The news media is full of the announcement of new rules related to the 2008 mental health parity law. As usual, the presentation positions the insurance companies as being the bad guys in the past for not providing mental health coverage. This time the Administration has linked the expansion of mental health coverage to reducing gun violence so everyone will be on board with the changes. The Affordable Care Act mandates coverage for mental health care.
As the New York Times puts it:
What the new rule would mean in practice is that limits on the amount of co-payments and the number of doctor visits or hospital days cannot be less generous than those that apply to most medical and surgical benefits. The same would be true of other rules, like those requiring prior authorization.
The benefits for the American public could be substantial, bringing help to many people previously unable to get it because of the cost. About a quarter of Americans 18 and older have a diagnosable mental disorder in a given year, and 6 percent have a seriously debilitating disorder, according to the National Institute of Mental Health. Nearly 60 percent of the people with mental health conditions and 90 percent of those with substance abuse problems don’t get the treatment they need, according to the administration.
The administration hopes that making treatment available to the mentally ill will help reduce gun violence, including mass murders. Some backers of parity believe it will also help veterans suffering from stress disorders from the battlefield get easier access to mental health services
Now all we have to do is be able to identify potential mass murders and figure out why the Veterans Administration does not provide adequate care to veterans as it should.
Proponents of the rules say they will save money, proponents of everything say their cause will save money just like paying for birth control will save money.
Clearly treatment of mental health is important. And logic says people should not pay more for this care than for physical illness. However, as often is the case with all health care, logic, objectivity and affordability are in conflict.
We have, in effect, a new law mandating coverage, new regulations removing virtually all unique limits on the coverage, an apparent pent up demand because someone else is not paying the bill and an illness that is sometimes hard to define and frequently with no clear cure or end to treatment and in the case of some care, a high likelihood of repeat confinement of some type. There was good reason why mental health and substance abuse benefits were limited and subject to closer scrutiny than physical health; these benefits are subject to abuse. Under the parity rules pre-certification or requiring pre-approval of mental health treatment is not permitted (unless it applied equally to all medical care).
You can do the math. Just look at the percentages above that the Administration says are not now getting the care they need. Consider that long before Obamacare, it was estimated by various sources that scores of benefit coverage mandates by the various states added between 15% and 25% to health insurance premiums. As is typical, we are now focused on half the equation and discounting the overall impact on costs. The next battle will be over determining medical necessity for mental health care.
Make no mistake about it. The many mandates and expanded coverage we cheer today, will be the drivers of ever escalating costs tomorrow… and we won’t have the insurance companies to blame… although we probably will anyway.
Everything we are doing in the name of social progress today under the mantel of affordable health care is actually regressive in terms of affordability.
As I have said more than once, it is not a matter of just affordability, it’s a matter of the spending priorities that generally don’t include spending our money on health care so we petition our cause and find a way to have someone else pay. Depending on the source, the average family spends between $225 and $500 per month eating out … enough to pay for a good portion of outpatient mental health care.
And by the way, there is a shortage of qualified mental health professionals and few are participating providers in health plans.
QUINNSCOMMENTARY 
Unless and until we get Federal spending under control and work on weeding out programs that include a lot of pork none of these program benefits will be affordable to the average American. And, the only people who will be paying for these wonderful new benefits will be the very people who make up the lower and middle class of wage earners nationally.
I am 100% in favor of some way to provide some level of health services to those not able to afford their own. I am not in favor of providing any of this care to those who do not want to find a job that provides benefits or those who are willing to accept years of being on the public dole and proud of it.
It seems to me that one way to deal with this situation is to create more meaningful jobs for Americans thereby collecting more taxes and a the same time weed out nonessential pork barrel projects and cut waste from existing programs. Unfortunately I do not believe either party is willing to tackle any of this type of activity.
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