The Mythical Land of Free Behavioral Health Care

A few weeks ago, I read a Wall Street Journal  article, "Law Prompts Some Health Plans To Cut Mental-Health Benefits," which summarized a Kaiser Family Foundation survey (Employer Health Benefits 2010 Annual Survey) on the effects of the behavioral health parity law on employer-sponsored health plans  – this article shouldn't have come as a surprise to those who are familiar with the past data. Of employers with over 50 employees, 69% didn't change their benefits at all. Of the 31% that did change their benefits, 66% changed their behavioral health benefit limits to equal physical health benefits; 16% increased their use of managed care; and 5% eliminated behavioral health benefits overall. That last 5% was, of course, the focus of The Wall Street Journal article.  

The article's authors did cite the Congressional Budget Office estimate that parity would increase premiums for group health insurance by an average of 0.4%, and the work by Steve Melek, a behavioral health  expert for the actuarial firm Milliman Inc., which showed that not providing benefits for mental health and addiction leads to higher overall health care costs. The article also referred to the fact that these plans would have to add back this coverage if the health care reform legislation moves ahead; the law requires that health plans offered through the soon-to-be-launched health insurance exchanges meet certain minimum level of benefits.

But the line that really got a rise out of me was the very last of the article; it referred to how the Screen Actors Guild (SAG) was going to help their members now that they had eliminated all their behavioral health benefits (both services and pharmaceuticals).  The article stated that their plan "will begin working with its members to help refer them to community-treatment options […]." I don't know what mythical free sources of mental health and addiction treatment services and pharmaceuticals the CEO of SAG was referring to, but I certainly haven't come across any. Our team at OPEN MINDS works with a wide range provider organizations who see the 'flood' of Americans who are uninsured and (in this case) underinsured looking for free services. Provider organization budgets for free services are very small—certainly not enough to cover the U.S. population currently uninsured and underinsured for the treatment of mental illnesses and addictions.

In the future, I'm hoping that policymakers will drop their references to this land of "happily ever after," wherein everyone can magically receive free behavioral health services. Policy decisions only work when you make them for the real world.