Originally published in Alcoholism & Drug Abuse Weekly
By Robert Weiner and Elizabeth Burke
Despite the ongoing opioid crisis, insurance companies are
skirting the Mental Health Parity and Addiction Equity Act (MHPAEA). Both the
Affordable Care Act of 2010 (ACA) and the MHPAEA require insurance companies to
provide parity for mental health and substance use disorders, but the insurance
companies are coming up with every possible excuse not to do it. The law
provides a strategy to take meaningful action -- but the health insurance
companies are, quite simply, blocking it.
Health care has been a constant issue in both the Republican and Democratic presidential debates. Chris Christie's strongest moment of his failed presidential campaign was his speech, which went viral on social media, about his personal connection to constituents with drug addiction. It was a shining moment regardless of what party anyone supports. In September 2015, Hillary Clinton proposed a $10 billion plan to provide substance use disorder treatment, as well as reversing the mass incarceration for nonviolent drug offenses that is overcrowding prisons. President Obama proposed a $1.1 billion plan toward treatment of prescription opioid abuse and heroin use.
Despite the existence of both the ACA and the MHPAEA, people still are not receiving the promised coverage. Private insurance exists, by definition, for profit. The companies maximize what people have to pay out of pocket. Their alternative is to remain untreated. Insurance companies have identified the loopholes in the MHPAEA and take advantage of their customers' lack of knowledge about the requirements, and a willingness to accept the insurance evaluation as trustworthy.
For instance, under the MHPAEA, insurance companies are supposed to provide coverage for what they believe is "medically necessary." This vague language allows insurance companies to be the decision-makers, rather than the actual doctor. In addition, insurance companies continue to deny coverage for their clients that clearly violate the MHPAEA. In one case, Chicago citizen Elizabeth A. Craft brought Health Care Service Corporation (HCSC, which includes Blue Cross and Blue Shield) to court for refusing to cover her 16-year-old daughter's medical expenses in 2014. Although HCSC covered her daughter's nine hospitalization visits caused by her post-traumatic stress disorder, major depressive disorder and anorexia nervosa, they denied the same coverage when they relocated her daughter to a residential treatment center. Insurance directly interfered with the treatment location that her physician recommended. The court forced HCSC to pay, because denying the location of treatment is a direct violation of parity laws.
Even covering simple medical treatment, such as prescription pills, is difficult. Insurance companies require "prior authorization" for controlled substances. This is a form of discrimination.
Insurance companies do not understand the immediacy and necessity in treating mental health and addiction.
Even with the confusion and lack of effective implementation of the Mental Health Parity and Addiction Equity Act, there is a solution, to strengthen and build the Affordable Care Act. Single payer, and the government option, would have been solutions. But Hillary Clinton has said that revisiting the law could create a horrific congressional debate that could jeopardize health care reform completely. A far easier approach would be for the Department of Health and Human Services to set regulations in place that force the insurance companies, who make enormous profits, to do their jobs.
Health insurance profits have soared with the 20 million new enrollees and the private-insurance structure compromise Obamacare employed versus the single payer and government option Congress rejected. Since March 2010, each of the six largest health insurance companies -- United, Health Net, Anthem, Aetna, Cigna and Humana -- have increased profits by 224 percent to 375 percent.
Instead of allowing insurance companies to force consumers to empty their wallets while at the same time restricting their care, we need to tighten up the federal regulations and enforcement of the two laws. Insurance coverage is possible. If we build up the ACA, more people can receive their basic rights to health insurance. The federal government needs to take a tip from states with the strongest parity laws.
(Article changed on April 11, 2016 at 08:15)