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Some Health Insurance Providers Must Improve Mental Health Care

Wellstone mental health insurance

Beginning in 2010, health insurance coverage of mental health care and treatment of substance use disorders will improve for many working Americans. That’s when a new law goes into effect that will impact most employers who have more than 50 workers. The new law does not extend to private health insurance holders.

Officially known as the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, the new legislation was included in the economic bailout bill signed by President George Bush on October 3, 2008, and goes into effect on January 1, 2010. The law requires health insurance plans that offer mental health coverage to provide it on equal terms with the medical and surgical services that it covers. That means deductibles, co-pays, out-of-pocket expenses, visit and length of stay limitations, and co-insurance must be offered on the same level for mental health and substance use conditions.

Advocates of people with mental health conditions and addiction disorders had been fighting for about 12 years for an end to health insurance discrimination in these areas of health care. In a statement in the Nation’s Health, Georges C. Benjamin, MD, executive director of the American Public Health Association, said that the new law “will not only benefit the millions suffering from mental illness and addiction by making it easier for them to access care, but will also make great strides in reducing the stigma and discrimination they experience.”

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An estimated 26.2 percent of Americans ages 18 and older suffer from a diagnosable mental disorder in a given year, according to the National Institute of Mental Health. Mental disorders are the leading cause of disability in the United States for people ages 15 to 44, and many people suffer more than one mental disorder at a time. The majority of people who need mental health services do not get help, however, and part of the reason is that many health insurance plans discriminate against those with mental health or substance disorder issues, requiring higher co-payments and strict limits on benefits.

According to Mental Health America, the law should extend health insurance coverage for mental health issues to 113 million Americans. Exactly what those mental health issues are, however, is not spelled out in the legislation. This gives employers latitude in deciding which conditions will be covered in their plans, which can range from autism to eating disorders, depression, schizophrenia, drug addiction, and bipolar disorders. Not all companies are required to follow the new law, either. Companies that employ 50 or fewer workers are exempt, as are those whose health insurance costs rise by more than 2 percent in the first year or by 1 percent in succeeding years.

Once the new law is implemented, employers, employees, health insurance companies, and lawmakers alike will have an opportunity to see how it shakes out. Changes to the law may be necessary if it becomes clear that employers are refusing or significantly limiting coverage for mental health and substance disorders.

Mental Health America
National Institute of Mental Health
The Nation’s Health Feb. 11, 2009
Wall Street Journal, August 24, 2009