Now that it looks like some form of health care reform will be passed this year — barring a catastrophe like Joe Lieberman — we have some idea of how the eventual act will affect mental health services. All of the plans now under consideration will mean some real improvements for mental health consumers, and there doesn’t seem much likelihood of these improvements being cut out before passage. However, it appears that individuals and employers will still have to purchase their insurance from private insurance companies, without competition from a strong public option like Medicare available for everyone. Nevertheless, the “reform” aspect of the bill would require private insurers to make some real changes in how they treat mental health issues.
Key Benefits
- Parity for mental health and substance abuse services. As it is now, when you see a mental health provider, your insurance company will probably pay him or her less for your visit than they would pay your GP or specialist for a similar service. They might require a higher copay from you for a mental health service than a GP visit. They might limit your total annual or lifetime benefits for mental health services. For instance, I have many chronic depression clients who need year-round supportive therapy, but their annual benefits run out in August or September. Most patients have to pay me a $30 or $40 copay from their own pockets, rather than the $10 or $15 that their GP charges.
With a reform bill, private insurers would have to end these practices. That will make it much more possible for patients to receive the care they need without added expense. It will also make it possible for patients who need medication to see a specialist, and not have to rely on the family doctor to prescribe medications he’s not really expert at. Eventually, it may lead to more practitioners entering mental health, a real benefit because credentialed providers are in short supply.
- No discrimination based on pre-existing conditions. The fact that insurers currently can, and do, refuse to insure you for pre-existing conditions is one of the major factors that keeps consumers tied to their jobs. It also forces them to contort themselves anxiously through COBRA plans and sensitive negotiations with their employers to stay on their old plan. And of course the old plan currently is still free to let you go, cap your benefits, or charge you a higher rate for those pre-existing conditions.
This doesn’t hurt only mental health consumers, of course, but also those with cancer, heart disease, diabetes, or any other chronic or recurring illness. The current policy thus causes a great deal of stress for many, many consumers, which hopefully will be greatly eased by the new legislation.
- No rate changes based on health status. With reform, insurers will no longer be able to raise your rates because you develop a chronic or expensive condition. All subscribers in the same age group will pay the same rate.
- Greater availability of insurance, at lower cost. Though the details haven’t been worked out yet, a major goal of all the bills is greater availability of individual insurance plans to people who can’t afford health care now. Many people with mental health disorders such as long-term depression are not able to sustain themselves in challenging or stressful jobs, resulting in poverty or underemployment. The current economic collapse and the fact that insurance rates keep rising more than twice as much as the general cost of living has put health insurance out of reach for many. Reform is meant to make insurance much more available.
- Expansion of Medicaid. Medicaid is the government-run health care plan available to the poor. It’s a program that works well, and though there are some problems they are nothing like the problems with private insurance. The bill would basically expand the definition of the poor to include more working-class, low-income families. The fact that so many households have parents working two or three part-time jobs, none of them providing private insurance, means that Medicaid expansion and the greater availability of low-cost private plans will take a tremendous worry off of working people’s backs.
These are all great steps forward, especially for everyone who sees a therapist or takes an antidepressant or other psychiatric medication—or needs to. However, the devil is always in the details.
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What Health Care Reform Means for Mental Health | World of Psychology | Health Blog (11/3/2009)
17 Comments to
“What Health Care Reform Means for Mental Health”
Regarding the first section on parity for mental health and substance abuse services — congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act in 2008 and it was signed into law. So, the good news is that regardless of where the current health reform debates take us, mental health parity will go into effect January 1, 2010. You can read more about the new mental health parity law and what it means for employee benefits at http://www.phwa.org/resources/goodcompany/newsletter/article/112.
Excellent article, so many practitioners in my area are doing more pro bono work than they can afford just because clients don’t have coverage. The proposed options aren’t perfect but what we have is just not working for many and we have to start somewhere.
Thanks for the important note, David — indeed you are correct that the parity law we’ve previously covered here on the blog will make the first concern hopefully go away for good come January 1!
“Frustrated but hopeful” You stated practioners in your area are doing more pro-bono work. I find that statement difficult to believe!! With today’s economy,.. noone works for free, especially Psychiatrists and Psychologists.
Although it is unfortunate that a public option is not available, forcing the hand of insurers to prevent various form of illness-based discrimination is at least a very important step to protecting people from the catastrophic effects of medical costs. As with all laws, however, someone will be looking at the loopholes to see how they can avoid paying claimants so only time will tell just how protected people are.
Finally, a post about health care reform, as the 1990 page legislation is about to be voted on by the House, if not this week than next. Did the author read this legislation proposal? Or did he just get the Cliff Notes version being forwarded by the Democrats who have passed the point of no return in trying to get this passed?
A little reality check, please. You think politicians are going to show deference and consideration to the mental health community, regardless of the 2008 parity act, that took an additional 1 plus year to get enacted? I have little to no regard for defenders and apologists for matters that are geared to benefit minority and self interest agendas, not public or majority causes.
If it sounds too good to be true, then, maybe it isn’t. I defy any commenter to come forth and honestly admit this individual not only read the whole bill, but could understand at least 70% of it. And yet that simple point gets swept under the table by said defenders and apologists.
And this said by a mental health care provider who would love to see mental health care be equally prioritized as any somatic matter. It won’t with the current system and alleged leaders running the show. Don’t believe me, just watch what happens when the results of ill conceived interventions ooze through our communities.
Sorry, not a choir comment.
I have not heard any language in any bill that actually explains and can prove how cost of healthcare for individuals and small businesses will go down and become more affordable. All I read and hear explain how rates will increase and create more of a struggle for small business owners. In addition, Medicare is bankrupt and the idea of government managing even a bigger portion of the healthcare system is laughable. We definitely need reform and more competition but government is not the answer. It seldom is. Open up the ability for companies to go across state lines. This would increase competition exponentially.
@hassfam4 – Few people can say they’ve read any large, important bill put forth by Congress in the past decade or two. That alone should not be a deciding factor in whether you support it or not.
The costs of untreated mental health concerns in society are high — the cost of loss productivity at work, the cost of broken marriages and bad parenting, the cost of people’s lives torn apart by lack of access to affordable care.
Medicine does not lend itself well to pure marketplace competition. As it is *your* life you’re talking about, you will always place a much higher price on it than anyone else. Because of this, costs are artificially inflated while we all focus on “Whatever it takes.”
The reform bills now being considered are a healthy step in the right direction. And while they don’t do a great job in addressing specific mental health services, they do indirectly with the parity act requirements kicking in next year.
While the parity act may seem like a welcome support (and in some ways it is), there is a downside: we are further drawn into the medical model and its description of our identity. And psychotherapy is not a medical endeavor; it is a relational one. And yet, the medical model is what is usually used to describe clients and what we do. Ironically, its assumptions and practices are not supported by the data. The parity bill promises further bondage to medical thinking and the DSM.
And don’t forget for a moment that payers will still set fees, and pay us as little as they want. They will have to cover the costs associated with equal access somehow and you know reducing profit margins is not going to be on the table for them. In the context of parity, negotiating sessions based on benefit, or a fixed number of sessions, in return for better rates and relative autonomy would be moot. Parity does not address the outcome of the service.
Those who understand polotics, knows, that this healthcare reform bill as it stands, will never see the light of day.
Suppressed Medical Records
St. Catharines, Ont.
– Privacy Commissioner of Canada (Sect. 25,26,28)
- C.M.H.A – Brock University
Parity won’t mean a thing for the high-deductible plans. In addition, the insurer can still narrow the newtork of mental health professionals to those who provide only short term therapy. (Happened to me.) And, I don’t think there is any requirement to provide the same copay for all visits, or to prevent them from being gatekeepers and approving/denying treatment, or even the very intrusive practice of requireming all treatment to be pre-authorized.
I guess I am skeptical that they won’t just find another way around providing quality mental health care benefits.
Here is a mental health trend that is disturbing: EAP offering only telephonic contact with a mental health professional. It used to be EAP would provide for 3 or 6 visits. My EAP told me that for face to face consultation, I would need to use my plan’s mental health benefits ($5000 deductible…)
Yet I feel that we are moving in the right direction in healthcare reform. It sure has people talking and that’s a good thing.
We certainly need healthcare reform, but not ObamaCare nor the plans being advanced in the House and Senate.
Q: Why is it not reasonable to require lawmakers to READ the legislation upon which they vote?
Q: Why do I need insurance at all if I can buy it at the same price after I get sick?
Q: Why does ObamaCare explicitly abolish my HSA? What could possibly be wrong with people saving and paying for their OWN medical care?
Q: Answer the question that White House Press Spokesman Gibbs has repeatedly dodged: Of the many socialized health care systems in the world, which one would you offer as a model of success after which we should base ours?
Q: Name ONE government run entitlement program that isn’t bankrupt or facing bankruptcy in the proximate future?
Q: Name ONE government run entitlement program that hasn’t cost =multiples= of what it was initially promised to cost? There is always excess demand for a free good or service.
Of the 47 million uninsured in the 2000 census, 10-12 million are in the United States illegally (when do they become the burden of the U.S. taxpayer?), another 20% earn over $75,000 a year and can afford to buy their own, and around 30% are under the age of 30 and =choose= not to buy health insurance. All of these groups would be covered under the proposed legislation.
Contrary to what Obama & Pelosi have said, the proposed health care bill WILL abolish most private coverage by mandating a time window within which employers must transition to an approved government-run plan.
Obama and the Democrat leadership has said that such government largess will be funded by taxing “the rich”. First of all, the top 10% of income earners already pay two-thirds of all income taxes; the bottom 40% of all American wage-earners pay $0.
Secondly, “the rich” includes all business owners whose operation GROSSES over $250K per year. This is basically a tax on ALL businesses, because for a business owner usually must gross that amount to earn a NET income of even $30K-$50K a year–hardly qualifying him or her as “rich”.
So, no, I don’t see great benefit to the mental health of Americans. I see a segments of the health industry awaiting a taxpayer-sponsored boom in their customer base.
If you think health care is expensive now, just wait till it’s free.
Regards,
Mark
All great questions from the last post. I have yet to hear a legitimate answer to any of those questions. Politics in general have become absurd. Each position putting a spin on things to the point that no one sounds reputable. And the legislation that they produce is filled with pet projects but no true benefit to the country as a whole. In fact it is usually a negative to the country. The free market, when left to work as it is designed to do, will do a far greater job in controlling costs. There is more greed and corruption in government then in the free market.
Actually, they are silly questions in the context of healthcare REFORM. Reform means change. Change means some things go away, and other things change. You can’t have reform without change, and if anyone voted for Obama thinking he wasn’t about change, then apparently they weren’t paying attention.
As for government being able to run things, it seems to be able to run Medicare fine. Seems to run our military fine. Seems to run social security benefits fine. Seems to run the treasury fine. There is zero evidence that private insurance companies will disappear because of this bill… Sure, a multi-trillion dollar industry will just disappear overnight. LOL!
The Republican’s alternative plan is not even a plan. It covers only 3 million more Americans than today, and continues to allow insurance companies to deny you coverage for a pre-existing condition. That’s not “reform,” that’s the status quo + a little bit to make it sound like something. It’s the most abysmal reply to legislation I’ve ever seen.
I mean, look at this quote, “Representative John A. Boehner of Ohio, the Republican leader, called it the “greatest threat to freedom that I have seen in the 19 years I’ve been in Washington.”” How does trying to cover more Americans with healthcare access a “threat to freedom?” Apparently Mr. Boehner has never been unemployed or without health insurance in his life. Too bad, because his voice is a radical fringe element that preys on Americans’ fears rather than discuss the facts of the bill.
The American Cancer Society, the AARP, and the AMA have all thrown their support behind this bill. There is unlikely to be a better compromise to help change American healthcare again in our lifetime.
http://www.nytimes.com/2009/11/06/health/policy/06health.html?_r=1&ref=health
Mark at 11:59 am on November 5th, 2009: “Obama and the Democrat leadership has said that such government largess will be funded by taxing “the rich”. First of all, the top 10% of income earners already pay two-thirds of all income taxes; the bottom 40% of all American wage-earners pay $0.”
Mark – if I’m not mistaken, I believe those statistics are based on Adjusted Gross Income. Lots of stuff deducted from income to calculate AGI.
The lowest of income earners may pay little to no federal income tax, but 100% of their income is subject to social security taxes (as opposed to someone who makes $10 million where only the first approximately $100k is subject to the tax), so the lowest earners pay social security tax, medicare tax, local and state income taxes, along with sales taxes. These taxes add up to a substantial proportion of their real income.
But you may already know this to be true. It’s really not as “unfair” as it seems.
John, PsyD said:
As for government being able to run things, it seems to be able to run Medicare fine. Seems to run our military fine. Seems to run social security benefits fine. Seems to run the treasury fine. There is zero evidence that private insurance companies will disappear because of this bill… Sure, a multi-trillion dollar industry will just disappear overnight. LOL!
What are you smoking. I want some so I can get that rose colored glasses look at the disaster our government bureaucracy has created.
Medicare is a mess. Ask any physician who serves Medicare patients. The MediCare bill is increasing astronomically. There is over 60 billion dollars wasted to outright fraud each year. This doesn’t even consider the fudged billings so physicians can cover their costs.
Social Security is a mess. It is a ponzi scheme that is running out of new suckers. I am in the SSA system and it stinks.
Our military is run as a “close enough for government work” organization. Ask any enlisted member of the military. The ‘kiss butts to get a promotion’ gets in the way of effective use of our tax dollars.
The Treasury is not even run by our government. It is ghost administered by the Federal Reserve for the benefit of the ultra-rich. Try to get a straight answer from the Treasury or Fed Reserve.
Take a look at the United States Postal Service. They can deliver a simple letter without asking for more money each year. They are statutorily protected from Fed Ex and UPS and still lose money.
Reid-Pelosi care will be a catastrophe. Eventually, we will run out of rich peoples’ money to tax away from them.
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Last reviewed: By John M. Grohol, Psy.D. on 3 Nov 2009
