In 2008, when comprehensive healthcare reform was only a theory in Democratic presidential primary debates, one bit of changes occurred. That year, Congress passed a bill that requires health insurance companies to treat physical and mental illness equally. This law was mostly spearheaded by Democrats, though mental health parity is nowhere near as much of a controversial issue as general healthcare reform has turned out to be.
Specifically, the law prevents discrimination against mental health and substance abuse patients by insurers. They can no longer be charged higher deductibles or co-payments of medications or hospitalizations than would be charged if they had a physical illness. For example, the insurer can no longer limit the number of reimbursed days a patient can remain in a hospital or in-patient treatment beyond the standard limit they have for other types of care. Nor can they limit the number of outpatient visits to a psychiatrist.
The health care industry has supported the law, and insurance companies support its intent. However, formal guidelines for enforcing the law were only released recently. Some fear that the Obama administration’s rules go too far.
While they agree with the goal of ending discrimination towards mental health care, insurers feel that the federal government regulating so-called “non-qualitative treatment limits” is an overstepping of its boundaries. Major health insurance plans believe that the intent of the bill is not to equalize provider reimbursement of services. As a result, interfering in how they manage care will have a negative impact, especially since the rules are so vague that they could potentially apply to any method used to manage benefits.
On the other hand, mental health advocates believe that doing so is necessary because of historically low reimbursement rates. Their view is that if insurers don’t pay competitive rates, they will attract few mental health services to their networks. Patients will therefore be forced to either travel long distances to receive services, go out-of-network for more expensive treatment, or forgo treatment altogether due to cost. In effect, that puts more of a burden on those with mental illness than people with physical illness–therefore violating the spirit of the law.
Another aspect of the rules disliked by Aetna, Blue Cross Blue Shield, and other large health insurance companies is the provision that mandates them to charge one combined deductible, as opposed to separate deductibles for medical and mental health. They predict that the requirement will actually make mental health care more expensive, but Obama believes that it is necessary to avoid inappropriate distinctions.