Health Care Reform and Parity Law Are Game-Changers for the Mental Health Community, But it's a Wait-and-See Game

Adults with attention deficit hyperactivity disorder (ADD/ADHD), parents of ADD/ADHD children, and the larger mental health community have much to celebrate, but has health care gone far enough?

The health care reform legislation Barack Obama signed into law on Tuesday March 23, 2010 promises long-sought-after and far-reaching benefits for those with attention deficit hyperactivity disorder (ADD/ADHD) and other mental health conditions, members of the mental health community say.

Over time, the Patient Protection and Affordable Care Act of 2010 will extend health insurance coverage to 32 million uninsured Americans, allow young adults to remain on family insurance plans until age 26, and require that insurance companies no longer reject people with pre-existing medical problems such as ADD/ADHD, or deny coverage for any treatment related to the pre-existing condition.

It will also expand the reach of a 2008 parity law which requires that insurance companies impose no greater restriction, in terms of cost or limitation on access to treatment, for mental health conditions and substance abuse disorders than for all other medical/surgical procedures.

More than that, health care reform may be a harbinger of a not-so distant future where there is no stigma associated with being diagnosed with ADD/ADHD, bipolar disorder, depression, or any other mental health disorder.

"By bringing mental health into the physical health arena, it helps normalize mental illnesses," said Michael Fitzpatrick, executive director of the National Alliance on Mental Health Illness (NAMI). "We've said for years, mental illnesses are no different than all other illnesses. Both improve with effective treatment and care."

"You take the parity law, along with the health care reform, and it's a real game-changer for the mental health community," Fitzpatrick said, adding that many of the provisions in health care legislation are ones NAMI has been trying to get implemented for years.

Passed in 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act is a federal law requiring insurance companies and group health plans to level the playing field between the costs (such as co-pays and deductibles) and restrictions (such as frequency of treatment and number of visits) for mental illnesses and substance abuse disorder treatments with those of medical treatments. Out-of-network benefits for medical/surgical care must also be equitable to offer out-of-network coverage for mental health and addiction treatment. Prior to health care reform passage, parity laws did not apply to those on Medicaid or working for companies with 50 employees or fewer.

Will there be loopholes? "Sure, absolutely," said Fitzpatrick. He said that for the last 12 to 15 years as NAMI has tried to help pass state-level parity laws, he has watched as the insurance industry has grown "very adept" at finding ways to lessen access to mental health services, by "using 'medical necessity' language," to reduce the number of visits allowed, the number of treatments available, and access to treatment practitioners.

Another important piece of health care reform is funding dedicated to studying treatments for mental illnesses. "We hope this will generate new research and more effective treatments, as well as move new treatments into clinical practice, to get what current research has found to be the best practices into use in patients' daily lives…and eventually find a cure," Fitzpatrick said.

The 2010 health care law also allows for more mental illness-related training for health workers, which is a huge issue, Fitzpatrick said. He was hopeful that the funding will go toward helping provide nurses, physician's assistants, and other health care workers, especially in rural areas, with the most up-to-date information so they can better understand how to treat and diagnose mental health illnesses.

Fitzpatrick cautioned that health care reform and parity are complex pieces of legislation that will play out over a number of years. "We have a long way to go to watch this get implemented."

What's in it for You? A Summary of Health Care Reform Benefits:

· Young adults may remain on a family insurance plan until age 26. [Source: WhiteHouse.gov]

· Health insurance coverage will be extended to 32 million uninsured Americans. [Source: WhiteHouse.gov]

· Insurance companies may no longer reject people with pre-existing medical problems such as ADD/ADHD, or deny coverage for the pre-existing condition. [Source: WhiteHouse.gov]

· If employers of companies with 50 employees or less participate in state-run exchange plans, available in 2014, workers will receive equal mental health benefits guaranteed by parity. [Source: The New York Times]

· Basic benefit packages for all health plans in the individual and small group markets are required to cover mental health and substance use disorder services. [Source: Community Anti-Drug Coalitions of America (CADAC)]

· An increase in the number of people eligible for Medicaid; Medicaid is required to provide equal mental health benefits. Before only Medicaid-managed care plans provided that coverage. [Source: The New York Times]

· More training for workers in the mental health field. [Source: The New York Times]

· Funding for nongovernmental research centers to study treatments for mental illnesses. [Source: The New York Times]

· Grants will be given to school-based community health centers, which will be required to provide mental health and substance use disorder services. [Source: CADAC]

Are You Happy About Health Care Reform? Join the Conversation
ADDitude's scientific advisory board member Rachel G. Klein, Ph.D., said, "I support the bill strongly, [but I] am sorry that a government plan did not go through, so I think it doesn’t go far enough." On ADDitude's Facebook wall, Regina Harris had this to say, health care reform is "a step in the right direction, albeit [it's] not perfect; hopefully Congress will find a way to join forces, flush out the kinks, and get back to their job: working for the best interest of the people vs. their respective parties!"

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Learn More About Parity
The U.S. Department of Health and Human Services has set up a hotline to answer questions and listen to concerns about a health plan’s compliance with the law. To contact the department: call 1-877-267-2323 ext. 6-5511 or e-mail phig@cms.hhs.gov. Department of Labor benefits advisers are also available to field inquiries about the parity law -- they can be reached at 1-866-444-3272 or through this online form. Click here to read the parity fact sheet prepared by the U.S. Department of Health and Human Services.