Ten years ago, the Mental Health Parity and Addiction Equity Act was signed into law by President George W. Bush. It was a milestone — a major acknowledgment of the importance of mental health. It was also a challenge for the health care system and culture to rectify decades of fragmentation that kept mental health separate and distinct.
The law, known widely as the Federal Parity Law, requires most insurers to cover illnesses of the brain, such as depression or substance use disorders, no more restrictively than illnesses of the body, such as diabetes or cancer.
Sadly, the promise of the parity law has gone unfulfilled. Access to care remains elusive for millions of Americans while deaths from drug and alcohol misuse, as well as suicide, have skyrocketed.
In a just-published analysis, 32 states received a failing grade for their own parity statutes.
Strong state parity laws are one of the critical foundations for ending discrimination in the coverage of mental health and substance use disorder services. Without such laws, it’s basically a lottery as to what type of care a person might receive. There is little to no transparency regarding what health plans offer for medical and mental health benefits. Patients, providers, and policymakers are often unable to determine if a health plan complies with the parity law.
In the analysis of state parity statutes — jointly released by the Kennedy-Satcher Center for Mental Health Equity at the Morehouse School of Medicine, the Kennedy Forum, the Carter Center, and the Well Being Trust — just one state, Illinois, scored above a 79.
The Illinois parity statute, which scored 100, goes beyond federal parity protections by extending applicability to more plans and requiring plans to cover certain mental health and substance use disorder benefits. Combined, the Federal Parity Law and the Illinois statute apply to most health plans: large employer fully insured and self-insured plans, Medicaid, individual plans, state and local government plans, and federal government plans. The Illinois statute also has strong language to increase transparency and hold both insurers and regulators accountable, because any law is only as good as its enforcement.
Following the lead of Illinois, other states should take these steps to strengthen their parity statutes, setting a strong foundation for enforcement and improving access to treatment for mental illness and substance use disorder.
Proper recognition of conditions. Mental health conditions, such as substance use disorders, must be recognized as broadly as “physical” health conditions. As such, states should define mental health conditions to include all disorders in the Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases with no exclusions. This will ensure that the full range of mental health conditions is covered as comprehensively as physical conditions.
No extra restrictions. Benefit management processes and treatment limitations must be no more restrictive for mental health conditions than they are for physical conditions. State statutes should mirror the Federal Parity Act by requiring that out-of-pocket costs and treatment limitations (including limitations such as requirements for prior authorization) for mental health and substance use disorder services be equitable with all other types of medical services.
Better enforcement and compliance. States should strengthen enforcement and compliance activities by empowering regulatory agencies to enforce parity laws, including the Federal Parity Law. States should also require monitoring agencies to regularly report on steps they have taken to enforce compliance and mandate that all health benefit plans submit regular analyses demonstrating compliance with the law.
Updated oversight mechanisms. States must update oversight mechanisms through intensive compliance verifications and reviews of consumer complaints, as well as by requiring health plans to submit detailed compliance analyses and compelling plans to come into compliance.
More consumer advocacy. States should fund and hire consumer advocate officers and other experts who can help patients understand, file, and process parity claims and appeals.
Designate a lead. States should also designate a lead for parity with the commensurate resources to regulate and enforce parity laws.
Ten years into the Mental Health Parity and Addiction Equity Act, the promise of parity remains elusive for many people. Every day people are being denied care with few resources to advocate on their own behalf. It’s time to right a wrong — to see mental health for what it is: an essential and core component to health.
We cannot afford to sit idly by as another decade passes. People need comprehensive mental health coverage and care. Now.
Patrick J. Kennedy is the founder of The Kennedy Forum. He is also a former U.S. Representative (D-R.I.), a former member of the President’s Commission on Combating Drug Addiction and the Opioid Crisis, and author of “A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction” (Penguin Random House 2016). He recently launched the “Don’t Deny Me” campaign to empower families to stand up for their rights to mental health and substance use disorder treatment. Benjamin F. Miller, Psy.D., is the chief strategy officer at Well Being Trust. He previously worked at the Department of Family Medicine at the University of Colorado School of Medicine, where he was the founding director of the Eugene S. Farley Jr. Health Policy Center and is currently a senior adviser.