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Separate is not equal — mental health is core to health

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at December 8, 2016

For people living with a mental illness, factors like isolation, stigma, delayed care and inadequate community support can be barriers to living well.

Acknowledging that “there is more work to be done” to ensure that patients with mental illness and addiction do not face discrimination in their health care, a presidential task force made a series of recommendations including $9.3 million in funding to improve enforcement of the federal parity law.

The long-awaited report is the product of a task force President Barack Obama announced in March during a speech about the opioid epidemic.

“These disorders affect society in ways that go beyond the direct cost of care,” the report authors write. “Without effective treatment, people with these health conditions may find it difficult to find or maintain a job, may be less able to pursue education and training opportunities, may require more social support services, and are more likely to have their housing stability threatened.”

“These disorders affect society in ways that go beyond the direct cost of care.”

Since the passage of the Mental Health Parity and Addiction Equity Act in 2008, health insurers and employers have made progress toward improving coverage for mental health and substance abuse issues.

Most insurance plans, for example, no longer charge higher copays or separate deductibles for mental health care.

But there have been significant problems with the parity law, too, including lax enforcement and little guidance for the public about the law itself or how to file a complaint.

Over the past seven months, the task force received 1,161 public comments from patients, families, insurers, advocates, state regulators and others. Based on the findings, the group has taken several actions.

The Centers for Medicare & Medicaid Services is awarding $9.3 million to states to help enforce parity protections. California, New York, Massachusetts, Oregon and Rhode Island were cited as models of promising enforcement efforts.

A new government website will help consumers identify the right agency to assist with their parity complaints and appeals.

A newly released consumer guide will help patients, families and providers understand their rights and look into whether they have experienced a parity violation.

The Department of Labor will report each year on its investigations into parity violations.

In addition, the task force recommended that the government increase its capacity to audit health plans for parity compliance and allow the DOL to assess civil monetary penalties for violations.

Former congressman Patrick Kennedy, one of the authors of the parity law, said the report and actions were a step in the right direction. “However, much of what was released today still places the burden of real action squarely on the shoulders of the patients living with these conditions,” he said in a written statement. “[We] are asking these individuals to take up their own cases when they experience a parity violation, which usually occurs at the height of their crisis.”

The next administration, Kennedy added, will need to be vigilant in enforcing the parity law.

America’s Health Insurance Plans, the insurance industry’s main trade group, gave its support to the task force’s finding. “Health plans are committed to parity. We will continue to work hard to implement these changes,” AHIP said in a statement. “The report also recognizes the need for clearer, more consistent guidance on parity compliance for everyone.”

The American Psychiatric Association was also on board. “Adoption of the Task Force recommendations is essential to achievement of parity for patients with mental illness,” said Dr. Saul Levin, the CEO and medical director of the association. “APA trusts that Congress and the Administration will work together to ensure that the recommendations become reality.”

But even if the recommendations of the task force are successfully implemented, Benjamin Miller, director of the health policy center at the University of Colorado School of Medicine, said true parity will only come from erasing the lines between “mental” and “physical” health care.

Separate is not equal — mental health is core to health,” said Miller. “People do not see themselves as a disease or a select health benefit, but rather a person who has needs. Benefits and payments should follow the person, address their needs, and address the whole of their health.”

EDITOR’S NOTE: With the promised “repeal and replace” of the Affordable Care Act, we remain concerned about whether that only touches the funding mechanisms relating to health insurance, or whether the larger social policy issues encompassed with the 12 Essential Health Benefits, which includes mandatory care for mental illness and Substance Use Disorder will remain. We have no reason to believe they will be removed, particularly in light of the pending signature of President Obama of the 21st Century Cures Act and the U.S. Surgeon General’s recent report on “Facing Addiction in America.”  However, as stated above, President-elect Trump will have to determine whether parity is important enough for him to put his muscle behind it.

As always, thanks goes to PBS News and Kaiser Health Network for providing this important information.

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