How efforts to curb gun violence will increase health care costs and insurance premiums

Some of us who have been on this planet for a few decades (ok, not so few) have come to realize that there is a great connection between just about everything. Shortly we will come to realize that the latest initiative to control gun violence will have a direct impact on health insurance premiums. This is not a criticism, merely a statement of fact. Treatment of mental health problems is coming to the forefront as part of the gun violence initiative and one aspect that is agreed to by all parties.

Under the Mental Health Parity and Addiction Equity Act (MHPAEA) enacted several year ago, treatment for mental illness must be covered under health insurance the same as medical conditions. This means no separate deductibles, no special co-pays, no limit on in or outpatient treatment and no pre-certification of care that is not also applied to all medical conditions. In other words, there is virtually no difference between mental and physical care when it comes to insurance coverage.

Interim regulations to implement this 2008 law were issued nearly three years ago, but final regulations are expected shortly, driven in part by the President’s gun violence initiative. Mental health and substance abuse treatments are also required under Obamacare’s essential health benefits with final rules still pending.

Prior to the MHPAEA health plans limited treatment of mental health typically as to the number of office visits per year, perhaps limits on the types of providers and certainly on the number of days of inpatient care. The same is true of substance abuse treatment. Conventional wisdom held that without such limits there was a great potential for abuse. Patients could visit a psychiatrist or psychologist for many conditions that could be less than “necessary” care and treatment could go on for years, if not indefinitely with weekly or more frequent visits and no point at which a “cure” was reached or care definitively ended.

When final regulations are issued it can be expected they will be liberal in their parity requirements enhanced by new awareness and initiatives to curb violence. As a result, mental health services may be subject to abuse and over utilization. It is impossible that increasing access to mental health services will not also increase spending and hence health insurance premiums.