By Kelsey Berry
One of my previous blogs discussed how potentially discriminatory practices in insurance design may continue to dissuade people with high-cost conditions from enrolling in insurance plans, even in a post-ACA world. Last week, colleagues Haiden A. Huskamp, Howard H. Goldman, Colleen L. Barry and I published new findings in Psychiatric Services on the same issue, except with a focus on an area that has historically been subject to considerable regulation: mental health benefits.
The Affordable Care Act shows considerable promise for extending mental health benefits with federal parity protections to several million Americans, which has been a main aim of mental health policy advocates for decades. However, insurers may still have an incentive on health insurance exchanges to avoid enrolling individuals who use mental health services because their care is more costly than average. In the study, we examined benefits information available to consumers shopping on state health insurance exchanges to assess whether the new insurance offerings were living up to the promise of mental health parity laws. We found that some plans may still be offering people with mental illness insurance benefits that are less generous than benefits for other medical conditions. Specifically, one-quarter of the health plans being sold on health insurance exchanges set up in two states through the ACA offer benefits that appear to violate the federal parity law requiring equal benefits for general medical and mental health care. Such benefit designs may dissuade people with mental health and substance abuse treatment needs from enrolling in the plans, furthering concerns about adverse selection and suggesting that some discriminatory practices persist despite efforts to equalize insurance offerings for individuals with behavioral health conditions.
Most of the compliance problems we observed related to the use of prior authorization for behavioral health but not general medical visits, which could add lengthy delays to the process of obtaining behavioral health treatment. Other apparent discrepancies with the parity law included differences in the financial requirements like cost-sharing required for behavioral health versus medical visits. We saw different types of compliance problems across the two states, which suggests that inconsistencies with parity law may manifest in patterns that vary from state to state.
Psychiatric Services has generously made the column available for free here. Our findings suggest that a more comprehensive study is warranted to see if this is a systematic problem beyond the two states we examined. To the extent it is, steps need to be taken where there are apparent violations of the law. In addition, we ought to consider carefully what discriminatory practices in insurance design may look like post-ACA and post-mental health parity, in order to be sure that our standards for fair treatment of people with costly health conditions are being met.