that ‘mental illnesses represent real diseases of the brain.’” More specifically:
“Genetic mutations and unlucky combinations of normal genes contribute to the risk of autism and schizophrenia…..There is also strong evidence that people with schizophrenia have thinning of the gray matter in parts of the brain that permit us to control our thoughts and behavior.”
The new law will now make is easier for people to get treatment for conditions such as depression, autism, schizophrenia, eating disorders and alcohol and drug abuse. Employments and group health plans have set limits to hospital stays and to the number of outpatient visits for mental health treatments, and insurers have set higher co-payments and deductibles; under the new law, these will restrictions are eliminated.
As Regan noted, a “collateral benefit” to the passage of the bailout bill.
It is going to be fascinating to see how this plays out. I don’t want to be a complete cynic, but… what loopholes, what weasel-words are contained in the legislation that will allow the insurance companies to cover less than we expect/hope? Also, I’m eager to see how this interfaces with state autism-insurance legislation, and what it will mean for such legislative efforts in a state like mine (Wisconsin) where we haven’t gotten an autism-insurance requirement passed yet.
Do you know if the newly-signed version looks more like what the House passed in March (very broad) or what the Senate passed a year ago (quite a bit more limited)?
I hope Kristina has better luck than I’ve had trying to find the text of the final bill online; the only thing I’m sure about is that it doesn’t apply to businesses of fewer than 50 employees (so, it’s not going to benefit some folks).
I”ll be curious to see how this goes into effect through Medicaid, too. And WHEN.
Is autism considered a pre-existing condition and can a child be denied coverage because if it? I would hope not, but might this be a “loophole” that insurers will use to get around paying for therapies?
Alicia – I think I’ve found it. Try this:
Go to http://thomas.loc.gov/
Click on H.R. 1424
Click on “Printer Friendly Display” in the table, 4th cell from the left.
Search or scroll down to Sec. 512.
(Sorry not to give you a direct link, but Thomas likes to generate temporary links on the fly. Easiest to go in from the front page.)
Here is a direct link:
http://thomas.loc.gov/cgi-bin/query/F?c110:1:./temp/~c110abSqdk:e372570:
Or just go here.
Kristina — The reason I gave the long-way instruction for linking to the bill is that direct links (like the one you gave) are only temporary and expire in 30 minutes… sorry, should have explained that better up front.
Hope this works, I’m not real good with the HTML….
This should be a semi-permanent link, it’s from the Senate Banking Committe website. The mental health parity piece is in section 512, starting on page 310.
This doesn’t require businesses to cover mental health in the packages they buy, only changes what kind of coverage is obtainable if they do. Because of that, what I’m more concerned about is that employers, mine included, may drop the mental health rider when this goes into effect. Think about it. It’s going to cost them more to purchase that nice of a package, so either premiums have to go up for employees or businesses have to shell out more for it, probably both. The end result will be that it may be harder to get the insurance, but if you get it it’ll be better. I’m glad they’ve done it, but other problems could be around the corner.
What I’d really wish was allowed was to pick up extra riders from off the basic package work provided out of pocket. Maybe that’s allowed some places but not here that I’ve learned yet.
Regarding premiums going up, from the NY Times article:
It’s about time something was done. Now it can be fine tuned to be more inclusive and get rid of the loopholes. It is a disgrace that mental health is so poorly covered.
Thanks for the links, peeps!
@ Owl – I didn’t know that, and it poses a very interesting question: How many employers are going to continue offering mental health coverage in their group coverage packages?
Is two-tenths of one percent considered a lot in terms of increased premiums? (Really, I’m asking – I don’t know.)
From my reading and some syntheses from the news:
The law doesn’t require health insurers to cover mental health care. But if they do, they’ll have to treat psychological and addictive disorders just as they do other medical conditions.
Insurers will no longer be able to limit the number of visits or charge higher deductibles and co-payments for mental health and substance abuse services.
The law applies to health plans covering more than 50 employees.
While many states already have mental health parity laws, often these do not apply to employers that fund their own insurance plans, including many large companies. Employees of those firms will be protected under the new national legislation.
The law is projected to be effective for most health plans as of January 1, 2010.
According to “Health Insurance Mandates in the States, 2008″, excluding HMOs, PPOs or self-funded large group policies
Mandated mental Health-General in 39 states is 1-3% increase/policy
Mandated mental Health Parity in 47 states is 5-10% increase/policy
(with caveats on their calculations as noted in the text.) This is just to give a rough idea of what existing costs might already be.
Don’t quote me, but I am guessing that the Congressional Budget Office estimate is in addition to these pre-existing costs.
If there is someone of a more actuarial bent who has exact numbers or more accurate information on impact to policies, I cede to him/her.
This bill should have been able to stand on it’s own. It is a shame that this was attached to the bailout bill along with all of the other millions of dollars in “pork”. Both presidential candidates have sworn to stop this type of unethical ear marking and attaching unrelated bills to other primary legislation. Unfortunately, they both lacked the courage to stand up and say no.
I have gone through the text of the bill; I have not seen the word autism appear in it at all. I don’t know how that will play out, or perhaps I have missed the section on autism.
I don’t know why it was handled in such a devious fashion since it will not cost the taxpayers any money. The entire cost will be covered by the working people who have mental health benefits as part of their health insurance and are employed by a company with fifty or more employees.
I have not seen the word autism appear in it at all. I don’t know how that will play out, or perhaps I have missed the section on autism.
I looked too and didn’t see it–hence the question whether anyone knows the specific clause or conditions of the law that might be applicable.
I think at one point the bill would have covered all disorders listed in the DSM; that was scaled back in order to make it palatable for passage.
I agree, Another Voice. This bill should have been able to stand on its own. I believe lawmakers and mental health advocates have been trying to get it to do just that for about six years. It really says something about our country, government, the influence of health insurance companies, and the power of stigma itself that it took the passing of the bailout bill to make the passing of this mental health legislation finally happen.
While certainly important, the legislation fills, indeed, like an afterthought and buried away. But we’ll have to make it that’s not how it stays.
Hi,
It was the triumvirate of Dominici, Paulstone and Kennedy who shepherded this bill along for 12 years, along with many advocacy organizations. Dominici has a degenerative condition and is retiring, Paulstone died in 2002, and Kennedy is also in a rather grave medical situation. I believe that these gentlemen are glad of the bill’s passage, although not in the most ideal circumstances–that’s politics. If it gives the coverage intended, for me, that works.
A more politically minded friend wrote me this AM. Her interpretation is that if a state already mandates autism coverage under mental health, this law has positive effect by removing caps and extending coverage to the self-insured, under the conditions stated. If not, it’s probably no change.
Probably the most accurate and applicable interpretation will be from your state’s insurance division.