Advancing Mental Health Parity in Insurance Policies

Ensuring Fair Coverage: Advancing Mental Health Parity in Insurance Policies Jacob Wolmetz

Overview This capstone will examine policies that strive toward mental health parity in terms of insurance coverage in the United States. Reaching true mental health parity means insurance companies would have to treat physical and mental health equally, and cover mental health services as they would for physical conditions ( What is Mental Health Parity? ). This would allow many across the nation who currently lack coverage the ability to access the care that they need in order to live healthily. Under current policies and legislation, gaps in coverage remain which affects millions of people across the country. People often face hurdles in getting the mental health care that they need because their insurance does not cover the costs as fully as they do for physical conditions.

Relevanc e This issue is highly relevant because it addresses the need for the expanded treatment of mental health conditions on the national level. With the ongoing mental health crisis in the country, it s critical that we ensure that everyone is provided with the accessible care that they need. Millions of people currently suffer from mental health issues, but many still face barriers to receiving proper care. According to "The State of Mental Health in America", 10% of adults and 8.5% of youth still have private insurance that doesn't include mental health services. This lack of parity leaves a significant portion of the population without access to necessary treatments and comprehensive health coverage. It s imperative that the federal government acts swiftly to improve access to vital mental health services and treatments through policy.

Background The idea of parity means enforcing that insurers treat mental and physical health conditions the same. For many years, mental health care was viewed as less significant than physical care, reflected in that insurance companies rarely offered coverage for mental health services. At present, some insurance companies provide coverage for certain mental health conditions and/or services, but millions still suffer from a lack of treatment. A first step toward parity was taken by Congress in 1996 when it enacted the Mental Health Parity Act, which introduced the notion that there should be no disparities between the two forms of care ( Issue Brief: Parity ). However, the MHPA only applied to large group health plans, demonstrating that there was still a long way to go to secure parity for all Americans.

Federal Policies The Mental Health Parity and Addiction Equity Act or MHPAEA (2008) -prevents insurance companies from offering less favorable benefits for mental health conditions than they would for physical conditions ( Mental Health Parity and Addiction Equity Act (MHPAEA) ). -this currently falls short because there are numerous exceptions to the law including Medicare, Medicaid, individual and group health plans created before 3/23/2010, and plans that received an exemption because parity would increase costs ( What is Mental Health Parity? ). New Provisions in 2020, enacted within the Consolidated Appropriations Act -mandates that insurers conduct comparative analyses to prove that they abide by MHPAEA. Insurers and health plans are required to produce these analyses upon request by state regulators or US Department of Labor ( Mental Health Parity ).

Case Studies Parity varies widely on a state-by-state basis. While the enforcement of MHPAEA is not as strong in certain states, other states have additional policies and requirements for insurers to build upon and reinforce federal parity legislation. New York Timothy s Law requires that New York group health plans provide broad- based coverage for the diagnosis and treatment of mental disorders at least equal to the coverage provided for other health conditions , cover at least 30 days of inpatient care and 20 visits of outpatient care per year , alongside other policies ( Mental Health Policy Laws ). California Similarly, in 2020, California passed Senate Bill 855, which became one of the strongest parity laws in the nation (Wiener).

Nonpartisan Reasoning Mental health parity transcends partisan differences and party lines. Bills pertaining to the advancement of parity have been written and sponsored by both Democrats and Republicans, demonstrating bipartisan support for the issue. Mental health affects all people regardless of political affiliation. Increasing access to mental health services would benefit society as a whole as the strength of individuals and communities is bolstered with expanded mental health care ("Understanding Mental Health as a Public Health Issue ). Mental health parity would directly lead to these increases in the availability and accessibility of care. Further, if we enact stronger federal parity laws, it can prompt reduced crime rates as offering mental health services can sometimes lead to the prevention of violent and non-violent crimes (J come).

A Three-Pronged Recommendation

Increase Enforcement of the MHPAEA The MHPAEA requires that insurance plans offer mental health and substance use disorder services equally to physical health services. However, enforcement has been lacking, and many insurers don t fully comply with the law. Strengthening enforcement would include: Introducing stricter penalties for non-compliance with the law. These could include financial penalties as well as mandatory plans to fix the issue. Conducting regular, random audits to identify non-compliance. This would allow the government to catch insurers who aren t following parity law. Mandate that companies submit annual reports detailing their adherence to the law.

Strengthen Existing Parity Law Expanding parity laws to include a broader range of mental health services is crucial to ensure comprehensive care for individuals. Require that insurers clearly explain which mental health services are covered to make efforts toward transparency. By doing this, those being insured will understand exactly what their benefits include, and can hold insurers accountable if they face unfair denials or delays in getting care. Promote the coverage of newer therapies and treatments that are often excluded from current insurance plans. Address existing loopholes that allow insurers to impose unnecessary restrictions on mental health services.

Expand Coverage of Preventative Services Preventative mental health services are often under-covered by insurance plans. Steps to be taken include: Requiring insurance plans to cover mental health screenings and preventative services at no additional cost to the patient (Rapfogel). Eliminating copayments, deductibles, and other cost-sharing structures for preventive mental health services in order to encourage proactive care (Rapfogel). Creating national programs that provide incentives, including financial bonuses, to insurers that incorporate preventative mental health care into their plans.

Conclusion Recognizing the ongoing mental health crisis in this country, there is an evident need for the federal government to take more action to combat the issues that prevent individuals from getting help ( America s Mental Health Crisis ). One of the most prevalent barriers to care is cost, and insurers often do not provide coverage for mental health services as they do for physical conditions. Mental health parity must be pursued in order to ensure that everyone who needs help is able to obtain it. A three-part policy recommendation that could instrumentally increase parity includes: increasing enforcement of the MHPAEA, strengthening the existing parity laws, and expanding coverage of preventative services. These specific solutions would help mitigate the issue cost-effectively and comprehensively.

Reference s 2023/americas-mental-health-crisis. "America's Mental Health Crisis." Pew Trusts, www.pewtrusts.org/en/trend/archive/fall- "Issue Brief: Parity." Mental Health America, www.mhanational.org/issues/issue-brief-parity. J come, Elisa. "How better access to mental health care can reduce crime." Stanford Institute for Economic Policy Research, siepr.stanford.edu/publications/policy-brief/how-better-access- mental-health-care-can-reduce-crime. "Mental Health Parity." American Psychiatric Association, www.psychiatry.org/psychiatrists/advocacy/federal-affairs/health-insurance-coverage-access- to-care/mental-health-parity. "Mental Health Parity and Addiction Equity Act (MHPAEA)." Centers for Medicare and Medicaid Services, www.cms.gov/marketplace/about/oversight/other-insurance-protections/mental- health-parity-and-addiction-equity-act-mhpaea. "Mental Health Parity Laws." Office of the New York State Attorney General, ag.ny.gov/publications/mental-health-parity-laws.

References Continued Rapfogel, Nicole. "The Behavioral Health Care Affordability Problem." Center for American Progress, www.americanprogress.org/article/the-behavioral-health-care-affordability-problem/. "The State Of Mental Health In America." Mental Health America, mhanational.org/issues/state- mental-health-america. "Understanding Mental Health as a Public Health Issue." Tulane University School of Public Health and Tropical Medicine, publichealth.tulane.edu/blog/mental-health-public-health/. "What is Mental Health Parity?" National Alliance on Mental Illness, www.nami.org/your- journey/individuals-with-mental-illness/understanding-health-insurance/what-is-mental-health- parity/#:~:text=Mental%20health%20parity%20describes%20the,use%20disorders%20in%20insuranc e%20plans. Wiener, Jocelyn. "California mental health agency on the hot seat as lawmakers review 'groundbreaking' law." Cal Matters, calmatters.org/health/mental-health/2023/10/california-mental- health-parity- review/#:~:text=Beginning%20in%20January%202021%2C%20the,parity%20law%20passed%20in%20 2008.