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Mental Health Parity at Risk

NAMI has long fought for mental health parity—covering mental health and addition care at the same level as other health care. But despite the passage of the Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008, millions of Americans were still not covered by parity law.

The Affordable Care Act (ACA) brought federal parity protections to individual and small group health plans, but new threats would weaken important insurance protections for people with mental illness. On June 13th, NAMI released a report, Mental Health Parity at Risk, that highlights how badly health insurance plans treated people with mental illness before the ACA.

 The ACA made mental health and substance use services an essential health benefit (EHB), requiring not only that insurance include mental health and substance use services, but that these services also be covered at parity with other health care.

Unfortunately, the Administration has proposed changes that would open the door to weaken protections for preexisting conditions like mental illness—threatening mental health care and undercutting insurance plans that provide fair coverage. The Administration has proposed a rule to expand the sale of short-term limited duration plans, a type of health insurance plan that does not need to comply with the protections put in place by the ACA. These plans would not need to cover preexisting conditions like mental illness, cover essential health benefits like mental health and substance use care or provide adequate provider networks. And just last week, the Department of Justice announced that it will not defend the insurance protections that were in the ACA for preexisting conditions.

Rolling back these protections will hurt people with mental illness.

Our new report found that, prior to the ACA:

  • 28 states had no requirement that individual market health insurance plans cover or even offer mental health services;
  • Health plans avoided enrolling individuals with mental health or substance use conditions by screening applicants;
  • Even when individual market insurance was accessible, insurers effectively fined people with a history of mental health or substance use conditions by applying a 20–50% increase in premiums while also excluding needed mental health and substance use services; and
  • Plans often used lifetime caps, limits on outpatient visits, limits on inpatient days covered, restricted access to mental health medications and high cost-sharing for mental health services.

Without a requirement to do so, insurers will likely remove protections for people with mental health and substance use conditions. And without these protections, premiums for all people who seek comprehensive health and mental health coverage will likely increase.

Weakening insurance protections hurts people with mental illness. We urge legislators and insurance commissioners to protect Americans that live with mental health and substance use conditions.

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