Introduction
Mental health has been a controversial topic in the field of health insurance. This is why multiple organizations and individuals were interested in implementing a law that would require mental health conditions to be covered with insurance. Since there is no actual health without addressing mental health, including this subject in the conversation of insurance has always been crucial. There has been a significant gap in funding for individuals with conditions other than physical, which had to be filled in with specific policies and regulations.
MHPAEA (Mental Health Parity and Addiction Equity Act) is a federal law that obliges health insurance companies and health plans to have an equal view on mental health problems, substance abuse, and drug abuse. According to researchers, the new guidelines restrict limitations on psychotherapy prescribed by clinicians (Lazar et al., 2018). While this is not the only regulation that would touch upon the subject of mental health parity, the law was close to revolutionary in the field of health policies. However, there have been difficulties with the new regulation being genuinely beneficial for society as a whole. Nevertheless, mental health parity is a policy that is important not only for people who suffer from mental health issues but for the general population.
Problems
The implementation of the regulation was a necessary measure due to the catastrophic lack of attention towards mental conditions. Most health insurance providers focused on physical problems rather than creating an equal opportunity for each person regardless of the situation. This led to a disastrous void in the field of mental health assistance and medication, which subsequently had a negative impact on the health of the general population. The biggest problem that needed to be addressed is the stigma and lack of knowledge. Besides the overall negative connotation that most physiological issues suggest, insurance companies and employers realized that treatment of these conditions would be problematic and pricey. This is why health insurance was covering physical issues while avoiding any other health problems.
Researchers point out that the effects of mental conditions lead to a loss of several billion dollars every year for the US economy alone (Scarbrough, 2018). Moreover, while physical conditions are usually predictable when it comes to measures of control and time of recovery, physiological issues can be more unpredictable. This is why many insurance providers were skeptical about including psychology and psychiatric help within their agenda.
Areas
The areas that need to be explored in order to be able to adequately address mental health parity include the legislation behind the problem, the standard policies followed by insurance companies, and the human factor. In terms of legislation, several laws and acts have been implemented to include mental health problems under the list of conditions that have to be covered by insurance. Although the policies have been accepted, evidence shows that not all insurance companies are willing to make changes and address the mental health crisis in a fair manner. Insurance providers are interested in keeping the expenses as low as possible while still following the legal guidelines. The human factor suggests the broad spectrum of different physiological issues that individuals deal with. Every patient requires additional treatment, medications, and therapy, which is why it is hard for insurance companies to assess the costs for all these procedures beforehand.
Disciplines
While mental health is a subject that refers to the domain of medicine, the parity law brings social sciences into the discussion. The legality of including psychological health into the array of conditions covered by insurance providers takes into consideration the economic factor. The main issue for insurance companies is cutting down on expenses, and since mental health treatments are expensive, many individuals would choose to use the insurance when dealing with such issues. This being said, business and social sciences are the two disciplines that have to be explored in regards to mental health parity.
Federal and State Regulations. MHPA
Physical problems used to be the only issues that insurance would cover. However, the demand for more focus on mental health allowed policymakers to implement specific regulations that would imply a broader range of medical services. The changes started in 1996 when legislators agreed to add physiological problems as valid conditions that have to be covered by insurance (Karger & Stoesz, 2017). The central aspect of The Mental Health Parity Act (MHPA) was to implement the new policy for every employer that has at least 50 employees and offers health insurance.
The rule would oblige the insurance providers to treat mental health at the same level as physical health. This means that insurance would cover the cost of medical treatment for people who suffer from various mental conditions just as it would cover the expenses for physical issues. Moreover, group health plans that are used by multiple people cannot have limits that are lower than the limits imposed on physical treatments. This suggests that the insurance plans are not able to restrict someone from undergoing treatment only because the expenses become high compared to the money spent on surgeries and other medical benefits. MHPA’s key concern was implementing a regulation that would equate mental and physical health in terms of insurance coverage and overall importance.
MHPAEA
Several years after implementing The Mental Health Parity Act, legislators decided to improve the legislation and add a new aspect to benefit the general population. The new federal law, MHPAEA (The Mental Health Parity and Addiction Equity Act), imposes the policy of treating mental health or addiction to substances at the same level as physical problems. While MHPAEA is based on the initial MHPA law, the improvement allows people suffering from substance addiction to receive the same benefits. Insurance has to cover any addiction-related treatments and medications based on the general rules that are applied for physical health. The law still includes employers with a certain number of staff members (more than 50) who provide the workers with medical care. The implementations from the initial act remain preserved while the new federal law includes individuals suffering from drug abuse as beneficiaries of addiction-related medical care.
At the present moment, every state follows the law that implies mental health parity. However, the benefits, the conditions that are covered by insurance, and the level of care differ.
An example is Arkansas, which provides equal coverage for every mental illness. In other states such as Delaware, the law only applies to severe conditions and those that are biologically based. The same rule applies to substance abuse. In certain states, there is a covering of substance use disorder (Alaska, Colorado), while the other ones do not imply such care (Illinois, Iowa).
Impact
The implementation of the laws that deal with mental health parity has had many impacts on several different fields of the provision of services. While the intention was a positive one and the goal was to have equal opportunities for people who have insurance, there have been good and bad outcomes through the process of policy enactment. Mental health parity has been a subject of advocacy for multiple individuals who suffer from various conditions. It is essential to mention the human services workers who were also willing to advocate for more tools to allow the general population to have access to insurance-covered treatments that focused on health and considered physiological well-being a big part of that. Besides changes for insurance providers, the service industry and the economic domain have been going through specific reforms that directly correlate with the execution of MHPA and MHPEA.
Downsides
MHPA was initially designed to include mental health treatments under the umbrella of conditions and diseases covered by insurance. According to researchers, recent times and the Covid-19 pandemic have been described as a trigger for emotional responses for people diagnosed with mental health issues (Yao, Chen, & Xu, 2020). While the mental health parity act is supposed to help individuals in such situations, and case managers would often use this law to ensure effective treatment for patients, the downside did not allow the procedure to go further. Since only employers with more than 50 employees fall under the requirements for the mental health parity act, the situation with unemployment and loses of jobs made it impossible to service providers to attend to patients. The downside consists of the inability of people to access the benefits because they are not assigned a plan by their employer. It may be linked to unemployment or to the general rule that only big employers have to provide such bonuses.
Covid-19 has definitely become the current pinnacle of mental health problems that the parity act could not adequately address. However, there have been other negative impacts prior to this situation. It is essential to highlight that the legislation itself is a step in the right direction in terms of trying to manage mental health through policies. However, experience shows that insurance providers are not eager to increase spendings as long as there are ways to avoid providing services for individuals with physiological issues. It is a fact that insurance companies have been selecting individual cases and providing brief treatments instead of fully applying the legislation (Lazar et al., 2018). Insurance providers would typically allow treatment for atypical groups of the population while creating a significant gap in services for most individuals with mental problems. The help was usually directed towards patients with serious issues that were chronic or highly complex. Moreover, even such people did not receive the long-term or recurring treatment they would require to control their illness.
Positive Outcomes
While there were negative connotations linked to the new legislation related to the unwillingness of insurance providers to accept the new system, certain positive changes have been associated with MHPEA. Researchers point out that the new law of mental health parity has resulted in a slight increase in spendings and use of the new policies (Harwood et al., 2017). People are starting to see the benefits of receiving insurance-covered treatments. Case managers are also willing to use the new implementation on their assigned patients who work for employers who can cover mental health treatments with insurance plans.
Another impact that has been observed is the positive outcomes for people who are diagnosed with autism. Children enrolled in plans regarding mental health parity and were diagnosed with ASD (autism spectrum disorder) were able to benefit from the new policies. It has been highlighted that children with ASD have been benefiting from the program after the findings have shown that the use of the service has increased (Stuart et al., 2017). Service providers, such as case managers, have an obligation to assist such patients through specific service systems (Herzberg, 2015). Children with autisms are now often guided by the case managers in receiving benefits and treatment through the mental health parity law.
Impact on Development of Budgets
The implementation of MHPA and MHPAEA has been viewed as a threat in terms of expenses and resources required for insurance companies and specific segments of behavioral wellness. Firstly, assessing the actual cost or necessity of someone’s treatment was a challenge. Providing medication, therapy, rehab, or inpatient treatment would begin by spending resources on certain aspects of the assessment. The things to observe are deductibles, specific criteria for medical necessity and care management for both physical and mental health. This can be a burden in terms of the economic field of the institution in charge, which may subsequently have an impact on the development of budgets.
It is a known fact that mental health is often more expensive in terms of medical services compared to general care. While it is an economic burden for individuals who deal with psychological issues, insurance companies that cover their treatments would take the role of the buyer of such services. Subsequently, more individuals had access to mental help covered by third parties. However, insurance providers would have to focus their resources on a different field besides general medical help. This meant that insurance companies had to increase their budgets and keep up with the economic impact of the new legislation.
While, in theory, the budget would have to undergo substantial changes, recent years have shown the unwillingness of insurance providers to cover every necessary expense that mental health patients would benefit from. Instead of creating a fair monetary environment with resources for every beneficiary, service providers chose to minimize the spending by having a narrow array of conditions. The economic impact was minimized by covering expenses mainly for chronic illnesses. Even in that case, the patient was not able to receive every single benefit that was promised when the law was implemented. This allowed service providers to be more cost-effective yet less helpful for individuals suffering from mental conditions.
Impact on The Management of Staff/Volunteers
Case managers, human service workers, and volunteers found the implementation of MHPAEA to be a good solution for individuals with a history of mental disease. The parity act became one more tool that would allow the general public to benefit and receive help in regards to specific physiological problems. People who were included in plans that were aligned with insurance provided by some employers were starting to receive guidance from volunteers and case managers on how to adequately approach the problem from an economic perspective. Since mental health has always been notoriously expensive to attend to, volunteers and human service staff were able to focus on the provision of treatment itself rather than on meant to make the process possible.
Advocacy
Mental health has always been a subject that many advocates would fight for. While the parity act is a step in the right direction and is based on positive intends, there are still many issues with insurance policies and treating psychological problems in general. This gives advocacy a reason to continue researching the subject and propose new reforms to create an equal platform for all patients. The mental health parity act did not have a negative impact on the ability to engage in advocacy efforts but added a new topic for discussion, which will hopefully lead to positive changes within the system.
Addressing the Issue
The mental health parity act is designed to address inequality regarding insurance coverage of physical and mental illnesses. Friedman et al. point out that the historical differences between providing physical health compared to mental health are obvious (2016). While the reforms are beneficial in certain areas, such as easing access to treatment and lowering the expenses on mental health problems, certain regulations and policies must be implemented for further progress. Firstly, only employers with more than 50 workers have to promote insurance plans that cover mental health expenses. This leaves out a large number of people without necessary resources, and it needs to be looked into by policymakers. Secondly, insurance providers tend to minimize spendings while primarily attending to patients with severe or chronic illnesses. A more in-depth investigation would lead to a more maximized service platform that would be favorable for more individuals.
A more regulated insurance strategy and in-depth investigations are crucial when it comes to ensuring fair obedience to the law. Since insurance companies are interested in keeping the expenses as low as possible, preventing beneficiaries from receiving adequate treatment is the option they tend to use. However, this creates a gap between the treatment of physical and mental conditions, which contradicts both MHPA and MHPAEA. This means that certain institutions have to monitor the dynamic of general medicine and psychological care services in order for the statistics to show the actual overlap of spending. It would hold insurance providers accountable and benefit the general public that is eligible for insurance-covered mental health treatment.
Conclusion
The federal mental health parity laws and regulations have been enacted in every state with certain differences in the approach of the implementations. The issue of lack of insurance that would cover psychological issues affects not only the mental health community but also the welfare and traditional healthcare sectors. While MHPA and MHPAEA have been implemented and are designed to promote a fair share of expenses in terms of mental and physical insurance coverage, there have been both downsides and positive aspects in terms of the health of the general population, the medical fields, insurance policies, and the service sector in general. There have been improvements in terms of more accessible services and treatments, but further discussions, investigations, and regulations are needed in order for the strategy to be entirely beneficial. Overall, the mental health parity act is a favorable initiative that has potential in the future. While the policy itself proves to be promising, the delivery is yet to be maximized and upgraded until both patients and service providers are able to find common ground that would have positive outcomes for each party.
References
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Karger, H. J., & Stoesz, D. (2017). American social welfare policy a pluralist approach. NY: Pearson.
Lazar, S. G., Bendat, M., Gabbard, G., Levy, K., McWilliams, N., Plakun, E. M.,… Yeomans, F. (2018). Clinical necessity guidelines for psychotherapy, insurance medical necessity and utilization review protocols, and mental health parity. Journal of Psychiatric Practice, 24(3), 179-193. Web.
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Stuart, E. A., McGinty, E. E., Kalb, L., Huskamp, H. A., Busch, S. H., Gibson, T. B.,… Barry, C. L. (2017). Increased service use among children with autism spectrum disorder associated with mental health parity law. Health Affairs, 36(2), 337-345. Web.
Yao, H., Chen, J., & Xu, Y. (2020). Patients with mental health disorders in the Covid-19 epidemic. The Lancet Psychiatry, 7(4). Web.