Whether the treatment of mental illness in New Brunswick has improved or not, and what will happen in the next few years, remains a mystery. Health insurance agency’s coverage of mental illness and addiction services has been minimal in the past, compared to surgical and medical services. But for the past 20 years, the gap has narrowed because of the implementation of the Affordable Care Act or commonly known as Obamacare. Insurance plans that are open to small businesses and individuals have been made to accommodate people and small businesses that can’t afford it. Recent news confirms that insurance plans should offer equal coverage for all medical and behavioral services according to law.
It means that insurance should cover prescription drugs for medical, surgical and mental needs. For example, if an insured patient goes to the emergency room with a medical or psychiatric emergency, the insurance company is required to cover the patient’s expenses for both prescription drugs and their hospital stay.
Making the companies liable if they don’t comply with the law is the first step in ensuring that everyone will receive the care they needed whether it is a mental health care medical problem. Today we experienced the rise of the opioid epidemic and the rise in suicide rates due to depression. Having insurance is very important when getting treatment and services. The government should maintain the parity protection that is already in place. If the government removes these protections, it could harm the access of the people to quality treatment and services. If the marketplace plans revert to the level of coverage before mental health care rule takes effect, at least 20% of
programs will no longer cover mental health conditions.
(To know more about Obamacare or the Affordable Care Act, visit https://www.hhs.gov/healthcare/about-the-aca/index.html.)
We all know that most, if not all, insurance companies are less generous when it comes to mental illness compared to medical and surgical benefits. From an economic point of view, people who are seeking mental health care are more likely to use more services. Most insurance companies look for the least expensive patients, that’s why they are discouraging people mental health problems to seek weak mental health benefits.
To address this problem in incentive structure, the mental health community is fighting to pass a law that will require insurance companies to cover both behavioral and medical services equally. The first step was the Mental Health Parity Act of 1996. This law was a symbol of change in the mental health care field, despite its limited scope. In 2008, the Congress passed a stronger bill that will require parity when it comes to employer-sponsored insurance. In 2014m the ACA designated mental health as one of the ten essential health benefits and requires insurance companies to cover the two categories equally According to the Kaiser Family Foundation, Insurance companies only comprise 7% of the entire United States population. Employer-based insurance plan covers 49%, while a public insurance like Medicaid and Medicare covers more than a one-third.
According to new research, they compared 78 plans from 2014 and 60 programs from 2013, whether insurance companies abide by the provisions given by the ACA. Implementation is very complex, despite the passage of federal legislation. It is always important for us to know that the law should effectively translate into real change. Researchers gathered insurance plans across the country, some of it they found publicly available in the Internet, but others insurance plans are difficult to get, investigators have to reach out to the insurers and the states or submit an FOI Act request. Due to the difference, the study was not nationally representative. The researchers reviewed all the documents to determine the services that are explicitly included and excluded.
(Click here if you want to know more about the FOI request on ACA)
According to the study, plans covering mental health services rose from 80% to 100%, from 2013 to 2014. It suggests that on paper, psychiatric and medical benefits are included equally. According to researchers, the result is auspicious. How simple legislation like ACA can change how mental health benefits are perceived.
The problem is, merely complying with all the requirements does not mean that it will translate into better treatment or affordable care for mental health patients. The study is very important, and the result is very encouraging, but it is still not the full story when it comes to mental health and substance abuse treatment, and whether these patients are getting the right help or services.
Most insurance companies can eliminate all the restrictions, but they still make it very challenging for patients to access mental health and addiction care compared to patients who need medical attention. These companies use three critical tactics as leverage: limiting the in-network service providers in the region, requiring patient’s authorization before they can access the services, and reviewing the patient’s request of health care before they are approved.
People in the health insurance business are brilliant, and there are still ways and opportunities to practice the traditional methods of giving attention to mentally ill patients and people with addiction problems. Research shows that the parity laws produce a small increase in mental health and addiction service use, but not that broad that patients are hoping for. It goes to parity’s effect to lower service costs for patients. To move forward, the researchers should continue to check every loophole and find ways to eliminate them permanently.
(To know more about health care insurance restrictions, visit http://www.ncsl.org/research/health/health-insurance.aspx)
Parity to the insurance plan also has its benefits in helping to reduce the stigma. Equity will move mental health problems and addiction care from the bench into the mainstream of health care. Mental illness like depression sits alongside heart illness and diabetes as a chronic condition rather than being simple and separate, low-level diseases
Although the landscape for mental illness care is changing, the administration as slowly chipped away from legislation like ACA. For example, government agencies like the Justice Department refused to defend all the provisions in ACA, which can endanger every protection it entails for pre-existing mental conditions, much of it is chronic mental diseases. The Department of Health and Human Services are encouraging every insurance holder to work all requirements for Medicaid, which can threaten the coverage for patients with a severe mental illness.
The Administration is also proposing an expanded short-term insurance policy, that can limit or exclude mental health coverage. All of these changes can potentially roll back all the important gains that we have experienced so far.