The Health Care Debate and Its Impact on Substance Abuse and Mental Health Services

With all the heated debate over health care reform, just what was supposed to happen to the often ignored areas of substance abuse and mental health services? At least, a new law that took effect at the start of 2010 will give parity to these services in large employee group insurance plans.

Although these important elements of health services weren’t entirely forgotten in the speeches in Congress and around the nation at public hearings, were they going to receive their proper attention, even as agreement on health care reform remained divisive?

In a Dec. 16, 2009, speech, Health and Human Services Secretary Kathleen Sebelius spoke about the need for mental health and substance abuse services as she addressed health care providers and others near Baltimore.

Sebelius spoke of “the huge opportunity we have in the next couple of years to make some big improvements in the lives of Americans with mental illnesses and substance abuse disorders.”

She added: “There are a lot of changes happening right now that could have a big impact on behavioral health: parity, health insurance reform, the growing popularity of integrated care models, an increased focus on prevention, huge gains in our understanding of the science behind mental illness and substance abuse.”

Sebelius made no promises, though, leaving future measures for these dual diagnosis treatment services up in the air, but she did stress the need to work together on a solution. “These changes are creating a lot of potential for progress, but we also know that nothing is guaranteed. The integrated care models that spread could have a strong mental health component.  Or they could not.  We might find effective ways to apply some of the research we’re doing.  Or we might not.  In order to get the most out of the next few years, all of us in government, the private sector, and the non-profit world are going to have to work hard to steer these changes in a direction that benefits our friends and neighbors with mental illnesses and substance abuse disorders,” she said.

What was most encouraging about her speech was the recognition of the seriousness of the problem and how common it is. She cited figures that “about one in five Americans will have a mental illness this year” and “almost half of Americans will have a mental illness in their lifetime.”

While health care reform is still up for debate, there is the implementation of the Mental Health and Addiction Equity Act, which Congress passed last year and went into effect Jan. 1, 2010, for employer group health plans with more than fifty employees.

“Thanks to parity, millions of Americans with mental illness and substance abuse disorders will get the care they need.  It’s going to help people afford their medicines.  It’s going to make them less likely to put off important care.  And it’s also an important symbolic step,” Sebelius said.

The law is directed to put mental health benefits on equal terms in many health plans today and applies to all plans subject to the Employee Retirement Income Security Act (ERISA), including self-insured plans.

But just like the debate over health care, more focus is needed on these essential services.