How well has it Fared?
On October 3rd, 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 was signed into law. The new Federal law meant that large group health plans and Medicaid managed-care plans that already offer coverage for mental illness and substance use disorders to provide those benefits in no more restrictive way than all other medical and surgical procedures covered by the plan.
The Mental Health Parity and Addiction Equity Act does not require group health plans to cover mental health and substance use disorder benefits but, when plans do cover these benefits, the benefits must be covered at levels that are no lower and with treatment limitations that are no more restrictive than would be the case for the other medical and surgical benefits offered by the plan.
The significance of this law was so the practice of unequal health treatment would be eliminated. Prior to this, individuals with untreated substance use and mental health disorders were often unable to get critically important treatment services. Providing parity provides insurance coverage for substance use and mental health disorders equally to other chronic health conditions like diabetes, asthma, and hypertension.
Yet, some 15 years later, according to a new Health Care Cost Institute (HCCI) report, consumers are still paying more out-of-pocket for substance use admissions than for other types of hospital admissions. This report is one of the first of its kind to look at hospital spending, utilization, prices, and out-of-pocket payments for mental health and substance use admissions for those younger than age 65 with employer-sponsored health insurance.
The Parity Act enhanced the 1996 Mental Health Parity Act by extending parity to substance use treatment. Under the Parity Act, large group health plans were required to make behavioral health coverage rules similar to medical/surgical benefit rules. Large group plans were also required to make copays, deductibles, coinsurance, and out-of-pocket maximums for behavioral health care equivalent with the most common medical/surgical treatments.
The HCCI found substance use admissions grew by 19.5 percent in 2011 for people younger than age 65 and covered by employer sponsored health insurance. By comparison, between 2010 and 2011, mental health admissions grew by 5.9 percent and medical/surgical admissions declined by 2.3 percent for this population.
In 2011, out-of-pocket payments for mental health admissions more closely aligned with payments for medical/surgical admissions. However, the amount spent out-of-pocket on substance use admissions remained higher than payments for medical/surgical admissions. Out-of-pocket payments for substance use hospital admissions grew at twice the rate of out-of-pocket payments for mental health or medical/surgical admissions between 2010 and 2011.
The report “The Impact of the Mental Health Parity and Addiction Equity Act on Inpatient Admissions” reflects the national health care spending of more than 40 million people younger than 65 and covered by employer-sponsored insurance between 2007 and 2011. The report is focused on hospital care and looks at facility fees; it does not include payments to medical personnel. The data were contributed by a set of large health insurers who collectively represent almost 40 percent of the US private health insurance market.
