This story was updated to include additional comments from AHIP. (12/18, 2:33 PM)聽
Even though more Americans have access to health insurance because of the health law, getting access to mental health services may still be challenging.
聽by the advocacy group Mental Health America (MHA) concludes that despite the 2008 mental health parity law, some state exchange health plans may still have a way to go to even the playing field between mental and physical benefits. The findings are based on minimum insurance benefits determined by the states before Obamacare plans began to be sold in late 2013. America鈥檚 Health Insurance Plans, an industry group, says the findings represent only 鈥渁 snapshot in time鈥� before mental health parity regulations were released in November 2013 and became requirements last July.
The report was paid for by Takeda Pharmaceuticals U.S.A. and Lundbeck U.S.A, a pharmaceutical company that specializes in neurology and psychiatric treatments.
The report listed the states with the lowest prevalence of mental illness and the highest rates of access to care as Massachusetts, Vermont, Maine, North Dakota and Delaware. Those with the highest prevalence of mental illness and most limited access are Arizona, Mississippi, Nevada, Washington and Louisiana.
Among its other findings:
鈥� 42.5 million of adults in America, 18.19 percent,聽suffer from a mental health issue.
鈥� 19.7 million, or 8.46 percent, have a substance abuse problem.
鈥� 8.8 million, or 3.77 percent of Americans have reported serious thoughts of suicide.
鈥� The highest rates of emotional, behavioral or developmental issues among young people occur just west of the Appalachian Mountains, where poverty and social inequality are pervasive.
The group found that, while information provided through plans鈥� 鈥渆xplanation of benefits鈥� might show that there aren鈥檛 limits on mental health coverage, limitations including treatment caps and other barriers may exist.
鈥淧arity聽is in its infancy. Most plans know the numerical requirements around cost-sharing, but few have taken seriously the requirements around equity 鈥斅燼round access through networks and barriers to care through prior authorization,鈥� said Mike Thompson, health care practice leader at PricewaterhouseCoopers. 鈥淎nd, in practice, we have a history of imposing much more stringent medical necessity standards on mental health care than other health care.鈥�
The report doesn鈥檛 reflect the fact that many health plans have rolling renewals, meaning they have until Jan. 1, 2015 to fully comply with the parity law. AHIP, the insurance group, said insurers are following the law.
鈥淥ur members are committed to mental health parity, and we鈥檙e supportive of legislation, and what isn鈥檛 apparent is that benchmark plans represented聽a snapshot in time 鈥� so that doesn鈥檛 give us the full picture,鈥� said Susan Pisano, vice president of communications. 鈥淥ur plans have really been working to get in compliance.鈥�
Chuck Ingoglia, senior vice president of public policy at the National Council for Behavioral Health, a Washington-based trade group for community mental health and substance use treatment organizations, said the report鈥檚 findings aren鈥檛 surprising 鈥斅爐hough they are troubling. Implementation of the parity law remains a work in progress, he said.
鈥淭he law is based on a sound policy premise 鈥斅爐hat addiction and mental health treatment decisions and management should be comparable to physical health conditions,鈥� he said. 鈥淏ut this also creates a tremendous barrier to proving violations as it requires a consumer to obtain access to plan documents for both types of care, which is frequently handled by different plans,鈥� Ingoglia said.
In addition, the report found that some plans didn鈥檛 set out what and how many services were covered. That means consumers would only find out a treatment wouldn鈥檛 be paid for by their insurer after they鈥檇 already received care.
Americans with mental disorders have the聽of health insurance coverage, so obtaining聽 insurance is a good first step, according to Al Guida, a Washington, D.C.-based lobbyist who works on mental health issues with Guide Consulting Services. But the only way a denial can be reversed is through an appeal, which can be a long and arduous process.
鈥淭he vast majority of insurance plans offered on Affordable Care Act federal and state exchanges have close to no transparency, which could lead to abrupt changes in both mental health providers and psychotropic drug regimens with the potential for serious clinical consequences,鈥� Guida said.
Meanwhile, there is a shortage of mental health care professionals 鈥斅爊ationally there is only one provider for every 790 people, according to the report.
All of these factors can cause minor mental illnesses to grow more severe, according to 聽CEO Paul Gionfriddo.
He suggested that mental illness should be screened for and covered in the same way cancer, kidney disease and other illnesses are.
鈥淩ight now we鈥檙e trapped in a stage where we wait for a crisis, when they鈥檙e in advanced stages and then we treat it, and we wonder why it鈥檚 so hard to treat it more cheaply,鈥� Gionfriddo said.