Addiction treatment shouldn’t be exclusive to the rich

Recently, President Trump signed the Omnibus Spending Bill, which will keep the government funded through the end of September. Bipartisan negotiations led to more than $3 billion in funding to address the opioid crisis. $2.55 billion of that is new funding. 

There is also a broad package of opioid-related legislation being considered in Congress that contains much-needed policy solutions.

{mosads}While I strongly commend members of Congress for making substantive efforts to address the greatest public health crisis of our time, one thing is still missing from the Omnibus Spending Bill and all of the bills under consideration: parity enforcement.

The Mental Health Parity and Addiction Equity Act, also known as the Federal Parity Law, requires insurers to cover illnesses of the brain, such as depression and addiction, no more restrictively than how they cover illnesses of the body, such as diabetes and cancer. It has been on the books for almost a decade, yet most insurers are still not in compliance. Some are complying with the more straightforward components of the law, such as making sure that copayments for mental health and addiction treatment are no more expensive than those for other medical care, and eliminating inpatient day and outpatient visit limits.

Unfortunately, there is still considerable ground to cover regarding the more complex aspects of the law, which relate to how insurers design and apply managed care practices. For example, nearly every insurance plan in the country requires prior authorization before it will cover certain services, items, or medications, including some for the treatment of mental illness or substance use disorders. The Federal Parity Law requires insurers to perform prior authorizations for such treatment in a way that is no stricter than prior authorizations for other types of treatment.

However, state and federal investigations into this component of the law have found that prior authorizations and other medical management practices are more restrictive for mental health and addiction. Often, people seeking lifesaving treatment are denied coverage completely or don’t receive enough treatment because of aggressive managed care techniques, and subsequently die from overdoses or suicides. Or, families desperate to keep their loved ones alive take out second mortgages, deplete retirement accounts, and drain college funds to pay for the treatment their insurance plan won’t cover. I encounter these families every day.

No parent should have to face financial ruin to save their child’s life, especially after paying into an insurance plan diligently for years. Many suffer in silence because they don’t know where to turn or what to do. What if you don’t own a home, have a retirement account, or have a college fund? What are your options? Is help only available to upper-class families?

Make no mistake: this is the norm across America. Not only is it discriminatory, it is illegal. And, it is actually costing the federal government billions of dollars. When private insurers don’t provide adequate coverage, people often turn to Medicaid or other federally-funded programs for assistance. No coverage also leads to more people in jails and prisons, which carries an exorbitant price tag for the federal government, states, and localities.

Congress must address this crisis from the inside out. That means prioritizing parity enforcement! By focusing on more severe penalties for drug traffickers and other criminal justice issues, we are losing sight of what really matters: access to treatment. The irony is that without affordable care, many patients will ultimately receive their own death penalty via unjust insurance denials.  

The first thing Congress must do is to follow the Opioid Commission’s bipartisan recommendation that the Department of Labor (DOL) be given enhanced enforcement authority over the Federal Parity Law. DOL has primary enforcement authority for the majority of health plans in America, but doesn’t currently have the teeth it needs to mandate compliance.

We’re losing 300 people a day to overdoses and suicides. Life expectancy has dropped. Instead of just hoping insurers will do the right thing, let’s hold them accountable through a law that already exists. This is not someone else’s problem. If your household hasn’t yet been touched by the opioid crisis, it is only a matter of time. Isn’t your life or your child’s life worth saving? Silence kills. It’s time to stand up and demand parity enforcement.

Patrick J. Kennedy, former U.S. Representative (D-RI), was the lead sponsor of the 2008 Mental Health Parity and Addiction Equity Act. He served on the President’s Commission on Combatting Drug Addiction and the Opioid Crisis and is the founder of ParityTrack.org and ParityRegistry.org.