Employer-sponsored coverage for substance abuse treatment continues to have annual limits and lifetime caps on treatment visits and inpatient days and also requires higher cost sharing than coverage for general medical care, according to a new analysis published as a Health Affairs web exclusive.
In 2006, 88 percent of insured workers had some coverage for substance abuse services, but only 19 percent were enrolled in a plan without limits on the number of office visits or hospital stays. Such limitations are virtually unknown in general medical care, where nearly all covered workers had unlimited medical-surgical hospital days and office visits, according to Jon Gabel, a senior fellow at NORC, and coauthors.
A second Health Affairs web exclusive reports that many workers are exempt from state mental health “parity” laws aimed at bringing private-sector mental health benefits more in line with coverage for other types of disorders. As a result, as of 2003, only one-fifth of U.S. workers with employer-sponsored health insurance were covered by “strong” parity laws that mandate mental health benefits, prohibit limits on outpatient visits and inpatient days, and limit the extent to which enrollees can face higher cost sharing for mental health services.
Researchers say that nearly every state has enacted mental health parity laws since the passage of the federal Mental Health Parity Act (MHPA) in 1996. However, the MHPA is limited in scope; for instance, it does not mandate mental health benefits, it exempts small firms, and it allows caps on outpatient visits and inpatient days. Many state initiatives are stronger, but their impact has been blunted by exemptions. Most notably, the federal Employee Retirement Income Security Act exempts self-insured firms from state regulation.
