Mental Health Providers Lining Up Behind Reforms – Good News For Individuals Suffering From Mental Health and Substance Use Disorders?

The American Psychological Association (APA) announced today that it supports H.R. 3200, America’s Affordable Health Choices Act, as the basis for health reform. This action follows the American Medical Association’s (AMA) decision to do the same. The benefits of the bill cited by the APA include:

• Requiring a “basic benefit package” for all plans in the proposed Health Insurance Exchange. Notably, that mental health and substance-use disorder treatment is included within the basic benefit package.
• Ending insurance discrimination based on health status and pre-existing conditions.
• Supporting a public health insurance option in the Health Insurance Exchange wherein physician participation is voluntary.
• Requirements for employers and individuals to obtain qualified health insurance coverage.

Frankly, it’s still early – with 5 competing Bills – to meaningfully discuss the outcome of the heated deliberations taking place in Congress. There are signs that point to the Mental Health Parity and Addiction Equity Act (MHPAEA) being applicable to small group and individual plans, however, and that is really big news – should reform come to pass.

If the MHPAEA applies to essentially all privately insured individuals (as it would in the case of new developments) and Medicaid and Medicare remain in place addressing the behavioral health issues they are designed to address, that really leaves us with the problem of the uninsured accessing behavioral health treatment. For anyone concerned with mental health and addiction sufferer’s access to treatment, that raises an obvious question: How many uninsured people are suffering from a mental health or substance use disorder? Or if you prefer: How many mental health and substance use disorder sufferers are uninsured?

Uninsured and Suffering From Mental Illness

In case you were wondering – as I was this morning – how suffering from mental health and substance use disorders and being uninsured overlap, you will find the following data-points illuminating:

1. Approximately 47 million Americans are without health insurance of any kind. They are uninsured
2. For every 1% increase in insurance premiums, the uninsured population grows by up to 250,000 Americans. This does not take the high rate of unemployment into consideration
3. Nearly 40% of those uninsured report not filling prescriptions
4. Every year, 18,000-22,000 Americans die because they do not have health insurance. That’s more than those Americans who lost their lives on September 11th and those brave young men and women who have given their lives in Iraq and Afghanistan – combined.
5. Mental health care of the uninsured is more costly than similar care provided by Medicaid and Medicare. These bills get paid for. Call it a tax if you prefer. It would be less costly (fiscally conservative) to cover these individuals under Medicaid or Medicare
6. Approximately 5 million Americans suffer from severe mental illness (SMI) AND are uninsured. That’s 20% of SMI sufferers. What’s worse? They’re disproportionately African American
7. 25% of the general adult population suffers from one diagnosable mental illness while more than 35% of low income earners suffer from mental illness (and more likely uninsured)
8. 33% of low income earners suffer from Depression and 36% suffer from Anxiety Disorder – three times the general population’s prevalence
9. People who report mental illness are far more likely to lose their insurance within a year than are those who do not suffer from mental illness
10. Treatment rates among the uninsured suffering from mental illness are 50% of what they are in the general population
11. Mental illness is the leading cause of disability among those aged 15-44 in America
12. A recent survey of more than 500  HR officers across a range of industries and sectors revealed that untreated behavioral health issues are more costly than any other health issue

The immediate impact – assuming something can be done for the uninsured – is that millions of mental illness sufferers will have access to preventative care, screening, early intervention, case management, appropriate medication management, and other forms of treatment that obviate emergency room care and early death. The impact is that we would be de-stigmatizing mental illness and substance use disorders, living up to a moral obligation, saving lives and saving money. This doesn’t seem too complicated to me. What do you think?

Sources: NCCBH, NAMI, SAMHSA and the Policy Research Institute