Glied, Frank: Republican Health Bill Fails People With Mental Illness
Monday, March 20, 2017
NYAPRS Note: Here’s a very pointed piece from noted experts, authors of the highly lauded review of our nation’s mental health system ‘Better but Not Well’ (http://www.nejm.org/doi/full/10.1056/NEJMbkrev57665#t=article) and former HHS officials Sherry Glied and Richard Frank, correcting Congressman Tim Murphy’s recent op ed lauding the GOP’s ACA ‘replacement’, the American Health Care Act.
While Congressman Murphy is seen by some as a champion for mental health issues, he states that “under the AHCA, states are free to cover mental health and addiction treatment in their plans. If they do, existing parity laws – which I helped write – require mental health benefits to be provided at the same level, or “at parity,” with medical and surgical coverage in that same plan (http://thehill.com/blogs/congress-blog/healthcare/324247-transforming-mental-health-and-addiction-treatment-weve-only).” That means that, under the AHCA, states are free to NOT cover BH benefits…..
Tim Murphy — Republican Health Bill Fails People With Mental Illness
By Richard G. Frank And Sherry A. Glied Opinion Contributor The Hill March 17, 2017
Representative Tim Murphy (R-Penn.) is correct in writing that helping people with mental illness is not a “partisan battle.” But we know he is someone who cares about this issue enough to realize this debate must be rooted in facts. The recent article Murphy penned for The Hill offers views that are at odds with basic facts and reality.
We think it is important to hold up some of the claims “of failed policies” in Congressman Murphy’s letter against the facts so that a more productive discussion of behavioral health policy can result. Moreover, the “better way” he argues that is offered by the American Health Care Act would make matters worse, not better, for the populations he champions.
Parity legislation and regulation: At the end of January 2010 the Obama Administration issued Interim Final Regulations for the Mental Health Parity and Addictions Equity Act. Those regulations had the force of law and covered the vast majority of points that appeared in the final regulations of 2013.
Moreover, starting in 2010 the administration trained Department of Labor inspectors and state insurance commissioner staff on the regulations in order to support enforcement and technical assistance efforts. The parity regulations improved the coverage for 103 million people starting in 2010.
The Affordable Care Act extended insurance coverage for mental health and substance use disorder treatment by including mental health and substance use disorders services as Essential Health Benefits that must be offered in the individual, small group and Medicaid expansion markets.
The ACA also extended the reach of the parity legislation supported by Congressman Murphy to require parity in individual, small group and Medicaid expansion coverage. The result was to expand coverage and the quality of coverage to about another 70 million people. Thus the total numbers that saw their coverage for behavioral health care improve was over 170 million. This is not exactly relegating behavioral health in the back seat.
The result of the efforts to expand and improve coverage was that about 1.84 million low people used services paid for through the Medicaid expansion and the Health Insurance Marketplaces. That directed estimated $5.5 billion new dollars annually towards treatment of behavior health conditions.
This is roughly five times the size of new spending called for in the 21st Century Cure Act that represented an historical increase in spending on substance use disorders. The well-being and support for people with mental illnesses and substance use disorders will not be advanced by the American Health Care Act that would result in a loss of insurance coverage for 24 million Americans many of who suffer from these illnesses (an estimated 29 percent). Nor will taking away $5 billion in treatment resources from the nearly 2 million people in treatment today improve the mental health of the nation.
Finally, claiming that the opioids epidemic reflects a simple failure of behavioral health policy of the last administration ignores the data on the trends in drug overdoses. The graph shows that the growing overdose problem pre-dates President Obama’s election. The trend data shows that the epidemic dates back to the Clinton and Bush administrations and is not the work of recent policy.
The loss of coverage for substance use disorder treatment that the American Health Care Act would cause would take away tools for fighting the opioid epidemic at a time they are badly need. Turning this on-going and changing national tragedy into a reflection on the important gains made over the last 10 years is a disservice to the importance of the challenge we must face together; we know that Congressman Murphy can do better.
Dr. Richard G. Frank, PhD, is the Margaret T. Morris Professor of Health Economics in the Department of Health Care Policy at Harvard Medical School. From 2009 to 2011, he served as the deputy assistant secretary for planning and evaluation at DHHS directing the office of Disability, Aging and Long-Term Care Policy. Dr. Sherry A. Glied is the Dean of New York University’s Robert F. Wagner Graduate School of Public Service and former Assistant Secretary for Planning and Evaluation in the U.S. Department of Health & Human Services.
The views of contributors are their own and are not the views of The Hill