Mental health and substance abuse insurance parity for federal employees: How did health plans respond?

Abstract

A fundamental concern with competitive health insurance markets is that they will not supply efficient levels of coverage for treatment of costly, chronic, and predictable

Increasing Access to Medication-Assisted Treatment for Opioid Use Disorders: Estimating Costs, Supply, and the Effects of Insurance Expansions

“…I extend prior work examining the impact of parity laws, by specifically evaluating whether the 2008 federal parity law, which removed the ERISA exemption, increased access to effective treatments for opioid use disorders (Gilmer et al, 2010;Azzone et al, 2011;Haffajee et al, 2015;McDaid, 2011;Barry and Ridgely, 2008;Busch, 2012).…”

“…Because of the magnitude of the opioid epidemic and the potential for opioid use disorder treatments to reduce future health care spending, understanding the benefits of improved access to these therapies is especially important for public and private insurers. I extend prior work examining the impact of parity laws, by specifically evaluating whether the 2008 federal parity law, which removed the ERISA exemption, increased access to effective treatments for opioid use disorders (Gilmer et al, 2010;Azzone et al, 2011;Haffajee et al, 2015;McDaid, 2011;Barry and Ridgely, 2008;Busch, 2012).…”

“…I use a difference-in-difference-in-differences (DDD) analysis in order to evaluate the effects of the federal parity law. Difference-in-difference-in-differences has been used in previous research addressing the effects of parity laws on utilization and health outcomes (Barry and Ridgely, 2008;Bao and Sturm, 2004). …”

“…Other studies suggest parity improved insurance protection, measured by the increased probability of being diagnosed with a substance use disorder or by eradicating quantitative treatment limits for MH/SUD treatment, but had little impact on utilization, costs for plans, or quality of care (Azzone et al, 2011;Haffajee et al, 2015;McDaid, 2011;Amber Gayle Thalmayer et al, 2016). All addiction treatments were jointly examined by these studies, so alcohol and/or tobacco treatment, which represent the vast majority of treatment therapies paid for by insurers, likely dominated the results (Barry and Ridgely, 2008;Busch, 2012).…”

Directions for Future Patient-Centered and Comparative Effectiveness Research for People With Serious Mental Illness

“…The FEHBP plans, which were under a 2001 presidential directive to increase parity for a wide range of mental and behavioral health benefits, were also seen as significantly more likely than private plans to implement a "carve-out" contract to better manage the costs of behavioral health services. 228 The use of carve-outs (see below) is believed to explain the lack of increase in total spending following implementation of parity requirements. 221,227,228 It should also be noted that because care for most people with serious mental illnesses is publicly financed, enhancing parity in the private sector may not be the most effective financing tool to improve patient-centered outcomes for this population, even though it may increase access and improve outcomes for people with milder or intermittent mental illness.…”