Psychiatric News April 15, 2005
Volume 40 Number 8
© 2005 American Psychiatric Association
p. 13
Congressman Fights for Better Substance Abuse Coverage
Christine Lehmann
Congress considers a bill that requiring private health plans
that cover substance abuse treatment to do so at the same level of benefits as
they provide for other types of illnesses.
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Rep. Jim Ramstad: "The empirical evidence supports what I already
know as a recovering alcoholic—providing treatment is good preventive
medicine."
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Rep. Jim Ramstad (R-Minn.), now serving his eighth term in Congress, knows
firsthand that alcoholism is a treatable disease. He has been a recovering
alcoholic for the past 23 years. He attributes much of his progress to the
treatment he received and has made insurance parity for substance abuse
treatment a legislative priority.
Last month Ramstad introduced the Time for Recovery and Equal Access to
Treatment in America (TREAT America) Act of 2005 in the House of
Representatives to increase access to substance abuse and chemical-dependency
treatment. He has been attempting to get a similar bill passed in Congress
since 1997, when he introduced the first substance abuse parity bill. Last
year, some progress was made on the legislation, with 62 representatives
signing on as co-sponsors, according to Ramstad's staff assistant.
No Senate companion bill had been introduced by late March.
Ramstad's bill, which APA supports, would prohibit private health insurers
and plans that provide medical, surgical, and substance abuse treatment
benefits from imposing financial requirements and treatment limits solely on
the coverage for substance abuse treatment unless similar limitations or
requirements are imposed for medical and surgical benefits. If the bill
becomes law, the prohibition would begin on January 1, 2006.
The legislation defines "financial requirements" as any
cost-sharing arrangements including copayments, coinsurance, and deductibles
or any annual or lifetime dollar limits.
"We defined treatment limitations as restrictions on the frequency of
treatment, number of visits or days of coverage, or other similar limits on
the duration or scope of treatment under the health plan or coverage,"
Karin Hope, Ramstad's health legislative aide told Psychiatric
News.
In a letter last month inviting colleagues to co-sponsor his bill, Ramstad
wrote: "Almost 50 years after the AMA declared that addiction to drugs
and alcohol is a disease, insurance companies are still allowed to openly
discriminate against alcoholics and drug addicts who need
treatment."
Treatment Reduces Costs
Several studies have shown that substance abuse treatment benefits would
save money in the long run. An estimated 23 million Americans suffer from
substance abuse or addiction, and untreated addiction costs the United States
an estimated $400 billion annually, according to the 2001 report
"Substance Abuse: The Nation's Number One Health Problem" by
Brandeis University's Schneider Institute for Health Policy.
Treatment reduces drug use by 40 percent to 60 percent, and one year of
methadone treatment costs on average $4,700 per patient; in contrast, one year
of imprisonment costs $18,400 on average, according to the National Institute
on Drug Abuse's 1999 publication "Principles of Drug Addiction
Treatment."
Minimal Cost Increase Predicted
Contrary to the argument espoused by opponents of parity, the cost of
implementing substance abuse parity would not increase health insurance
premiums significantly. The actuarial firm of Milliman and Robertson Inc.
estimated the increase to health insurance premiums to be just 0.5 percent,
according to the firm's 1997 report "Premium Estimates for Substance
Abuse Parity Provisions for Commercial Health Insurance Products."
That estimate is in line with that of the Congressional Budget Office to
implement parity for mental health treatment.
Ramstad is also the principal co-sponsor of the Paul Wellstone Mental
Health Equitable Treatment Act of 2005 (MHETA), which Rep. Patrick Kennedy
(D-R.I.) introduced last month in the House. Similar comprehensive parity
bills have been introduced in the House each year since 2001 to expand on the
1996 mental health parity law. The 1996 law expired in 2001 but has been
extended each year since then; it is now scheduled to expire on December 31.
The law requires health insurers and health plans to establish parity in
annual and lifetime limits on mental health benefits.
The MHETA would prohibit private health insurers and plans that provide
medical, surgical, and mental health treatment benefits from applying
financial requirements and treatment limits only on mental health treatment
benefits. If the bill becomes law, the mental health care parity mandate would
begin January 1, 2006.
The legislation states that mental health benefits are services "as
defined under the terms and conditions of the plan or coverage for all
categories of mental health conditions listed in the DSM-IV-TR, or
the most recent edition if different, if such services are included as part of
an authorized treatment plan... and such services meet the plan or issuer's
medical necessity criteria."
That provision is controversial because parity opponents complain that the
scope of DSM-IV-TR is virtually unlimited and using it as the
standard would drive up health insurance costs.
Proponents of the MHETA counter that argument by pointing to a provision
that allows utilization management practices to be instituted to control
costs. These practices include utilization review, preauthorization, and the
application of medical-necessity criteria, according to the legislation.
Both the MHETA and the TREAT America Act would waive the parity requirement
for small businesses with two to 50 employees and if health insurance premiums
increased more than 1 percent annually.
The federal legislation would not preempt provisions in state parity laws
that provide greater protections.
The parity bills are likely to face opposition in the House again this
year. Republican leaders have repeatedly argued, despite evidence to the
contrary, that parity will increase insurance premiums and taxes.
Ramstad and Kennedy are the co-chairs of the bipartisan Addiction,
Treatment, and Recovery Caucus, which they formed last year to educate their
congressional colleagues about substance abuse issues (see
page 13).
Ramstad hopes that educational briefings sponsored by the caucus will
underscore the importance of parity in substance abuse treatment, according to
Ramstad's office.
The Paul Wellstone MHETA of 2005 (HR 1402) and TREAT America Act of
2005 (HR 1258) can be accessed online at
<thomas.loc.gov>
by searching on the respective bill's name or number. 
Related Article:
-
House Members Educate Colleagues About Addiction
- Christine Lehmann
Psychiatr News 2005 40: 13.
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