(Source: MIRS.news, Published 09/21/2023) The sponsor of legislation requiring health insurers to cover mental health or substance abuse issues is reaching across the aisle in the hopes of finding bipartisan support to push the bill through the House.
Rep. Felicia Brabec (D-Ann Arbor)’s HB 4707, the Mental Health Access Act, requires insurers to cover their clients' mental health costs regardless of whether the patient is seeing someone in district or out of district.
She argues that in states with similar programs – Oregon, Illinois, and California, for example – there’s no evidence premium costs have increased as a result, but health services for patients have improved.
The customers are getting better service because their issues are being addressed upfront, before their situation devolves into larger and more expensive physical health issues that may require an emergency room visit.
“This is all about getting our residents the care they need and deserve,” said Brabec, a psychologist and social worker by trade. “It’s a no-brainer. Doctors, providers are saying this is what is needed. Patients need to be getting the care they need at the time that they need it for as long as they need it.”
The Mental Association of Michigan, the Kennedy Forum, SEIU Michigan, Michigan Health and Hospital Association (MHA) and several other groups have signed onto the Health is Health coalition to support a bill that goes beyond the traditional “parity” debate.
With mental health parity, providers can “wiggle away” from covering a treatment by arguing a certain psychiatric episode has no equivalent in the physical health world, said Angela Kimball, of “inseparable,” a mental health advocacy organization.
Sometimes, those with substance abuse or a mental health issue need more intensive care than what an insurer required to provide “parity” is willing to cover. That leaves patients and their families holding the bag when their insurer declines to pay.
The bill requires coverage for medically necessary treatment of a mental health or substance abuse disorder. The care provided needs to be treatment that follows the “generally accepted standards of mental health and substance abuse disorder care.”
These include coverage of the full continuum of care as laid out by the American Society of Addiction Medicine, the American Association of Community Psychiatrists, and several others.
Kimball noted that 5% of medical expenditures is for mental health and substance abuse treatment. The point is that customers should get what they pay for from their health coverage plan, which is a provider that covers their health episodes – mental or physical.
“We’re paying a super high price for coverage for services they deserve,” she said. “When patients don’t get that care, their conditions get worse, more complex and much harder to treat, often with taxpayer dollars.”
HB 4707 moved out of the House Insurance Committee in June without any Republican support.
While not present for that committee meeting, Committee member Greg Markkanen (R-Hancock) said the bill puts the cart before the horse. Northern Michigan does not have any in-patient mental health treatment options, so a coverage mandate won’t help his constituents.
People with severe mental health episodes need to be driven as far as 14 hours away, one-way, to downstate Michigan because the only in-house treatment options are the Community Mental Health boards, whose treatment options are “limited.”
He estimates the Upper Peninsula county sheriffs spend at least $1 million a year transporting mentally ill patients to Southeast Michigan for care.
So, before he’s willing to support this type of mandate, he’d need to see some providers.
“As a caucus, we’d love to talk about mental health, but let’s talk about the whole state,” Markkanen said.
The Michigan Association Health Plans (MAHP) came out against the bills in committee, but Deputy Director Brian Mills said they continue to work with Brabec to help her address the issue she believes needs to be addressed.
Like Markkanen mentioned, a big issue with the bill is the lack of providers in Michigan. Mandating coverage isn't going to make the providers suddenly appear. The other issue is requiring insurance companies to cover the costs provided by out-of-network providers. If there's no exclusivity in being an in-network provider, what is the benefit of being in-network?
“It's not workable. This will drive up costs on everybody,” said Bret Jackson of the Economic Alliance of Michigan.
He also said there's no requirement that those with public insurance would be given the same mental health benefits, which isn't fair.
