NAMI and Partners Release New Report on Inadequate Health Plans

Jun 19, 2018

People with mental illness shouldn’t have to worry about sky-high insurance premiums or being denied health care coverage because of a pre-existing mental health condition. Fortunately, the Affordable Care Act (ACA) currently requires health insurance to cover mental health and substance use treatment services at parity with other health care. But there are new threats from the federal government that would weaken insurance protections for people with mental illness.

Currently, the ACA allows certain “short-term health plans” to provide coverage that does not have to follow the same anti-discrimination requirements as other health insurance plans, such as individual market and small group health plans. The Trump Administration has proposed to expand these short-term health plans, which are currently only sold as a temporary solution for individuals until they can get more comprehensive coverage. These plans are not required to cover essential health benefits, including mental health and substance use treatment.

A report released today by NAMI, Families USA, Mental Health America and the National Council for Behavioral Health, “Short-Term Plans Do Not Cover Life-Saving Mental Health and Substance Use Treatment“, highlights the barriers to mental health and substance use coverage in current short-term plans. The report found that:

• None of the short-term plans examined cover treatment of a suicide attempt.
• None of the short-term plans examined offered treatment for injuries associated with alcohol or substance use.
• Short-term plans limit coverage or exclude services for individuals with a mental health diagnosis or who received mental health or substance use treatment within the last five years.

Before the ACA, health plans often discriminated against people with mental health conditions. In “Mental Health Parity at Risk“, a new NAMI report, researchers identified discriminatory practices in mental health and substance use coverage before the ACA:

• There were 28 states with no requirement that individual market health insurance plans cover or even offer mental health services.
• Health plans avoided enrolling individuals with mental health or substance use conditions by screening applicants.
• Even when individual market insurance was accessible, insurers effectively fined people with a history of mental health or substance use conditions by applying a 20-50% increase in premiums while also excluding needed mental health and substance use services.
• Plans often used lifetime caps, limits on therapy visits, limits on hospital days covered, restricted access to mental health medications and high cost-sharing for mental health services.

These reports show how dangerous these types of health plans can be. Suicide rates are rising and 115 Americans die every day from opioid overdose. We need more access to mental health and substance use coverage—not less.

Read the Report