By Patrick J. Kennedy
September 29, 2015
Today, the House Judiciary Committee is holding a hearing on the proposed merger of Anthem and Cigna and the proposal for Aetna to join with Humana. This potential consolidation in the insurance market would reduce the number of large insurers from five to three, a major change that would undoubtedly affect choice, accountability, and healthcare quality.
These are serious issues that my former colleagues in Congress and the Antitrust Division of the U.S. Department of Justice should weigh heavily and carefully.
I also think this is a critical opportunity to make sure that the laws we already have on the books are enforced, including parity for mental health and addiction. Before any merger is approved in any industry, shouldn’t companies have to be compliant with our federal laws?
For decades, I heard stories about people with mental illness or addictions being denied insurance coverage. Insurance companies routinely charged higher rates and copayments for depression, bipolar disorder, and other diseases in the brain than for cancer, diabetes, and other illnesses in the body.
That is why, when I served in Congress, I sponsored the Mental Health Parity and Addiction Equity Act, which was passed with bipartisan support and signed into law by President George W. Bush in 2008. The Parity Act outlawed discrimination in insurance coverage based on outdated distinctions between disorders in the brain and illnesses in the body.
It’s one thing to pass a law. It’s a whole new challenge to get that law implemented and enforced. And so far, outside of some notable exceptions in a few states like California and New York, state and federal regulators are lagging behind in enforcement of the Parity Act. Insurance companies are denying authorization for mental health and substance abuse treatment at nearly twice the rate of their denials for other medical care, according to a study by the National Alliance on Mental Illness.
Most insurance companies have stopped obvious violations of the Parity Act, such as higher copayments and separate deductibles for mental health. But other violations of the Act continue, such as limiting the number of days a person can stay in a treatment facility, requiring permission to start or continue receiving behavioral health services, and asking patients to “fail first” with less expensive treatments before covering the treatment their doctor has recommended.
Most importantly, we need to compel insurance companies to disclose how they make coverage decisions. Specifically, state and federal regulators need to investigate insurers to make sure that their “medical necessity” determinations comply with the Parity Act. Only with greater transparency will we learn whether insurance companies are treating mental health the same as physical health in defining medical necessity. Without meaningful disclosure, consumers, providers and advocates cannot ensure that insured individuals are getting the care that is mandated by federal and state law. By not holding health insurers accountable and making their coverage determination process transparent, we will perpetuate some of the insurance marketplace inequities that exist today.
We are a nation in crisis. One in five adults in the U.S. experiences mental illness each year. Serious mental illness costs this country $193.2 billion annually in lost earnings. It doesn’t have to be this way. The majority of people with mental illness -- up to 80 percent -- improve with appropriate diagnosis, treatment, and monitoring. In the future, with rapid advancements in technology and neuroscience, that figure will only increase.
We passed the Parity Act, but we still do not have parity for mental health and addiction. Everyone, especially our leaders in Congress, has a stake in making sure the families who’ve paid their premiums are treated with fairness and respect. The Justice Department should make compliance with the Parity Act an important part of their approval process.
Kennedy served in the House from 1995 to 2011. He is the founder of the Kennedy Forum.