Lora
Thomas,
Executive
Director
of NAMI
Illinois,
Linda
Virgil,
the
chair of
NAMI
Illinois’
legislative
committee
and I
recently
attended
a NAMI
legislative
conference
in a
Washington
DC
suburb.
The
three-day
conference
focused
on
coming
changes
to
mental
health
insurance
coverage,
the new
health
care
reform
act –the
Affordable
Health
Care Act
(AHCA),--
and what
NAMI
affiliates
can do
about
the
difficulties
states
are
having
in
funding
mental
health
programs.
It was a
jam
packed
three
days.
First,
the new
insurance
parity
law:
NAMI
believes
it will
be a
great
boon to
people
with
mental
illnesses.
The law
states
that if
an
employer-offered
group
insurance
plan
includes
mental
health
benefits,
treatment
for
mental
illnesses
must be
covered
on the
same
basis as
any
other
illness
–
co-pays,
deductibles,
annual
limits
and the
like
must all
be the
same for
mental
illnesses
as for
any
other
illness.
Some
things,
such as
number
of
office
visits
allowed,
limits
on days
of
treatment
or
lifetime
coverage
limits –
things
that can
be
expressed
numerically
– are
very
easy to
compare,
and they
must be
the same
for
mental
illnesses
and
other
medical
conditions.
But the
law says
that
things
not
expressed
numerically
must
also be
the
same.
This
gets a
little
tricky.
For
example,
prescription
drug
formulary
lists
must be
structured
the same
for
mental
illnesses
as for
any
other
illnesses.
Insurance
plans
cannot
apply a
“fail
first”
requirement
that
medication
be tried
in a
certain
order
for
mental
illnesses
and not
for
other
illnesses.
Standards
of what
constitutes
“medical
necessity”
must be
the same
for
mental
illnesses
and
other
illnesses.
Those
may be
harder
to
compare,
but the
law
specifies
an
appeals
process
if
patients
think
there
may be a
problem
in this
area
too.
The new
parity
law also
allows
state
parity
laws to
supercede
the
federal
law if
the
state
law is
more
stringent
that the
federal
law.
This is
good
news for
people
in
Illinois,
because
Illinois’
parity
law
applies
to all
employer-offered
group
insurance
plans,
not to
just
those
with
more
than
fifty
employees
as does
the
federal
law.
Unfortunately,
the
Illinois
does not
apply to
employers
who have
self-insured
health
plans.
The big
loophole
in the
parity
laws is
that
they
only
apply IF
the
insurance
package
offers
mental
health
benefits,
but it
does not
require
insurance
plans to
offer
any
mental
health
benefits.
But
there is
good
news
here
too.
When the
Affordable
Health
Care Act
(AHCA),
which
the
Congress
passed
earlier
this
year,
goes
into
full
effect
in 2014,
it will
require
all
group
insurance
plans as
well as
individually
purchased
plans to
offer a
minimum
standard
of
benefits,
including
mental
health
coverage.
It will
also
deny
insurance
companies
the
ability
to
reject
applicants
because
of any
preexisting
condition.
This
will
help
people
with
mental
illness,
because
they are
so often
denied
insurance
because
of that
very
pre-existing
condition.
By 2014
the AHCA
will
also
create
state
insurance
exchanges
where
small
businesses
and
individuals
can
purchase
insurance
policies
at
affordable
prices.
People
buying
individual
policies
will
have the
costs
subsidized
by the
federal
government
on a
sliding
scale
based on
their
income.
This
will be
a great
help,
since
many
people
with
mental
illness
are
living
on
limited
incomes
or are
being
supported
by their
families.
Another
benefit
of the
AHCA for
low
income
people
with
mental
illness
will be
the
expansion
of
Medicaid.
When the
law is
fully
implemented
in 2014,
it will
expand
Medicaid
eligibility
to
people
with
incomes
of 133%
of the
poverty
level,
and any
asset
tests
will be
eliminated.
And
mental
illness
and
prescription
drug
benefits
will be
mandatory.
The new
parity
law will
also
apply to
Medicaid.
So all
in all,
these
two new
laws,
the
parity
law and
the AHCA,
will be
a great
help to
people
with
mental
illness.
Unfortunately,
some
Republican
legislators
are
seeking
to
repeal
the new
law. Our
conference
also
heard a
presentation
by
Andrew
Sperling,
NAMI’s
director
of
government
relations.
Mr.
Sperling
was of
the
opinion
that
repeal
was
unlikely,
at least
until
2012.
In the
first
place,
Mr.
Sperling
said,
Democrats
still
control
the
Senate,
so
repeal
is
unlikely
to
succeed.
And even
if a
repeal
does
somehow
pass the
Congress,
President
Obama
still
has that
veto
pen.
And, Mr.
Sperling
thought,
should
that
situation
change
in the
2012
election,
many of
the
benefits
of the
new laws
are
quite
popular
with the
general
public
and
across
party
line, so
full
repeal
is
unlikely.
For
additional
information
see the
new US
government
website
dealing
with the
new
healthcare
reform
law:
