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.
- 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.