Advocates for Evidence-Based Health Policy Speakers
Shoulders, Knees, Toes…what about my Head?
In the wake of celebrity suicides by Kate Spade and Anthony Bourdain, mental health has again received national media attention. Although celebrity deaths raise awareness, many more average Americans silently battle with mental illness yet are too afraid to get help for fear of the associated stigma.
In 2008, Congress attempted to reduce this stigma and increase access to mental health treatment through passage of the Mental Health Parity and Addiction Equity Act (MHPAEA). MHPAEA required parity (i.e., equal coverage) for large group health plans and with adoption of the Affordable Care Act (ACA), this coverage requirement was expanded to individual and small group health plans in 2010. Under the ACA, behavioral health treatment (including mental illness and substance use disorders) was designated as an essential health benefit (EHB), which helped to ensure that all insurance plans sold on the insurance exchanges, small group, and individual markets covered behavioral health services.
A recent Health Affairs article examined the role of the ACA in bridging the gap for mental health parity since the MHPAEA. The study assessed the extent to which the ACA’s EHB requirements have affected the level of coverage for mental illness in comparison to physical illness. The results demonstrate that prior to the EHB program, 81% of in-network plans covered behavioral health services while 77% covered substance abuse services. After the implementation of the EHB program, 100% of in-network plans covered behavioral health services.
Obamacare’s opponents are often the same people who point to mental health reform in the wake of mass shootings, yet disregard the ACA provisions that increase access to mental health services, like the essential health benefits. The ACA has done a great deal to improve access to mental health services and its impact should not be denied.
Parity in itself is a complex issue to understand and although there are federal and state laws in place to regulate enforcement and compliance of parity, there is still considerable room for improvement. Under the Trump administration, ACA provisions remain continuously at risk especially the EHB provisions. As the issue of parity continues to be examined, it is important that the impact of the ACA and its role on increasing access to mental health services is considered before the ACA’s opponents try to “repeal and replace” yet again.
This Health Policy Journal Club review is a collaboration between Policy Prescriptions® and the Satcher Health Leadership Institute. It is written by Kiana Burgin. She is a student in the Masters in Public Health program at Morehouse School of Medicine.
Abstract
As of January 1, 2014, the Affordable Care Act designated mental health and substance use services as an essential health benefit in Marketplace plans and extended parity protections to the individual and small-group markets. We analyzed documents for seventy-eight individual and small-group plans in 2014 (after parity provisions took effect) and sixty comparison plans in 2013 (the year before parity provisions took effect) to understand the degree to which coverage for mental health and substance use care improved relative to medical/surgical benefits. The results suggest that plan issuers did what the provisions required them to do. Although in 2013 a lower proportion of plans covered mental health or substance use care, compared to medical/surgical care, in 2014 the proportions were the same. If essential health benefit requirements were to be removed and mental health and substance use coverage becomes similar to that in 2013, as many as 20 percent of the plans in our sample would not cover these conditions. To determine whether increases in behavioral health coverage will result in improved access to behavioral health services requires complementary data on the size of provider networks and use of services.
PMID: 29985686
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