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Mental health parity by rule if not in practice

By | January 30, 2010, 7:35 AM PST

The Obama Administration has issued final rules telling insurers they must treat mental and physical ailments equally, if they offer coverage for mental health and substance abuse.

The rules had been going through a comment period since August.

(Picture from CMR Canada, which quotes the WHO as estimating depression will be the second-leading cause of disability within 10 years, behind only heart disease.)

The rules, which take effect in July, implement a 2008 act named for the late Paul Wellstone and then-Senator Pete Domenici. Parity had also been a goal of former First Lady Tipper Gore, and the subject of a 1996 Act which the new law strengthens.

The rules appear while some states, notably Wisconsin, continue to debate the question. Republicans there call the act a “jobs killer.”

Naturally the American Psychiatric Association (APA) was happy about the new rules, while continuing to seek some tweaks.

The rules may create parity in law, but they may not create it in practice, because employees remain fearful of getting treatment.

A Harris survey commissioned by the APA said nearly three workers in four fear getting fired if they seek treatment for alcoholism and drug addiction. Even depression is resisted by 62%, the survey said, even though productivity is routinely lost because of these conditions.

Of course, there may be something more here. Over half of those in the survey said they feared employer sanctions for seeking treatment for heart disease or diabetes.

The health reform bill now stalled in Congress would guarantee coverage for people who need care, eliminating any incentive for employers to sanction workers who seek it.

The great depression in the American workforce, then, will continue.

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Dana Blankenhorn

About Dana Blankenhorn

Dana Blankenhorn was a contributing editor for SmartPlanet from 2009 to 2010.

Dana Blankenhorn

Dana Blankenhorn

Contributing Editor, Healthcare

Dana Blankenhorn has written for the Chicago Tribune, Advertising Age's "NetMarketing" supplement and founded the Interactive Age Daily for CMP Media. He holds degrees from Rice and Northwestern universities. He is based in Atlanta.

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Dana Blankenhorn

Dana Blankenhorn

Dana Blankenhorn has been a technology reporter since 1982, a business reporter since 1978, and a writer for as long as he can remember. His Schwab IRA has a few tech stocks in it, most notably some Intel and Applied Materials bought over 10 years ago. But the vast majority of his tiny fortune (emphasis on the word tiny) is invested in mutual funds. He presently writes for no one else but ZDNet, SmartPlanet and himself. But if you've got an opportunity let him know. If he takes the gig he"ll first add it to this disclosure page.

He writes for SmartPlanet and is not an employee of CBS.

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Wisconsin Ignores Its Past
The real life Psycho/Silence of the Lambs killer came from Wisconsin. Pretty sick to be calling mental health parity a "jobs killer." http://www.prairieghosts.com/ed_gein.html
Posted by MichP
1st Feb 2010
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RE: Mental health parity by rule if not in practice
Then if you can actually make the insurance companies obey the law
without another lawsuit is another thing. In Arkansas we have the "Any
Willing Provider" law and it still doesn't cost the insurance companies
enough to make them follow it completely.
Posted by MJY
1st Feb 2010
0 Votes
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Still not full parity
Note that these rules only apply to group insurance plans offered by companies with 50 or more employees. While these are rules to implement the Wellstone-Domenici Act, my guess is that they could be "tweaked" at a later date by a different administration. The notion of "parity" with physical ailments is also somewhat vague. The article linked to talks about the idea of "scientific evidence" to establish parity (for example, in deductibles), but I wonder how practical this will actually be.

I'm always a little bit leery about what represents full treatment of mental health conditions. These can be extremely debilitating, but also can be taken advantage of. Depression can easily become the "lower back pain" of physical ailments.

This is a stopgap measure at best, and does nothing for the uninsured or unemployed.
Posted by zackers
1st Feb 2010
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RE: Mental health parity by rule if not in practice
'Parity had also been a goal of former First Lady Tipper Gore'

I thought that Al Gore would have had to have been president for Tipper
to be called First Lady. Have I somehow strayed into an alternate
timeline or am I misled?
Posted by wezhind@...
2nd Feb 2010
0 Votes
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Tipper Gore
I mis-typed. But I think most like you picked up on the mistake.
Posted by DanaBlankenhorn
9th Feb 2010
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