In Washington, the law’s longtime proponent, Republican Congressman Jim Ramstad, thought of the late Sen. Paul Wellstone and how the two had worked for this moment.
This landmark legislation was virtually dead in late September, mired in a stalemate between the House and Senate as the retiring Ramstad’s congressional career came to a close. Its surprise resurrection wasn’t pretty: It was linked to the Wall Street rescue plan to snag extra House votes. Still, its passage is a health policy milestone, one with a surprisingly broad range of supporters, from mental health advocates to influential national business organizations.
Many of those who suffer from mental health disorders or chemical addiction have long faced blatant discrimination when care was needed: higher copays, limits on doctor visits, caps on hospital stays or less coverage for out-of-network care. The new federal law reinforces or adds to existing state parity laws in Minnesota and more than 40 other states to ensure that these very real and devastating disorders will be covered on the same terms as medical and surgical conditions.
The new law’s impact on consumers will likely will be felt about a year from now as open enrollment occurs for 2010 coverage. It applies to group health plans and group health insurers. An important point: It doesn’t require them to provide mental health care. Instead, it kicks in only if they already do.
Federal health officials estimate that the law will provide additional mental health coverage for 113 million Americans. In Minnesota, mental health experts believe the law will ensure parity for about 50 percent of those with health insurance. These are mostly enrollees whose coverage is through self-insured businesses, which are not subject to state parity laws.
Supporters of the law have long had to overcome doubts about the costs of providing comparable coverage for mental illness and addiction. While the real-world impact remains to be seen, there are some reassuring cost estimates and provisions built into the legislation. The Congressional Budget Office has estimated that the law will increase premiums by 0.2 percent to 0.4 percent for group health plans. One study of the federal employees’ health plan, which has had parity since 2001, also found no significant cost increase.
One explanation: Treating mental illness early prevents more expensive care and hospitalization down the road. The legislation’s chief proponents are so confident it will not significantly drive up costs that they built in an opt-out clause for insurance plans if costs rise more than 2 percent in the first year and 1 percent annually thereafter. Among the law’s business supporters: the U.S. Chamber of Commerce, the National Retail Federation, Aetna and Blue Cross Blue Shield Association.
The new law’s costs and impact need to be monitored carefully. Worrisome side effects to watch for: reduction in the number of employers offering insurance or narrowing by insurers of the range of products they offer, a regrettable outcome often accompanying state regulation. At the same time, the new law is a bold and pioneering step — one that will help end the discrimination and stigma faced far too long by families grappling with mental illness.