Mental Health Parity

As awareness grows relating to the mental health problems of those who served in Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), much of the focus has been on providing adequate and effective care to the newest population of combat veterans. Although efforts have significantly increased with the employment of Evidence Based Practices (EBP) and while the Department of Defense (DOD) and the Veterans Healthcare Administration (VHA), have updated their clinical practice guidelines, barriers remain and reaching the majority of this particular population remains a challenge.

The SMVTA Center works with states to bolster and support the behavioral health systems for active duty military service member, reservists, veterans and their families. They act as a liaison between agencies and the service members, specifically federal, state, territorial, tribe, local community, public, and private agencies. This organization monitors trends in behavioral health issues in relation to prevention, treatment and recovery support, and provides consultation, training and technical assistance to these agencies to provide the latest and best treatment

Mental health coverage has become a particularly notable topic in Indiana, made salient in the wake of the Scott County HIV outbreak related to needle sharing and the underlying issue of the unaddressed opioid crisis. (source, Source) An important response to the outbreak was Medicaid enrollment and treatment for both HIV and addiction (Source). Before the Affordable Care Act (ACA), many low-income adults could not afford health insurance that covered

In order to discuss the Affordable Care Act as it relates to mental health and addiction there needs to be an understanding of the historical development of mental health parity in the United States. There has been a long time struggle to make mental health comparable physical health in health benefits. In 1996 the Mental Health Parity Act (MHPA) was passed due to the crusade efforts of Paul Wellstone and Pete Domenici under the Presidency of Bill Clinton (Frank, Goldman, & McGuire, 2001). The Mental Health Parity act was designed to ensure that large employers that provided health plans did not use lower limits on lifetime dollar amount for mental health in comparison to physical health (Frank, Koyanagi, & McGuire, 1997). In order to continue to build on the MHPA the congress passed the

Escalating during the great recession and the drug epidemic, the rate of the uninsured and citizens with incomplete MH/SUD coverage escalated to cataclysmic proportions. Relatively, the economics of our nation were impacted by millions of American families affected by MH/SUD disorders that reduced their productivity and earnings potential. However, the fear that MH/SUD parity would further impact struggling businesses and increase the total costs of health care played a crucial role in delaying the passage of individual attempts at parity legislation. Naturally, amendments to a true mental health parity act were inspired by Republican opposition who were against government involvement in regulating health insurance.

The original purpose of the Affordable Care Act (ACA) was to address the rising amount of healthcare cost in the United States, and substantially increase the amount of Americans insured with access to affordable healthcare. The ACA allows for the expansion of Medicaid; the government health insurance program, which is designed to increase enrollees for low income families in Medicaid. With this new legislation people who are under the age of 65 who are at or below 133 percent of the poverty line will have access to Medicaid. Anyone who earns below 400 percent of the poverty line will qualify for subsidies for health insurance. (Cockburn, 7) Americans who earn above this level must either buy insurance, or use their employer’s coverage. This is a huge implication because the estimated of new enrollees in 2014 estimated by the Congressional Budget Office is between 16 and 17 million. The federal government has agreed to finance this expansion of Medicaid for the first three years of implementation, for states that agree to the program. After these three years the states will have to start to pay a small portion of Medicaid. Many people with substance abuse problems, and mental disorders without insurance, are low income earning childless adults. (Bainbridge, 5)Under the ACA these Americans now have access to behavioral health treatment, in the 26

Veterans are everywhere throughout the United States, but just because they are everywhere, doesn’t meant they are getting the proper care. According to the Iraq and Afghanistan veterans of America, “One in three veterans return home and suffer from some sort of mental health issue.” Their mental health issues vary from post traumatic stress disorder to anxiety and depression. The switch from fighting everyday to being home is tough for the veterans and they need to receive the proper treatment so they can possibly live a life as normal as possible. The state Department of Mental Health and Addiction Services, started a $810,000 program to support these veterans with their issues returning home. The transition is hard, not

I found a number of services that are currently available to Veterans that suffer from PTSD and their families such as counseling for individuals, groups, and families at all Va hospitals.

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) was enacted on October 3, 2008 as sections 511 and 512 of the Tax Extenders and Alternative Minimum Tax Relief Act of 2008. MHPAEA amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act (PHS Act), and the Internal Revenue Code of 1986 (Federal Register, 2013). The MHPAEA is an extension of the Mental Health Parity Act of 1996, which prohibited annual or aggregate lifetime financial limits on mental health coverage by addressing other restrictions, such as limits on outpatient visits or inpatient days (DOL, 2010). MHPAEA expands parity requirements to treatment limitations, financial requirements, and in- and out-of-network covered benefits (Smaldone, 2010). It also expands the opportunity of mental health parity requirements at the federal level and includes substance use disorders within its scope. Prior to 1996, health insurance coverage for mental illness had historically been less generous than that of other physical illness (Sarata, 2011). Mental health parity is a response to this disparity in insurance coverage, and generally refers to the concept that health insurance coverage for mental health services should be offered equally with covered medical and surgical benefits (Smaldone, 2010).

For many years, the VA has offered health care to the men and women who have surrendered a large part of their lives to protect our nation. The VA has made great stride in providing specialized services to veterans such as Traumatic Brain Injury (TBI), Military Sexual Trauma (MST), and Mental Health treatment. In fact, the VA is leading the field on Post-Traumatic Stress Disorder (PTSD) research, but now that many of our men and women are returning home from war, the commitment that the VA made to provide accessible health services and a smooth transition from military life back to civilian life to these heroes and their dependents are not being granted in a timely manner. Studies show that suicide among veterans is the number one leading cause of death in the United States and

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is an act that requires parity or equality between mental health treatment and medical/surgical treatment covered by private and public insurers with over 50 employees. That means that if an insurance covers mental health issues they can’t impose more stringent limits and financial requirements than medical/surgical coverage. The act was signed into law in 2008 by President George W. Bush. Before the act was signed into law, mental health care was not as affordable or accessible for individuals. (United States Department of Labor, 2016)

Regardless of where one stands, one must admit that the American economy is not thriving. Not only is it not thriving, but also the American economy has either been in depression or on the verge of depression for the last decade. Because of this, parity seems to be a dream. It is not the prime time to push for the ACA, perhaps during the 80’s or 90’s, but there were other political dilemmas that needed to be dealt with. Another factor to take into account is the reaction of the healthcare system once it truly has to cover for mental illness treatment. Because there is an immense amount of cost, around $131,000(Abelson), to

T. Stecker, J. Fortney, F. Hamilton, and I. Ajzen, 2007, address that mental health symptoms have the likelihood to increase within post deployment for military veterans, especially for the ones who have seen combat. An estimated quarter of recent war veterans who are currently receiving care in the Department of Veteran Affairs (VA) Health Care System have reported mental health problems. Soldiers who have served in Iraq come home suffering from depression, anxiety, and posttraumatic stress disorder (PTSD). The Statistics of Iraq soldiers meeting the criteria for depression, anxiety, and posttraumatic stress disorder (PTSD) is greater than the soldiers who served in Afghanistan. The mental health symptom rates for soldiers who served in Iraq were as high as 20% for PTSD, 18% for anxiety, and 15% for depression.

This should help lower all over cost. This introduces mental health parity. What is Mental Health Parity? The Substance Abuse and Mental Health Services Administration website explains that Mental health parity “describes the equal treatment of mental health conditions and substance use disorders in insurance plans…it means that if you are provided unlimited doctor visits for a chronic condition like diabetes then they must offer unlimited visits for a

Preceding the enactment of the Affordable Care Act and the Mental Health Parity and Addiction Equity Act, approximately forty-nine million individuals in the United States were uninsured. The Mental Health Parity and Addictions Equity Act (MHPAEA) does not command or require coverage for mental