Mental Health Parity Law Brought No Cut in Benefits
By Emily P. Walker, Washington Correspondent, MedPage Today
Published: December 02, 2011
WASHINGTON -- Most employers that offered mental health and substance use insurance coverage before the mental health parity law have continued to offer the same coverage, according to a new government report.
The report, from the Government Accountability Office (GAO), examined the extent to which employers provide mental health and substance use treatment to their employees and how that coverage has changed since the passage of the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act.
That law requires that if a group health plan covers treatment for mental illness or drug or alcohol abuse, the limits and financial requirements for those services can be "no more restrictive" than those that apply to medical and surgical benefits. The law does not require employers to provide mental health and substance use coverage.
Historically, private health insurance plans had provided lower levels of coverage for mental illnesses than for physical illnesses.
According to the GAO report, from 2007 to 2010, about 38% of Americans older than 12 who needed treatment for substance use disorders didn't receive it because of lack of coverage and prohibitive costs.
The GAO surveyed 168 employers with at least 50 employees about their most popular health plans for the year of the survey and what the most popular plan was in 2008, a year before the mental health parity law went into effect. The survey also examined what sort of benefits were excluded in 2008 and not excluded in 2010.
In addition, GAO interviewed employers on why they added, changed, or eliminated mental health and substance use coverage after the passage of the law.
In all, 96% of employers who responded to the survey said they offered mental health and substance use coverage in 2008 and still offered it in their most recent plan year (either 2010 or 2011).
Just 2% of respondents said they nixed the mental health and substance use coverage in order to cut down on the costs of providing insurance to employees.
Employers reported covering the same diagnoses in 2010 that they did in 2008. Most employers reported covering five broad diagnoses -- mental disorders due to a general medical condition, substance-related disorders, schizophrenia and other psychotic disorders, mood disorders, and anxiety disorders -- in both 2008 and in 2010.
The most common change employers reported in their mental health substance use benefits from 2008 to 2010 was enhancing those benefits by removing limitations, such as the number of office visits allowed. A number of experts interviewed for the GAO report said it was common for employers to remove treatment limitations and annual dollar limits after the passage of the law.
The report also found that beneficiaries in need of mental health services generally paid lower-out-of-pockets costs after the passage of the parity law.
Most employers surveyed by GAO said making changes required by the law wasn't difficult.
However, it wasn't clear whether the passage of the law has had a positive impact on improving access for those with mental illnesses and substance use issues.
The GAO reviewed 30 studies on the issue, and 17 of those found that coverage or enhanced coverage through the parity law had an effect on access to or use of mental health and substance use services, while 13 studies found there was little or no effect.
Five studies found that plans with comprehensive coverage were linked with greater use of mental health services. For instance, one large company reduced copayments and made an effort to destigmatize mental illness, which led to an 18% increase in the likelihood of enrollees initiating mental health treatment.
And studies are just as varied on whether the mental health parity law has so far improved mental health, the report noted.