Mental Health & Substance Use Parity: New Bill Could be a “Long Haul” Again
By Jeremiah Gardner
NOTE: This was originally published for the Hazelden Betty Ford Foundation’s monthly Recovery Advocacy Update. If you’d like to receive our advocacy emails, subscribe today.
One of my closest friends is battling cancer, and I was shocked to hear that doctors told her family the medical bills will likely add up to $5 million over the next two years. Thankfully, health insurance is expected to cover virtually everything.
What a relief. In the most difficult and momentous of situations, families deserve quality care without the extra stress of worrying about their financial solvency and future.
Of course, the same could be said for families facing addiction. And, as someone who works in that world, I couldn’t help but imagine what it would be like if insurance routinely covered two years of care and ongoing support (or more) for people with complex substance use disorders and co-occurring mental health conditions, plus services for their affected children and other family members. Or what kind of outcomes — in terms of extended lifespan, improved quality of life, and adjacent improvements in family functioning, work productivity, community engagement and all the rest — could be produced by investing $5 million in each patient and their family.
It’s mind-boggling to think about the potential positive impact — the return on that kind of investment, knowing the potential for people to sustain recovery and thrive. Or even a 10th, 15th or 20th of that kind of investment.
Many of the caregivers and families I meet say they wish their patients and loved ones could get more, or longer, care and recovery support. Such wishes make sense. We know that addiction is a chronic illness, co-occurring mental health conditions are common, and returns-to-use are a risk especially in the early months and years. We also know that sustaining recovery is a process and that long-term engagement in care and recovery support is important to successful outcomes. But more help is also more expensive, and our society and healthcare system are not yet oriented — philosophically or practically — around doing everything possible to help people with addiction.
This year marks the 15th anniversary of Congress enacting the federal “parity” law, which requires that group- and self-insured health plans providing behavioral health benefits do so on par with medical and surgical care.
It took more than a decade for the historic law to pass (see my colleague William C. Moyers’ article All in the Family). It also took years to implement, and many argue it is still not sufficiently enforced. Its rules also don’t apply to Medicare and parts of Medicaid.
Today, there seems to be broad bipartisan support for bolstering the nation’s behavioral health system. The question is, at what cost? Closing gaps by expanding benefit requirements to Medicare and other parts of Medicaid would cost a lot. Enabling individuals with the greatest needs (and their families) to engage longer in professional care and ongoing support activities, as I’m suggesting, would be even more of an investment.
A new parity bill on Capitol Hill — the Better Mental Health Care for Americans Act — aims to close the Medicare and Medicaid gaps, which would help millions of people and be a huge step forward. However, Sen. Michael Bennet, one of the main sponsors, says it will cost billions and is therefore unlikely to pass soon. “I think this is going to be a long haul,” he told the Washington Post. “This is an aspirational piece of legislation to try to put a marker down.”
As the push toward true parity continues, perhaps organized around this bill, I hope we will also move toward ensuring not just access to care, but access to the ideal length, amount and quality of care and recovery support for individuals and their families.
Jeremiah Gardner is director of communications and public affairs for the nonprofit Hazelden Betty Ford Foundation.
