Story URL: http://news.medill.northwestern.edu/chicago/news.aspx?id=99527
Story Retrieval Date: 5/21/2013 4:06:14 PM CST
What is the purpose of this law?
“It really has had a very simple premise all along,” said Dr. Michael Horowitz, president of the Chicago School of Professional Psychology. “[Its premise] is that mental health and mental illness needed to be treated by insurance plans on the same basis as physical health and physical illness and not discriminated against.” Often plans placed limitations on mental health visits that didn't apply to the treatment of physical ailments.
Who sponsored it?
In a bipartisan effort, the recently deceased Sen. Paul Wellstone (D-Minn.) and Sen. Pete Domenici (R-N.M.) first teamed up in 1996.
“I think [its sponsorship] speaks to the fact that it’s not a Republican or Democratic issue -- it’s a health issue of high import to all Americans,” Horowitz said.
What preceded it?
Since the passage of the Mental Health Parity Act of 1996, Dr. Terrence Koller of the Illinois Psychological Association has spent every spring lobbying against what he called its “loopholes and limitations.” The new law is an amendment to this act.
What limitations and loopholes does the new law fix?
A person is ensured equity if they are enrolled in a group health plan of 50 of more employees that provides both medical and surgical benefits and mental health or substance use disorder benefits.
Koller pointed out that the new law means that insurance plans can’t issue different deductibles, copayments, or limit frequency of treatment and days of coverage for mental health care as compared to treatment for physical ailments.
Building on the 1996 parity law, the new law requires parity coverage for annual and lifetime dollar limits.
What are some of the limitations that remain? Does the law leave anyone behind?
“It won’t, at the moment, touch the uninsured,” Horowitz said.
Tim Sheehan, associate director of mental health care at Lutheran Social Services in Chicago, said that while he thinks the new act is a step forward, it doesn’t have much impact for his clients who cannot hold jobs.
“Most of the folks we work with don’t have enough funds to get insurance,” he added.
Another limitation of the current law, according to the American Psychological Association Practice Organization, is that mental health or substance use benefit coverage is not mandated. Only those plans that offer such coverage must provide it at parity.
When does it take effect?
As implementation takes its “winding” path, as Horowitz described it, it is estimated that the act will take effect January 1, 2010.
What might it mean for Illinois residents?
Illinois has its own state parity act for serious mental illnesses that includes 11 diagnoses. The new federal act does not preempt the state law, but rather preserves it.
“If the state act is stronger than the federal act, the state act stays in place,” Koller explained.
Why is this act so important?
It could reduce the cost of overall health care, Horowitz said, citing studies that show the economic benefits of incorporating behavioral and psychological care into primary care treatment.
“We have estimates as high as 70 percent of primary care visits are in fact psychological or behavioral in nature,” he said. “This is just tremendous recognition of the need that’s out there and opens up access for a lot of people—I hope eventually for everybody.”