New rules promise equality in treatment coverage

The changes could affect 40 percent of Minnesota’s privately insured.

Tara Bannow

Even eight years after his death, the initiatives of the late Minnesota Sen. Paul Wellstone are still being realized in federal laws. ThatâÄôs what happened recently when the Obama administration issued new rules requiring that group and employee health plans treat physical and mental disorders equally. Although Minnesota has had its own version of such a measure since 1995, the new federal rules could affect the nearly 40 percent of privately insured people in the state who are covered under self-insured plans. Such plans are typically offered by large employers such as 3M and allow the company to manage its own coverage rather than go through an insurance company. The move is a step in implementing the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. After more than 10 years of debate, the law prohibits group health insurance plans âÄî not including businesses with less than 50 employees âÄî from restricting mental health care through limiting benefits or placing higher patient costs on mental ailments âÄî such as depression, substance abuse, schizophrenia and autism âÄî than physical ones, such as heart disease and cancer. Because there arenâÄôt methods to objectively identify mental disorders, like X-rays or blood tests, many people donâÄôt take them as seriously. While this has proven to be a barrier to equity in treatment, there have been significant steps in recent years, University of Minnesota psychiatry professor Ken Winters said. âÄúThere are a lot of researchers who have devoted their whole careers on how to best diagnose psychiatric disorders,âÄù he said. âÄúThe whole field gets to benefit from these rich research efforts.âÄù As Minnesota already boasts tighter regulations for mental and physical health equity than the federal law provides, the new rules are likely to have a marginal impact, said Julie Sonier, deputy director of the State Health Access Data Assistance Center in the school of public health. Because employers offering self-insured plans are competing to attract employees, the majority of them already follow state insurance mandates, she said. A total of 48 states have parity laws, although 19 offer partial parity, which is limited to specific mental conditions, coverage durations and financial limits, as well as the option for certain groups to opt out if the cost burden becomes too high. While some worry that laws granting equal treatment will raise premiums, MinnesotaâÄôs law has had virtually no effect on them, Bruce Weinstock, director of the State Advisory Council on Mental Health, said. After the passage of the state law, a group of six experts, including insurers, employers and regulators, said health care premiums in the state did not increase or did so only by a few percentage points, according to the Substance Abuse and Mental Health Services Administration. With the federal rules, the Congressional Budget Office predicts employer premiums will increase by 0.4 percent or a total of $25.6 billion in the next 10 years. The 2008 federal parity legislation was passed as part of the $700 billion financial bailout package signed by President George W. Bush. It was an expansion of the Mental Health Parity Act of 1996, signed by President Bill Clinton, which requires equal total lifetime and annual limits of coverage among mental health benefits and surgical and medical benefits. Unlike its predecessor, the Mental Health Parity and Addiction Equity Act of 2008 includes substance-use disorders, signifying a major step in lessening the negative bias that surrounds drug and alcohol addiction, Winters said. âÄúThereâÄôs a misperception that drug addiction is a voluntary illness that is rooted in somebodyâÄôs weak willpower,âÄù he said, âÄúwhereas mental illness is not necessarily a disorder that a person has control over.âÄù