Bridging the Gap: How to Achieve True Parity in Mental Health Coverage
For decades, Americans have fought for equitable access to mental health care. While there have been significant strides towards achieving what’s called parity – the idea that mental health should be treated with the same importance as physical health – real barriers remain.
So why is it still so hard for health insurance to cover mental and behavioral health the same way it covers physical health? There are tangled legal and financial complexities to unravel. Marisa Domino, a health economist and executive director of the Center for Health Research & Information at ASU’s College of Health Solutions, explains, “Coverage is a complicated thing. When we think of insurance coverage, we might think of co-payments—how much we pay each time we see a doctor. But there are also non-quantitative treatment limits, in which insurers use tools to control the types and quantity of services. Prior authorizations are a prime example.”
These authorizations require patients to get extra permission from health insurers before receiving certain treatments, often making it more challenging to access necessary mental health services. “While co-payments may be the same, these behind-the-scenes limitations restrict access to the supply of mental health services,” Domino explains.
But there’s more to the story.
Sybil, was not unable to get insurance coverage for her bipolar disorder. She knows from experience that having a mental health condition is not black and white, especially under insurance plans.
One key challenge is the hidden nature of mental health. Unlike a broken bone or a heart attack, these conditions can be difficult to diagnose and measure. We rely on individuals to describe their symptoms and the impact on their lives. As Domino further explains, "We don’t have a litmus test for mental illness, unlike for diabetes or a broken bone. There’s still a stigma associated with mental illness and substance use disorders.”
Stigma can add yet another layer of complexity. This can discourage individuals from seeking help in the first place, further hindering true parity.
What are the solutions? While the government can play a role in furthering legislation and setting guidelines, states are increasingly taking the lead. Maryland, for example, implemented a law requiring health plan coverage to be the same for mental health and physical healthman. Similar efforts exist in California and other states, demonstrating a growing recognition of this critical need.
Moreover, some advocate for a shift in focus: “There’s been a lot of progress tied to addressing social determinants of health, like food insecurity and housing instability. Health plans, especially Medicaid programs are increasingly investing in innovative programs to address these wider social factors. There’s a concern that some of these initiatives might be pulled back, which would impact vulnerable populations.”
Domino points out that prioritizing public health approaches, particularly for behavioral health, are vital in bringing true sanctity to this access while setting basic standards that all insurers must follow, making sure that "access really is happening in a meaningful way."
A prime example can be seen in Arizona, whichँच
has been a pioneer in integrating mental health into its Medicaid program. The state has developed new criteria and better integrated mental and primary care, allowing for more seamless care, regardless of the type of need. ”Arizona has become a real example for the nation,” says Domino.
The journey towards parity continues, requiring advocacy, policy shifts, and a commitment to understanding the complexities inherent in treating mental health with the same importance as physical health. It’s about ensuring people like Sybil get the help they need, when they need it, without facing undue burdens or stigma. It
In what ways does the stigma surrounding mental health conditions hinder progress toward parity?
## Bridging the Gap: How to Achieve True Parity in Mental Health Coverage
**Host:** Welcome back to the show. Today, we’re diving into a critical issue affecting millions of Americans: achieving true parity in mental health care coverage. Joining us is health economist Marisa Domino, executive director of the Center for Health Research & Information at ASU’s College of Health Solutions, to shed light on the challenges and potential solutions. Marissa, thank you for being here.
**Domino:** Thanks for having me.
**Host:** We often hear the term “parity” thrown around, meaning mental health should be treated equally to physical health. But in reality, why is it so difficult to achieve this in insurance coverage?
**Domino:** It’s a complex issue, unfortunately. While the Affordable Care Act and laws like the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act made significant strides, true parity goes beyond simply matching co-payments. [[1](https://www.apa.org/topics/parity-guide.pdf)]
Behind the scenes, insurers use tools like “non-quantitative treatment limits” which control the types and quantity of services. Prior authorizations are a prime example. They require extra permission before certain treatments, often making it harder for patients to access necessary mental health care.
**Host:** So, even if the co-payments are the same, these hidden limitations create barriers.
**Domino:** Exactly. It restricts access to the supply of mental health services.
**Host:** You also mentioned the hidden nature of mental health conditions. Can you elaborate on that?
**Domino:** Absolutely. Unlike a broken bone, mental health challenges are diagnosed based on symptoms described by the individual. We don’t have a definitive “litmus test” like we do for physical ailments. This makes it harder for insurers to assess and cover treatment consistently.
**Host:** And stigma adds another layer to this complex web. How does that hinder progress toward parity?
**Domino:** Stigma can prevent individuals from seeking help in the first place, fearing judgment or repercussions. This cycle not only impacts individual well-being but also undermines efforts to achieve true parity.
**Host:** What are some potential solutions moving forward?
**Domino:** We need multi-pronged approach. Greater transparency from insurers about their coverage policies is crucial.
Advocating for policies that address non-quantitative treatment limits and reduce reliance on prior authorizations is essential.
continued efforts to decrease stigma and promote mental health awareness are vital to encouraging individuals to seek the help they deserve.
**Host:** Powerful insights, Marissa. Thank you for sharing your expertise with us today.
**Domino:** My pleasure.