Policy-ish

MELISSA BLOCK, HOST:

This is ALL THINGS CONSIDERED, from NPR News. I'm Melissa Block in Washington.

AUDIE CORNISH, HOST:

And I'm Audie Cornish, wrapping up a week at NPR West in California. And we'll begin this hour with a big announcement from the Obama administration about health care. And this is not about the Affordable Care Act. The government is issuing rules to ensure that mental health and substance abuse problems will receive the same coverage as other medical conditions.

NPR health policy correspondent Julie Rovner is with us. Hey there, Julie.

JULIE ROVNER, BYLINE: Hey, Audie.

CORNISH: So tell us exactly what these rules require.

ROVNER: Well, basically, they set out to accomplish what's called mental health parity. They require that most health insurance plans offer equal coverage for mental health and substance abuse claims as they do for medical and surgical coverage. That means insurers can't charge someone more for mental health services than for other services.

It used to be that plans could - and would - pay 80 percent for medical care, but only 50 percent for mental health care. And under the new rules, plans can't cover fewer inpatient hospital days for mental health or substance abuse treatment than for a physical illness.

CORNISH: Now, since there's been some form of mental health parity, as you call it, on the books since 1996, I gather this actually maybe closes loopholes for the insurance companies. I mean, tell us about them.

ROVNER: That's right. One of the typical ones is insurance companies, because they couldn't impose limits on the number of hospital days or the amount of co-payments, they'd do things like require preauthorizations for mental health care when they wouldn't for other types of medical care. That won't be allowed anymore. These rules also clarify things like coverage of rehabilitation and other intermediate types of care that don't fall neatly into inpatient or outpatient categories.

CORNISH: And is there a catch? I heard you say earlier that this applies to most health insurance plans. Who's left out?

ROVNER: That's right. This law doesn't cover everyone. Technically, it only includes people covered by large group-health plans, those with more than 100 workers. The Affordable Care Act, the federal health law some people call Obamacare, applied the parity requirements to smaller insurance plans. By the way, that law also required those smaller group plans, and plans sold to individuals, to include coverage of mental health and substance abuse.

That's not the case for the overall parity law. For larger plans, it doesn't actually require coverage. It just says if the plan offers that coverage, it has to be the same for mental health and substance abuse, as it is for other medical care. But there are still some people who were left out. While Medicare now has a parity requirement, Medicaid and the Children's Health Insurance Program do not.

CORNISH: In the meantime, unlike a lot of other things health-related, this one has actually been bipartisan.

ROVNER: That's right. It's been among the most bipartisan health laws over the past couple of decades. The first bite at this came in kind of a surprise vote on the Senate floor in 1996, sponsored by a liberal Democrat - Paul Wellstone, of Minnesota - and a conservative Republican - Pete Domenici, of New Mexico.

What ended up passing was a very limited law that insurance companies managed to mostly evade. Wellstone died in a plane crash, and the cause was taken up by the late Sen. Edward Kennedy in the Senate, along with Domenici; and in the House by Kennedy's son, Congressman Patrick Kennedy, of Rhode Island, who'd been open about his own mental health and substance abuse problems, along with Republican Congressman Jim Ramstad, of Minnesota.

Eventually, the bill got passed in the fall of 2008, and it was signed by President George W. Bush. And I might add, the mental health community has been waiting and agitating for these final rules ever since.

CORNISH: That's NPR's Julie Rovner. Julie, thank you.

ROVNER: You're welcome.

Copyright © 2013 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR’s programming is the audio.

Comments

 

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

NPR thanks our sponsors

Become an NPR sponsor

Support comes from