This week, Minnesotans are remembering the legacy of Paul Wellstone as the 15th anniversary of his death is upon us. One of his achievements was the bipartisan bill to create parity between mental health and substance use disorders and other health care conditions. His efforts will long be remembered by the mental health community.
The first bill was signed into law in 1996 but only required parity for annual and lifetime dollar limits. It was a first step in protecting families from bankruptcy but didn’t go far enough. The second bill, passed in his memory in 2008 — the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act — thanks to the advocacy of people like U.S. Reps. Patrick Kennedy and Jim Ramstad, was much broader. The act required plans to treat mental health and substance use disorders the same as other health care conditions when it comes to treatment limits, out-of-pocket expenditures and nonquantitative treatment limits (such as covering similar services, drug formulary design, prior authorization, etc.). Minnesota law requires other types of health plans to follow the federal law.
The promise of this act, however, has not yet been realized. NAMI, the National Alliance on Mental Illness, continues to receive calls from families who cannot obtain coverage for the treatment needed by their loved one. This is even more important as young people stay on their parents’ health insurance until age 26, with many serious mental illnesses developing by then. The largest complaints are under the nonquantitative treatment limits: private insurance not covering adult mental health rehabilitation in a residential facility; requiring step therapy where someone has to fail on the oldest, cheapest medication before trying a medication that might work better; setting lower reimbursement rates for mental health providers; and using more-stringent utilization reviews.
When a family is in the midst of a mental health crisis, it does not occur to them to contact the U.S. Department of Labor or the Minnesota Department of Commerce to file a complaint. We need our Commerce Department to be proactive in determining ahead of time if plans meet the parity law. A bill was introduced during Minnesota’s 2017 legislative session to create a better review and enforcement mechanism for our current laws. It’s time to hold hearings and pass this measure during the 2018 session.
Discriminatory practices under Medicaid, Medicare and private insurance have resulted in not a broken mental health system but a system that was never built. It is no secret that the needs of children and adults with mental illnesses are not being met. We, as a community, would not tolerate boarding in emergency rooms, discharges to the streets or three-month waits to see a professional for any other illness — but we have tolerated this for mental illnesses for decades.
It’s time to fully implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act and ensure that people with mental illnesses obtain the right services at the right time in the right place. It’s time to shed our health care system of this inequality. Let’s do this in Sen. Wellstone’s memory and on behalf of the 1 in 5 Minnesotans whose lives are affected by mental illnesses.
Sue Abderholden is executive director of NAMI Minnesota.